Crohn Disease, Inflammatory Bowel Diseases, Ulcerative Colitis
Conditions
Brief summary
Methotrexate is one of the immunosuppressants used in chronic inflammatory bowel disease (IBD). It is indicated as monotherapy for induction and maintenance treatment of Crohn's disease (CD), or in combination with anti-tumor necrosis factor (TNF) agents for prevention of immunization. The main objective is to assess the persistence rate of methotrexate treatment in patients followed for chronic inflammatory bowel disease (IBD).
Detailed description
Methotrexate is one of the immunosuppressants used in chronic inflammatory bowel disease (IBD). It is indicated as monotherapy for induction and maintenance treatment of Crohn's disease (CD), or in combination with anti-tumor necrosis factor (TNF) agents for prevention of immunization Thiopurines are the most commonly used immunosuppressants in IBD, which contrasts with rheumatology data where methotrexate is the first-line immunosuppressant. Thiopurines and methotrexate have equivalent efficacy in CD 4. Methotrexate is available in injectable (intramuscular (IM) or subcutaneous (SC)) or tablet form. In IBD, only parenteral administration has been shown to be effective. There is no consensus on the optimal maintenance dosage. Tolerance problems remain an obstacle to its use, even if the side effects are not severe. In this context, the objectives of this study are to describe the use of methotrexate in current practice in patients followed for IBD, its persistence, compliance, tolerance, as well as the factors associated with the persistence of treatment.
Interventions
None listed
Sponsors
Central Hospital, Nancy, France
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Inclusion criteria
1. Person who has received full information on the organization of the research and has not objected to the use of this data 2. Age ≥18 years 3. Certain diagnosis of IBD (European Crohn's Colitis Organization criteria) 4. Introduction of methotrexate mono- or combination therapy between January 1, 2015 and December 31, 2022 5. Minimum 6-month follow-up after initiation of methotrexate therapy 6. Person affiliated with a social security plan or beneficiary of such a plan
Exclusion criteria
1. Age \<18 years 2. Person referred to in articles L. 1121-5, L. 1121-7 and L1121-8 of the public health code * Pregnant woman, parturient or nursing mother * Minor (not emancipated) * Adult person subject to a legal protection measure (guardianship, curatorship, safeguard of justice) * A person of full age who is unable to give consent 3. Persons deprived of liberty by a judicial or administrative decision, persons under psychiatric care by virtue of articles L. 3212-1 and L. 3213-1
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Persistence rate of methotrexate treatment in chronic inflammatory bowel disease patients | minimum follow-up of 6 months post-induction of treatment and maximum on the date of cessation of treatment or date of last news 12/31/2022 | Persistence is measured as the time between starting treatment and stopping the drug or switching to another drug. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Assess the effectiveness of induction therapy with methotrexate for Crohn's patient | minimum follow-up of 6 months post-induction of treatment and maximum on the date of cessation of treatment or date of last news 12/31/2022 | Clinical response defined as a decrease of at least 3 points in the Harvey-Bradshaw Index (HBI) for CD assessed at 6 months of methotrexate therapy. The Harvey-Bradshaw Index consists of a few questions (n=5) to quickly categorize the severity of Crohn's disease and detect remission. Harvey-Bradshaw Index Score: Remission: \<5 Mild Disease: 5 to 7 Moderate Disease: 8 to 16 Severe Disease: \>16 |
| Assess the effectiveness of induction therapy with methotrexate for Ulcerative colitis patient | minimum follow-up of 6 months post-induction of treatment and maximum on the date of cessation of treatment or date of last news 12/31/2022 | Clinical response defined as a decrease of at least 3 points in the partial Mayo score for Ulcerative colitis (UC) assessed at 6 months of methotrexate therapy Mayo score composed by 4 items: stool frequency; rectal bleeding, mucosal appearance at endoscopy and physician rating of disease activity. Mayo score: Score \<2 : no activity Score between 3 and 5: mild activity Score between 6 and 10 :moderate activity Score \>11 : severe activity |
| Assess the safety of methotrexate therapy | minimum follow-up of 6 months post-induction of treatment and maximum on the date of cessation of treatment or date of last news 12/31/2022 | Adverse reactions associated with methotrexate treatment: hematological, hepatic, pulmonary, renal toxicity, allergic reaction, abdominal pain, nausea, vomiting. |
| Describe the reasons for discontinuation of methotrexate therapy | minimum follow-up of 6 months post-induction of treatment and maximum on the date of cessation of treatment or date of last news 12/31/2022 | Reasons for discontinuing methotrexate: inefficiency and intolerance |
Countries
France
Outcome results
None listed