Inflamm Bowel Dis：甲氨蝶呤联合激素治疗溃疡性结肠炎有助于缓解后激素的撤药

     糖皮质激素是一种诱导溃疡性结肠炎缓解的主要药物，但由于副作用较多，并不推荐长期应用。甲氨蝶呤被推荐用于作为克罗恩病诱导和维持缓解的二线药物，但目前关于甲氨蝶呤治疗溃疡性结肠炎的研究较少。为此，来自美国路易斯安那州东南部退伍军人健康中心的Nabeel Khan等人进行了一项队列研究，探讨甲氨蝶呤在诱导溃疡性结肠炎撤离激素后缓解中的作用，该研究发表在6月份的Inflammatory bowel diseases杂志上。

        研究通过对2001-2011年间使用甲氨蝶呤治疗激素依赖型的溃疡性结肠炎患者进行了一项回顾性队列研究，数据来自美国退伍军人事务部。回顾性随访时间为15个月，开始接受甲氨蝶呤为随访起始点，并通过数据库中记录的发放强的松、甲氨蝶呤、硫唑嘌呤以及英夫利昔单抗等药物的时间进行随访。随访终点是：（1）达到缓解，指继续应用甲氨蝶呤过程中停用强的松后疾病不再活动 ；（2）继续应用甲氨蝶呤，但不能停用激素 （3）停用甲氨蝶呤，继续应用激素。最后共纳入91名平均年龄为59岁的溃疡性结肠炎患者。研究中口服和肠外途径给甲氨蝶呤的每周平均剂量分别为14和25mg。口服和肠外甲氨蝶呤治疗的同时接受强的松的每天平均剂量分别为12和25mg。其中在随访的第12个月，有37%口服甲氨蝶呤和30%肠外给甲氨蝶呤的患者可以停用激素治疗。研究还发现联合口服强的松和甲氨蝶呤的患者，在其随访结束时他们的激素并无显著性减少。

        目前为止这是最大的一项有关甲氨蝶呤治疗溃疡性结肠炎的队列研究，研究表明接受甲氨蝶呤治疗的患者中大约有1/3可以完全停用激素，说明甲氨蝶呤可能可以作为激素治疗溃疡性结肠炎后维持长期缓解的一个选择。

Methotrexate in Ulcerative Colitis: A Nationwide Retrospective Cohort from the Veterans Affairs Health Care System
Background
There are paucity of data regarding the utility of methotrexate (MTX) in the management of ulcerative colitis (UC). The aim of this study was to describe the efficacy of MTX in achieving steroid-free remission.
Methods
A retrospective cohort study was conducted using the nationwide Veterans Affairs database to identify steroid-dependent patients with UC using MTX for the period 2001 to 2011. Patients were followed up for 15 months after MTX initiation by tracking their prednisone, MTX, thiopurines, and infliximab dispense. Endpoints were: (1) successful remission, defined as cessation of prednisone filling activity while continuing MTX; (2) failure with continuance, failure to be weaned off steroids while continuing MTX; (3) failure with discontinuance, cessation of MTX while continuing steroids.
Results
We included 91 patients with UC with mean age 59 years. The average weekly dose for oral and parenteral MTX was 14 and 25 mg/week, respectively. The average daily dose for prednisone within the oral MTX and parenteral MTX groups was 12 and 25 mg/day, respectively. By the 12th month of follow-up, 37% and 30% of patients on oral and parenteral MTX, respectively, were able to discontinue steroid. There was a nonsignificant trend toward dose reduction of steroids in those who were concomitantly taking oral MTX and steroids.
Conclusions
Our study represents the largest cohort of patients with MTX and UC reported to date and suggests that approximately one-third of patients were successfully weaned off steroids with MTX therapy. MTX should be considered in the long-term management of patients with UC on steroids.