Low-dose methotrexate is ineffective in primary biliary cirrhosis: long-term results of a placebo-controlled trial.

Abstract

BACKGROUND & AIMS:

New treatments for primary biliary cirrhosis (PBC) need to be evaluated. We conducted a single-center double-blind, randomized trial of methotrexate, 7.5 mg/wk (n = 30), vs. placebo (n = 30) for up to 6 years in PBC.

METHODS:

Methods included three monthly symptom assessment and liver function tests and liver biopsy and gastroscopy at baseline, after 2 years, and after 4-6 years.

RESULTS:

Patients randomized to methotrexate had, compared with patients randomized to placebo, (1) significantly lower on-treatment serum alkaline phosphatase, gamma-glutamyltransferase, immunoglobulin (Ig) M, IgG, and (after 24 months) aspartate aminotransferase and alanine aminotransferase levels (P < 0.02-0.001 by analysis of covariance to adjust for baseline differences); (2) a nonsignificant trend toward lower on-treatment pruritus scores; (3) similar on-treatment Knodell inflammatory scores but nonsignificant trends toward lower Knodell fibrosis score and less ductopenia; (4) a trend toward greater increases in serum bilirubin level and Mayo score with time (both significant after 5 years of follow-up); and (5) a 2.9-fold (95% confidence interval, 0.85-10.25-fold) increase the rate of death or liver transplantation as a result of liver disease during or after the trial (P = 0.09) in a Cox multivariate regression analysis compared with patients randomized to placebo.

CONCLUSIONS:

These results do not support the clinical use of low-dose methotrexate in PBC.

• Authors: M T Hendrickse, E Rigney, M H Giaffer, I Soomro, D R Triger, J C Underwood, D Gleeson
• Journal: Gastroenterology (Gastroenterology) Vol. 117 Issue 2 Pg. 400-7 (Aug 1999) ISSN: 0016-5085 [Print] United States
• PMID: 10419922 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)

Chemical References

• Autoantibodies
• Alanine Transaminase
• Bilirubin
• Methotrexate

Topics

• Aged
• Alanine Transaminase (blood)
• Autoantibodies (blood)
• Bilirubin (blood)
• Female
• Humans
• Liver Cirrhosis, Biliary (drug therapy)
• Liver Transplantation
• Male
• Methotrexate (adverse effects, therapeutic use)
• Middle Aged
• Mitochondria (immunology)