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Methotrexate: Holding the Line Against Crohn’s Disease While medical researchers work to find the cause and develop new treatments for inflammatory bowel disorders such as Crohn’s disease, they are also focusing recent efforts on medications currently in use that might provide prolonged remission of symptoms. Although identifying a cure is the ultimate goal, being able to reduce symptoms, both in severity and in frequency, is as important to individuals currently afflicted with these conditions. Methotrexate, a medication used successfully in patients diagnosed with certain types of rapidly growing cancers, rheumatoid arthritis and severe psoriasis, has been identified as a means to bring about remission in those individuals suffering from bowel disorders. In a recent study, this hypothesis was tested to see whether, after an initial course of drug therapy, a low dose of the drug might prevent the recurrence of Crohn's disease symptoms. Dr. Brian G. Feagan, and other members of the North American Crohn’s Study Group Investigators, conducted a forty-week observation of two groups of patients who were in remission after being treated over a period of 16 to 24 weeks with low doses of methotrexate. Individuals were selected at random, with one group of 40 participants receiving low doses of methotrexate and the other group of 36 participants receiving placebos. Feagan’s group believed that the level of recurrence would be significantly less in patients who continued to receive the low dose of methotrexate. This theory was borne out by the end results: remission continued for 65 percent of the test group as compared to 39 percent in the control group. Those patients who did have relapses received the drug prednisone. Here, too, the test group fared better: a 28 percent relapse occurred among those who had taken methotrexate, compared with a 58 percent relapse among those who had taken the placebo. Lastly, 22 of the 36 participants who suffered a relapse during the study were given a slightly higher dose of methotrexate: 55 percent went into remission by the end of the forty weeks. Fegan's results confirm those of an earlier study by the same group on the efficacy of low dose methotrexate in the treatment of Crohn's. The earlier sixteen-week study evaluated 141 people: 39 percent of the 94 participants receiving methotrexate remained in remission as compared to 19 percent the 47 participants taking the placebo. This research established that the use of methotrexate might well be a long-term source of remission for people with Crohn’s or similar conditions. This is not to say, however, that it is a remedy for everyone. Issues concerning the potential increase of liver disease are still not resolved and will definitely require further study. Other issues, such as the drug’s contraindication for use in women of childbearing age, must also be addressed. Overall, however, these studies showed that long-term remission is possible. Until a cure is found, this finding is a major step in improving the quality of life for persons afflicted with Crohn's disease. Resources Feagan, B. G., Fedorak, R. N., Irvine, E. J., Wild, G., Sutherland, L., Steinhart, A. H., Greenberg, G. R., Koval, J., Wong, C. J., Hopkins, M., Hanauer, S.B., McDonald, J. W. D. (2000, June 1). A comparison of Methotrexate with placebo for the maintenance of remission in Crohn’s disease. The New England Journal of Medicine, Vol. 342, No. 22:1527-1632. Feagan, B. G., Rochon, J., Fedorak, R. N., Irvine, E. J., Wild, G., Sutherland, L., Steinhart, A. H., Greenberg, Gillies, R., Hopkins, M., Hanauer, S.B., McDonald, J. W. D. (1995, February 2). Methotrexate for the treatment of Crohn’s disease. The New England Journal of Medicine, Vol. 332, No. 5:292-297. Teasdale, C. (2000, June 20). Chemo agent may also aid Crohn's disease patients. The Medical Post, Vol. 36, No. 23. Retrieved August 18, 2002, from http://www.medicalpost.com/mdlink/english/members/ medpost/data/3623/02C.htm.

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