Methotrexate in Chronic Active Crohn's Disease: A Double-Blind, Randomized, Israeli Multicenter Trial

Background: At present only one large controlled study has indicated that parenteral methotrexate may he effective in chronic active Crohn's disease (CD). Aim : To evaluate the effectiveness of oral methotrexate in chronic steroid-dependent CD. Patients : Patients with active CD, who have received steroids and/or immunosuppressives for at least 4 months during the preceding 12 months and with a current Harvey-Bradshaw index of ≥ 7 were studied. Methods : Methotrexate (12.5 mg weekly) or 6-mercaptopurine (50 mg daily), or placebo were given during the 9 months of the trial in addition to steroids and 5-aminosancyIic acid as clinically indicated. Results : Eighty-four patients were included (methotrexate, 26 patients; 6-mercaptopurine, 32 patients; placebo, 26 patients). The proportion of patients entering first remission as well as the proportions of patients relapsing after first remission were not significantly different between the groups. The mean Harvey-Bradshaw index and the mean monthly steroid dose were also similar. However, when each patient was evaluated as his or her own control, the reduction in steroid dose, the general well being, and the reduction in abdominal pain were significantly better in the methotrexate treated patients. Conclusions : Methotrexate at a weekly oral dose of 12.5 mg was found to he moderately better than 6-mercaptopu-rine and placebo in patients with chronic active CD.