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P222. Methotrexate use in inflammatory bowel disease: A referral centre's 30 years of experience

K.H. Katsanos1, D.E. Sigounas1, K. Strogyli1, A. Tatsioni2, E. Panagiotou1, I. Vagias1, V.E. Tsianos1, D.K. Christodoulou1, E.V. Tsianos1

1Medical School of Ioannina, University of Ioannina, 1st Division of Internal Medicine and Hepato-Gastroenterology Unit, Ioannina, Greece; 2Tufts University School of Medicine and Institute for Clinical Research and Health Policy Studies, Department of Medicine, Boston, United States

Background: Data concerning the efficacy and safety of p.os Methotrexate (MTX) administration in inflammatory bowel disease (IBD) are limited.

Methods: The aim of this study was the investigation of the effectiveness and safety of p.os MTX in patients with IBD. It was a retrospective study of the electronic files of 543 patients with IBD treated during the period 1981–2010. A detailed electronic data recording included acquisition, coding and studying of data.

Results: Among 543 cases with IBD, 58.6% were ulcerative colitis (UC) patients and 60% of them male. Data from 48 patients (31 male, 17 female) treated with MTX (33 with Crohn's Disease, 14 with ulcerative colitis, 1 with undetermined colitis) were studied. The commonest localization for UC was left-sided colitis (57.1%), while for Crohn's disease (CD) was ileocolitis (54.5%). Methotrexate was combined with Infliximab in 12 patients and with Adalimumab in 1 patient. In 29.2% the dose of MTX was modified (usual dose: 15 or 25 mg). In total, 43% discontinued MTX due to ineffectiveness. Totally, 43.8% of patients exhibited 2 adverse events, while 29.2% exhibited 1. The commonest adverse event was infection (25%). In 6 patients an intestinal or extraintestinal malignancy was diagnosed during follow-up. Among 19 patients with fistulizing Crohn's disease, methotrexate was ineffective in 14 (73%).

Conclusions: Methotrexate was effective in 57% of patients with IBD and 27% of patients with fistulizing disease. Infection was the commonest adverse event during treatment with MTX.