PMID- 32300735
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220414
IS  - 2589-5370 (Electronic)
IS  - 2589-5370 (Linking)
VI  - 20
DP  - 2020 Mar
TI  - Efficacy and safety of methotrexate in the management of inflammatory bowel 
      disease: A systematic review and meta-analysis of randomized, controlled trials.
PG  - 100271
LID - 10.1016/j.eclinm.2020.100271 [doi]
LID - 100271
AB  - BACKGROUND: The therapeutic role of methotrexate (MTX) for management of 
      inflammatory bowel disease (IBD) remains unclear. METHODS: We systematically 
      reviewed randomized, controlled trials (RCTs) of MTX for induction and 
      maintenance of remission in IBD until January 2020 in accordance with PROSPERO 
      protocol (#CRD42018115047). Relative risk (RR) of maintenance of remission, 
      induction of remission, endoscopic disease activity, and adverse events were 
      combined in a meta-analysis. FINDINGS: MTX monotherapy was not superior to 
      placebo for induction of clinical remission in Crohn's disease (CD). However, MTX 
      was superior to placebo in maintaining clinical remission of CD. Concomitant 
      therapy with MTX and the TNF inhibitor infliximab (IFX) was not superior to IFX 
      monotherapy in CD. In ulcerative colitis (UC), MTX monotherapy was not superior 
      to placebo neither for induction of clinical remission, nor for maintenance of 
      clinical remission. MTX did not result in superior endoscopic outcomes during 
      induction or maintenance therapy compared with placebo. Regarding adverse events 
      (AEs), our meta-analysis on CD studies showed a significantly higher risk of AEs 
      when comparing MTX versus placebo in studies investigating induction of 
      remission, but not in maintenance of remission. In UC, no such differences in AEs 
      between MTX or placebo were observed. INTERPRETATION: Current data support the 
      efficacy of parenteral MTX monotherapy for maintenance of clinical remission in 
      CD. MTX is not confirmed to be effective for treatment of UC or for induction of 
      remission in CD. No evidence supports concomitant MTX to improve efficacy of IFX 
      (no other biologics investigated).
CI  - (c) 2020 Published by Elsevier Ltd.
FAU - Nielsen, Ole Haagen
AU  - Nielsen OH
AD  - Department of Gastroenterology, Herlev Hospital, University of Copenhagen, 
      Copenhagen, Denmark.
FAU - Steenholdt, Casper
AU  - Steenholdt C
AD  - Department of Gastroenterology, Herlev Hospital, University of Copenhagen, 
      Copenhagen, Denmark.
FAU - Juhl, Carsten Bogh
AU  - Juhl CB
AD  - Research Unit for Musculoskeletal Function and Physiotherapy, University of 
      Southern Denmark, Odense, Denmark.
AD  - Department of Physiotherapy and Occupational Therapy, Herlev and Gentofte 
      Hospital, University of Copenhagen, Copenhagen, Denmark.
FAU - Rogler, Gerhard
AU  - Rogler G
AD  - Department of Gastroenterology and Hepatology, University Hospital of Zurich, 
      Zurich, Switzerland.
LA  - eng
PT  - Journal Article
DEP - 20200204
PL  - England
TA  - EClinicalMedicine
JT  - EClinicalMedicine
JID - 101733727
PMC - PMC7152823
OTO - NOTNLM
OT  - Crohn's disease
OT  - Inflammatory bowel disease
OT  - Methotrexate
OT  - Therapy
OT  - Ulcerative colitis
COIS- The authors have no competing interests to declare as concerns MTX. In general, 
      OHN, CS, CBJ have no conflicts of interest to disclose. Gerhard Rogler has 
      consulted to Abbvie, Augurix, BMS, Boehringer, Calypso, Celgene, FALK, Ferring, 
      Fisher, Genentech, Gilead, Janssen, MSD, Novartis, Pfizer, Phadia, Roche, UCB, 
      Takeda, Tillots, Vifor, Vital Solutions and Zeller; received speaker's honoraria 
      from Astra Zeneca, Abbvie, FALK, Janssen, MSD, Pfizer, Phadia, Takeda, Tillots, 
      UCB, Vifor and Zeller; and educational grants and research grants from Abbvie, 
      Ardeypharm, Augurix, Calypso, FALK, Flamentera, MSD, Novartis, Pfizer, Roche, 
      Takeda, Tillots, UCB and Zeller.
EDAT- 2020/04/18 06:00
MHDA- 2020/04/18 06:01
PMCR- 2020/02/04
CRDT- 2020/04/18 06:00
PHST- 2019/08/20 00:00 [received]
PHST- 2020/01/16 00:00 [revised]
PHST- 2020/01/16 00:00 [accepted]
PHST- 2020/04/18 06:00 [entrez]
PHST- 2020/04/18 06:00 [pubmed]
PHST- 2020/04/18 06:01 [medline]
PHST- 2020/02/04 00:00 [pmc-release]
AID - S2589-5370(20)30015-8 [pii]
AID - 100271 [pii]
AID - 10.1016/j.eclinm.2020.100271 [doi]
PST - epublish
SO  - EClinicalMedicine. 2020 Feb 4;20:100271. doi: 10.1016/j.eclinm.2020.100271. 
      eCollection 2020 Mar.