P230 Methotrexate in the treatment of Crohn's disease: a Portuguese real-life single center experience
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".