P230 Methotrexate in the treatment of Crohn's disease: a Portuguese real-life single center experience
Notice bibliographique
Résumé
Background: Methotrexate (MTX) is frequently used as a second-line immuno-modulator in patients with Crohn's disease (CD) when purine analogs are not tolerated or lack efficacy. However, evidence on indications for its use, efficacy, adverse effects and patient outcomes is still limited. Our objective was to evaluate the experience with the use of MTX in CD in a high-volume Portuguese tertiary center. Methods: The records of all patients treated with MTX were evaluated with regard to the dose, duration, response, and tolerance to MTX. Remission was defined as improvement in symptoms with no corticosteroid requirement for 3 months or ability to wean off steroids. Results: Sixty-two patients were included, 35 female (56.5%), with a mean age of 37.5 (± 11.3) years. According to the Montreal classification, the distribution of the disease was as follows: age - A1 12.9%, A2 46.8%, A3 38.7%; location - L1 27.4%, L2 12.9%, L3 51.6%, L1+4 1.6%; behavior - B1 33.9%, B2 25.8%, B3 40.4%. Twenty-one patients had perianal disease (33.9%) and half had previous surgery. MTX was the first-line immunosuppressant in 9 patients (14.5%). Indications for initiating MTX included: adjuvant to anti-TNF agent (43.5%), intolerance to azathioprine (27.4%), corticodependence (19.4%) and corticoresistance (9.7%). Almost half of the patients were on steroids at the onset of MTX (n=28, 47.5%). Eighteen patients achieved clinical remission under MTX (29%), 22 clinical response (35.5%) and 22 were nonresponders (35.5%). Absence of response was associated with a lower cumulative dose (784 vs. 1365 mg, p=0.004), shorter duration of treatment (66 vs. 89 weeks, p=0.003), diagnosis at an earlier age (21 vs. 27 years, p=0.028), and colonic involvement (48% vs. 0%, p=0.006). During treatment with MTX 35.5% developed flare(s), 37.1% needed steroids, 9.7% started anti-TNF agent, and 12.9% had surgery. Forty-nine patients discontinued MTX after a mean period of 88 (±86) weeks. Reasons for suspension included hepatitis (34%), absence/loss of response (31.2%), intolerance (17%), patient decision (14.9%) and pregnancy (2.1%). In total, 21 patients had adverse effects (36.8%) and 4 (6.9%) had opportunistic infections, all of them under anti-TNF. After MTX discontinuation, 43.6% of the patients had further flare(s), 20.4% started anti-TNF agent, and 12.7% underwent surgery. Conclusions: Despite the moderate efficacy demonstrated in the management of Crohn's disease, mainly as an adjuvant to anti-TNF agents, the use of MTX is limited by the development of adverse effects by more than 30%. Longer treatment, especially in patients with localized ileal disease, is associated with higher response rates.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».