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Lack of effect of methotrexate in budesonide-refractory collagenous colitis
Linköping University, Department of Clinical and Experimental Medicine, Gastroenterology and Hepatology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Gastroentorology.
Örebro University Hospital, Örebro University, Sweden.
Lund University, Sweden.
Örebro University Hospital, Örebro University, Sweden.
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2013 (English)In: Clinical and Experimental Gastroenterology, ISSN 1178-7023, Vol. 6, 149-152 p.Article in journal (Refereed) Published
Abstract [en]


In most cases, collagenous colitis can be treated effectively with budesonide. However, some patients develop side effects or have chronic symptoms refractory to budesonide. This paper reports an open case series of patients intolerant or refractory to budesonide who were treated with methotrexate (MTX).


Nine patients (seven women) with a median (range) age of 62 (44-77) years were studied. Bowel movements were registered during 1 week prior to baseline and after 6 and 12 weeks' treatment, enabling calculation of the mean bowel movements/day. All patients underwent colonoscopy with biopsies before inclusion to confirm diagnosis. Open treatment with MTX was given 15 mg subcutaneously weekly for 6 weeks and was increased to 25 mg for a further 6 weeks if symptoms were unresponsive to the first 6 weeks' treatment. The endpoint was clinical remission, which was defined as a mean <3 stools/day and mean <1 watery stool/day/week at Week 12. The Short Health Scale was used at baseline and Week 12 to assess health-related quality of life.


Five patients fulfilled the treatment according to the protocol and four patients discontinued the study after 3-6 weeks because of adverse events. No patient achieved clinical remission at Week 12. The mean stool frequency/day at baseline was 6.0 stools/day, thereof 5.4 watery stools/day and after 12 weeks treatment 6.4 stools/day, thereof 5.7 watery/day. No patient appreciated an improvement of health-related quality of life.


Short-term treatment with MTX had no clinical effect in collagenous colitis patients intolerant or refractory to budesonide. Alternative therapies should be investigated in these patients.

Place, publisher, year, edition, pages
Dove Medical Press , 2013. Vol. 6, 149-152 p.
Keyword [en]
microscopic colitis, health-related quality of life, Short Health Scale, MTX, stools, diarrhea
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-102419DOI: 10.2147/CEG.S48201PubMedID: 24039441OAI: diva2:677453
Available from: 2013-12-09 Created: 2013-12-09 Last updated: 2014-04-15

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