Methotrexate MTX

Conflicting results are available on the efficacy of MTX in UC. In an early RCT, no significant differences were found between oral MTX (12.5 mg/week) and placebo at 9 months in 67 UC patients [49]. In another RCT, MTX (15 mg/week) was as effective as 6-MP (1.5 mg/kg/day) and 5-ASA (3 g/day), but less effective in maintaining remission in steroid-dependent UC patients. A dose of subcutaneous MTX at 15 and 25 mg/week showed a similar efficacy in inducing remission [50].

It is often accepted that MTX is more effective in Crohn's disease than in UC. However, in a recent retrospective study on 22 UC and 48 CD patients treated with MTX (orally or i.m.) with a mean maintenance dose of 20 mg/week, remission was achieved in 34 of 55 patients who completed more than 3 months of treatment. Treatment was equally effective for Crohn's disease and UC. Life-table analysis showed that the chances of remaining in remission at 12, 24 and 36 months of treatment were 90, 73 and 51%, respectively [51].

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