Mucosal healing with methotrexate in Crohn's disease: a prospective comparative study with azathioprine and infliximab

David Laharie (1) , Armel Reffet (1) , Genevieve Belleannée (2) , Edouard Chabrun (1) , Clement Subtil (1) , Sylvie Razaire (1) , Maylis Capdepont (1) , Victor de Ledinghen (1)

1 Service d'Hépato-Gastro-Entérologie
2 Service de pathologie [Bordeaux]

Background: Mucosal healing (MH) has become a new therapeutic goal in Crohn's disease (CD) and can be achieved with azathioprine (AZA) or biologics. Methotrexate (MTX) is an effective drug for both the induction and maintenance of remission in CD. However, MH with MTX has been poorly investigated. Aim: to assess the MH rate in patients with CD with clinical response to MTX as compared to AZA or infliximab (IFX). Methods: From October 2007 to May 2009, consecutive patients with CD were prospectively enrolled into a single centre study when they met the following criteria: previous identification of mucosal ulcerations with ileo-colonoscopy, clinical remission within at least three months with MTX, AZA or IFX monotherapy, usual indication for colonoscopy in CD (dysplasia/cancer screening, suspected stenosis) excluding assessment for MH. MH was defined as absence of mucosal ulceration in all segments. Results: Fifty-one patients with CD (38 female; median age: 42 years) were included: 18 receiving MTX, 18 AZA, and 15 IFX. MH was achieved in 2/18 (11%) with MTX, in 9/18 (50%) with AZA (p = 0.011 vs. MTX) and in 9/15 (60%) with IFX (p = 0.008 vs. MTX). Conclusion: In patients with CD in sustained clinical remission, MH is less frequently achieved with MTX as compared to AZA or IFX.

Mots clés: Medicine

David Laharie, Armel Reffet, Genevieve Belleannée, Edouard Chabrun, Clement Subtil, et al.. Mucosal healing with methotrexate in Crohn's disease: a prospective comparative study with azathioprine and infliximab. Alimentary Pharmacology and Therapeutics, 2011, 33 (6), pp.714. ⟨10.1111/j.1365-2036.2010.04569.x⟩. ⟨hal-00608946⟩