Efficacy of Methotrexate and Anti-TNF Combination Therapy in Adults with Refractory Crohn’s Disease

Abstract

Background:

Biological medications have played a significant role in maintenance therapy for Crohn’s disease, but some cases become refractory to these agents. Methotrexate appears to be a cost-effective and readily available drug for enhancing the effectiveness of maintenance therapy when used in combination with anti-TNF therapy in such cases. However, its effectiveness is still to be established. (Editor: aim?) We aimed to assess the efficacy of MTX and anti-TNF combination therapy in patients with refractory Crohn’s disease.

Methods:

 A retrospective cohort study was conducted on adult patients with Crohn’s disease who were refractory to anti-TNF therapy and were initiated on weekly intravenous methotrexate in addition to the anti-TNF therapy. These patients were then followed up for over a year. The primary outcome measured was the clinical response to treatment, based on the Harvey-Bradshaw Index. The secondary outcomes included assessing the adverse events and complications of methotrexate therapy.

Results:

Of 70 patients, 44 were included in the final analysis. Among them, 30 patients (68.2%) achieved complete remission, four patients (9.1%) had a partial clinical response, and 10 patients (22.7%) required surgery. The adverse events and complications of methotrexate therapy were mild and infrequent (9.1%). None of the demographic or clinical factors were significantly associated with response to treatment (P>0.05).

Conclusions:

Combining methotrexate with anti-TNF therapy appears to be an effective and safe treatment for patients with Crohn’s disease, particularly those with severe disease who are less responsive to monotherapy. However, further studies are needed to confirm these findings.