Skip to main content
SpringerLink
Log in

Methotrexat als Therapiestrategie bei chronisch entzündlichen Darmerkrankungen

  • Conference paper
Chronisch entzündliche Darmerkrankungen

Part of the book series: Gastroenterologie Update ((GASTROUPDATE,volume 2002))

  • 95 Accesses

Zusammenfassung

Die Behandlung der Patienten mit chronisch entziindlichen Darmerkrankungen (CED),die einen steroidabhangigen oder steroidrefraktaren chronisch aktiven Verlauf zeigen, stellen den behandelnden Arzt sowohl hin-sichtlich der Induktion einer Remission als auch hinsichtlich des Remis-sionserhaltes vor anspruchsvolle Therapieentscheidungen. In den letzten Jahren mehren sich therapeutische Angebote, wobei sich der in der Tumortherapie bekannte Antimetabolit Methotrexat (MTX) in einer im Vergleich zu onkologischen Dosen niedrigen Anwendungsdosis in der Behandlung des Morbus Crohn (MC) einen Platz zu sichern scheint. In dieser Zusammenfassung sollen neben der Pharmakologie von MTX die wichtigen Studien zur Methotrexattherapie bei CED dargestellt werden; diese wurden initiiert als Antwort auf den erfolgreichen Einsatz von MTX bei chronisch entziindlichen Erkrankungen wie rheumatoider Arthritis und schwerem Verlauf einer Psoriasis.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 54.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 69.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  • Arora S, Katkov W, Cooley J, Kemp JA, Johnston DE, Schapiro RH, Podolsky D (1999) Methotrexate in Crohn’s disease: results of a randomized, double-blind, placebo-controlled trial. Hepatogastroenterology 46:1724–1729

    PubMed  CAS  Google Scholar 

  • Baron TH, Truss CD, Elson CO (1993) Low-dose oral methotrexate in refractory inflammatory bowel disease. Dig Dis Sci 38:1851–1856

    Article  PubMed  CAS  Google Scholar 

  • Barrera P, Laan RFJM, van Riel PLCM, Dekhuijzen PNR, Boerbooms AMT, Van de Putte LB A (1994) Methotrexate-related pulmonary complications in rheumatoid arthritis. Ann Rheum Dis 53:434–439

    Article  PubMed  CAS  Google Scholar 

  • Bellaiche G, Maisonneuve L, Nouts A, Ley G, Slama JL (1999) Fatal bone marrow aplasia after the 1st injection of methotrexate in a woman with Crohn’s disease. Gastroenterol Clin Biol 23:1102–1103

    PubMed  CAS  Google Scholar 

  • Bouma MG, Stad RK, van den Wildenberg FA, Buurman WA (1994) Differential regulatory effects of adenosine on cytokine release by activated human monocytes. J Immunol 153:4159–4168

    PubMed  CAS  Google Scholar 

  • Carson CW, Cannon GW, Egger MJ, Ward JR, Clegg DO (1987) Pulmonary disease during the treatment of rheumatoid arthritis with low dose pulse methotrexate. Semin Arthritis Rheum 16:186–195

    Article  PubMed  CAS  Google Scholar 

  • Chong RY, Hanauer SB, Cohen RD (2001) Efficacy of parenteral methotrexate in refractory Crohn’s disease. Aliment Pharmacol Ther 15:35–44

    Article  PubMed  CAS  Google Scholar 

  • Cronstein BA, Eberle MA, Gruber HE, Levin RI (1991) Methotrexate inhibits neutrophil function by stimulating adenosine release from connective tissue cells. Proc Natl Acad Sci USA 88: 2441–2445

    Article  PubMed  CAS  Google Scholar 

  • Cronstein BN, Levin RI, Philips M, Hirschhorn R, Abramson SB, Weissmann G (1992) Neutrophil adherence to endothelium is enhanced via adenosine Al receptors and inhibited via adenosine A2 receptors. J Immunol 148:2201–2206

    PubMed  CAS  Google Scholar 

  • Cunliffe RN, Scott BB (2002) Review article: monitoring for drug side-effects in inflammatory bowel disease. Aliment Pharmacol Ther 16: 647–662

    Article  PubMed  CAS  Google Scholar 

  • Egan LJ, Sandborn WJ (1996) Methotrexate for inflammatory bowel disease: pharmacology and preliminary results. Mayo Clin Proc 71:69–80

    Article  PubMed  CAS  Google Scholar 

  • Egan LJ, Sandborn WJ, Mays DC, Tremaine WJ, Fauq AH, Lipsky JJ (1999a) Systemic and intestinal pharmacokinetics of methotrexate in patients with inflammatory bowel disease. Clin Pharmacol Ther 65:29–39

    Article  PubMed  CAS  Google Scholar 

  • Egan LJ, Sandborn WJ, Mays DC, Tremaine WJ, Lipsky JJ (1999b) Plasma and rectal adenosine in inflammatory bowel disease: effect of methotrexate. Imflamm Bowel Dis 5:167–173

    Article  CAS  Google Scholar 

  • Egan LJ, Sandborn WJ, Tremaine WJ, Leighton JA, Mays DC, Pike MG, Zinsmeister AR, Lipsky JJ (1999c) A randomized dose-response and pharmacokinetic study of methotrexate for refractory inflammatory Crohn’s disease and ulcerative colitis. Aliment Pharmacol Ther 13:1597–1604

    Article  PubMed  CAS  Google Scholar 

  • Feagan BG, Rochon J, Fedorak RN et al. (1995) Methotrexate for the treatment of Crohn’s disease. The North American Crohn’s Study Group Investigators. N Engl J Med 332:292–297

    Article  PubMed  CAS  Google Scholar 

  • Feagan BG, Fedorak RN, Irvine EJ et al. (2000) A comparison of methotrexate with placebo for the maintenance of remission in Crohn’s disease. North American Crohn’s Study Group Investigators. N Engl J Med 342:1627–1632

    Article  PubMed  CAS  Google Scholar 

  • Fraser AG, Morton D, McGovern D, Travis S, Jewell DP (2002) The efficacy of methotrexate for maintaining remission in inflammatory bowel disease. Aliment Pharmacol Ther 16:693–697

    Article  PubMed  CAS  Google Scholar 

  • Kanik KS, Cash JM (1997) Does methotrexate increase the risk of infection or malignancy? Rheum Dis Clin North Am 23:955–967

    Article  PubMed  CAS  Google Scholar 

  • Kozarek RA, Patterson DJ, Gelfand MD, Botoman VA, Ball TJ, Wilske KR (1989) Methotrexate induces clinical and histologic remission in patients with refractory inflammatory bowel disease. Ann Intern Med 110: 353–356

    PubMed  CAS  Google Scholar 

  • Kozarek RA (1996) Methotrexate for refractory Crohn’s disease: preliminary answers to definitive questions (editorial). Mayo Clin Proc 71:104–105

    Article  PubMed  CAS  Google Scholar 

  • Kremer JM (1994) The mechanism of action of methotrexate in rheumatoid arthritis; the search continues. J Rheumatol 21:1–5

    PubMed  CAS  Google Scholar 

  • Kremer JM, Alarcon GS, Lightfoot RW Jr (1994) Methotrexate for rheumatoid arthritis. Suggested guideline for monitoring liver toxicity. Arthritis Rheum 37:316–328

    Article  PubMed  CAS  Google Scholar 

  • Landewe RB, van den Borne BE, Breedveld FC, Dijkmans BA (2000) Methotrexate effects in patients with rheumatoid arthritis with cardiovascular comorbidity. Lancet 355:1616–1617

    Article  PubMed  CAS  Google Scholar 

  • Lemann M, Zenjari T, Bouhnik Y et al. (2000) Methotrexate in Crohn’s disease: long-term efficacy and toxicity. Am J Gastroenterol 95:1730–1740

    PubMed  CAS  Google Scholar 

  • Leroux JL, Damon M, Chavis C, Crastes de Paulet A, Blotman F (1992) Effects of a single dose of methotrexate on 5-and 12-lipoxygenase products in patients with rheumatoid arthritis. J Rheumatol 19: 863–866

    PubMed  CAS  Google Scholar 

  • Lipsky PE, van der Heijde DM, St Clair EW et al. (2000)Anti-Tumor Necrosis Factor Trial in Rheumatoid Arthritis with Concomitant Therapy Study Group. Infliximab and methotrexate in the treatment of rheumatoid arthritis. Anti-Tumor Necrosis Factor Trial in Rheumatoid Arthritis with Concomitant Therapy Study Group. N Engl J Med 343:1594–1602

    Article  PubMed  CAS  Google Scholar 

  • Maini R, St Clair EW, Breedveld F et al. (1999) Infliximab (chimeric anti-tumour necrosis factor alpha monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomised phase III trial. ATTRACT Study Group. Lancet 354:1932–1939

    Article  PubMed  CAS  Google Scholar 

  • Morgan SL, Baggott JE, Vaughn WH et al. (1994) Supplementation with folic acid during methotrexate therapy for rheumatoid arthritis. A double-blind, placebo-controlled trial. Ann Intern Med 121: 833–841

    PubMed  CAS  Google Scholar 

  • Moshkowitz M, Oren R, Tishler M, Konikoff FM, Graff E, Brill S, Yaron M, Gilat T (1997) The absorption of low-dose methotrexate in patients with inflammatory bowel disease. Aliment Pharmacol Ther 11: 569–573

    Article  PubMed  CAS  Google Scholar 

  • Nyfors A, Poulsen H (1976) Liver biopsies from psoriatics related to methotrexate therapy. 2. Findings before and after methotexate therapy in 88 patients. A blind study. Acta Pathol Microbiol Scand [A] 84:262–270

    CAS  Google Scholar 

  • Oren R, Arber N, Odes S et al. (1996) Methotrexate in chronic active ulcerative colitis: a double-blind, randomized, Israeli multicenter trial. Gastroenterology 110: 1416–1421

    Article  PubMed  CAS  Google Scholar 

  • Oren R, Moshkowitz M, Odes S et al. (1997) Methotrexate in chronic active Crohn’s disease: a double-blind, randomized, Israeli multicenter trial. Am J Gastroenterol 92:2203–2209

    PubMed  CAS  Google Scholar 

  • Sajjadi FG, Takabayashi K, Foster AC, Domingo RC, Firestein GS (1996) Inhibition of TNF-alpha expression by adenosine: role of A3 adenosine receptors. J Immunol 156: 3435–3442

    PubMed  CAS  Google Scholar 

  • Schroder O, Stein J (1999) Methotrexat in der Therapie gastrointestinaler Erkrankungen. Z Gastroenterol 37:623–637

    PubMed  CAS  Google Scholar 

  • Schroder O, Stein J (2002) Low-dose methotrexate in inflammatory bowel disease. Eur J Gastroenterol Hepatol (im Druck)

    Google Scholar 

  • Searles G, McKendry RJR (1987) Methotrexate pneumonitis in rheumatoid arthritis: potential risk factors. Four case reports and a review of the literature. J Rheumatol 14:1164–1171

    PubMed  CAS  Google Scholar 

  • Smith JM Jr, Cosulich DB, Hildquist ME, Seeger DR (1948) The chemistry of certain pteroylglutamic acid antaginists. Trans NY Acad Sci 10:82–83

    Article  CAS  Google Scholar 

  • Te HS, Schiano TD, Kuan SF, Hanauer SB, Conjevaram HS, Baker AL (2000) Hepatic effects of long-term methotrexate use in the treatment of inflammatory bowel disease. Am J Gastroenterol 95:3150–3156

    Article  PubMed  CAS  Google Scholar 

  • Vandeputte L, D’Haens G, Baert F, Rutgeerts P (1999) Methotrexate in refractory Crohn’s disease. Inflamm Bowel Dis 5:11–15

    Article  PubMed  CAS  Google Scholar 

  • Zachariae H, Kragballe K, Sogaard H (1980) Methotrexate induced liver cirrhosis. Studies including serial liver biopsies during continued treatment. Br J Dermatol 102:407–412

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Zentrum Innere Medizin Abt. für Gastroenterologie und Hepatologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover

    M. N. Göke Dr.

Authors
  1. M. N. Göke Dr.
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Universitätsklinikum Charité Virchom-Kliniken Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Universitätsklinikum der Humboldt-Universität, Augustenburger Platz 1, 13353, Berlin

    Axel Dignass

  2. Medizinische Klinik II Gastroenterologie/Klinische Ernährung, Universitätsklinikum Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main

    Jürgen Stein

Rights and permissions

Reprints and permissions

Copyright information

© 2003 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Göke, M.N. (2003). Methotrexat als Therapiestrategie bei chronisch entzündlichen Darmerkrankungen. In: Dignass, A., Stein, J. (eds) Chronisch entzündliche Darmerkrankungen. Gastroenterologie Update, vol 2002. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-19025-4_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-19025-4_11

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-44152-6

  • Online ISBN: 978-3-642-19025-4

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation