IDDF2019-ABS-0336\u2005Systematic review with meta-analysis: the efficacy of methotrexate in ulcerative colitis

Abstract

Background Although methotrexate (MTX) is used for refractory ulcerative colitis (UC) in clinical practice, there is still controversy about whether MTX is as effective in UC as that in Crohn’s disease (CD). Aim To evaluate the efficacy of MTX in UC by performing a systematic review and meta-analysis. Methods We searched electronic databases for prospective studies evaluating the efficacy of MTX in UC. Data from cohort studies were pooled for effect estimates. Then in the meta-analysis we conducted controlled trials comparing MTX with controls. Results Thirteen cohort studies (401 patients) were included in the meta-analysis of proportion. Mean efficacy of MTX was 26% for induction and 39% for maintenance of remission in UC patients. Five controlled trials were included in the meta-analysis of comparison. Three studies were pooled, yielding a RR of 1.40 (95% CI, 0.97–2.02, P=0.07) for achieving clinical remission in UC patients who received MTX (45%, 46/102) vs. placebo or 5-aminosalicylic acid (33%, 32/96) during the follow-up of 16–30 weeks. Three studies were pooled, yielding a RR of 0.81 (95% CI, 0.49–1.35, P = 0.42) for maintaining clinical remission in UC patients who received MTX (28%, 18/65) vs. controls (37%, 22/60) during the follow-up of 32–76 weeks. The pooled rates of severe adverse events were comparable between UC patients treated with MTX (6%, 6/104) and placebo (5%, 5/91; RR 1.02, 95% CI 0.34–3.04, P = 0.98). Conclusions Although MTX has been proved well tolerated and safe, the studies show no benefit of MTX for induction or maintenance of remission in UC patients.