Korean J Gastroenterol.  2015 Oct;66(4):231-236. 10.4166/kjg.2015.66.4.231.

A Case of Crohn's Disease Showing Favorable Response to Induction and Maintenance Therapy with Methotrexate after Failure of Anti-tumor Necrosis Factor Therapy

• Choi J
• Yun GW
• Park YM
• Kim JH
• Youn YH
• Park H
• Park JJ

• KMID: 2373347
• DOI: http://doi.org/10.4166/kjg.2015.66.4.231

Abstract

Thanks to the introduction of immumomodulators and biologics, therapeutic approaches in Crohn's disease have changed significantly during the past decade. Although new biologic therapy has dramatically improved the treatment of Crohn's disease, a substantial number of patients are refractory to these therapies or lose their initial response. Methotrexate (MTX) is a structural analogue of folic acid that can competitively inhibit the binding of dihydrofolic acid to the enzyme dihydrofolate reductase and has been widely used as immunomodulator in rheumatology area for patients with rheumatoid arthritis and psoriasis. Although MTX has also been shown to be an effective agent for remission induction and maintenance of remission in Crohn's disease, the use of MTX in Crohn's disease has not yet been reported in Korea. Herein, we report a case of Crohn's disease patient who was successfully treated with MTX after treatment failure with thiopurine and anti-tumor necrosis factor.

Keyword

Methotrexate; Maintenance; Crohn disease; Remission induction

MeSH Terms

Adult
Antibodies, Monoclonal/therapeutic use
Colonoscopy
Crohn Disease/diagnosis/*drug therapy
Humans
Immunosuppressive Agents/*therapeutic use
Infliximab/therapeutic use
Male
Methotrexate/*therapeutic use
Remission Induction
Tomography, X-Ray Computed
Tumor Necrosis Factor-alpha/immunology
Antibodies, Monoclonal
Immunosuppressive Agents
Infliximab
Methotrexate
Tumor Necrosis Factor-alpha

Figure

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  Fig. 1. Endoscopic finings at the time of first presentation 2 years ago. Multiple aphtae lesions are noted in the terminal ileum (A) and the entire colorectum (B, C).

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  Fig. 2. Endoscopic findings. (A) Longitudinal ulcer with inflammatory exudates and erythematous mucosa is observed on terminal ileum. ‘Cobble stone' appearance (B) and narrowed lumen with inflammatory polyps (C) are also found on ascending and transverse colon.

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  Fig. 3. Abdomen-pelvis CT findings. Segmental wall thickening with mucosal enhancement and pericolic fat stranding are noted at hepatic flexure and descending colon.

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  Fig. 4. Clinical courses during medical therapy. CDAI, Crohn's Disease Activity Index; MTX, methotrexate; SQ, subcutaneous.

Reference

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