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Methotrexate in inflammatory bowel disease: A primer for gastroenterologists - PubMed

Review

Methotrexate in inflammatory bowel disease: A primer for gastroenterologists

Turki AlAmeel et al. Saudi J Gastroenterol. 2022 Jul-Aug.

Abstract

Methotrexate is an antineoplastic agent that is also used at lower doses for anti-inflammatory properties. Along with thiopurines (azathioprine and 6-mercaptopurine), it has historically been an important part of pharmacological treatment for patients with inflammatory bowel disease. Despite an increase in therapeutic options, these immunomodulators continue to play important roles in the management of inflammatory bowel disease, used either as a monotherapy in mild to moderate cases or in combination with monoclonal antibodies to prevent immunogenicity and maintain efficacy. In light of data linking the use of thiopurines with the risk of malignancies, methotrexate has regained attention as a potential alternative. In this article, we review data on the pharmacology, safety, and efficacy of methotrexate and discuss options for the positioning of methotrexate alone, or in combination, in therapeutic algorithms for Crohn's disease and ulcerative colitis.

Keywords: Crohn's disease; methotrexate; ulcerative colitis.

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Conflict of interest statement

None

Figures

**Figure 1**
Methotrexate development and major trials in IBD. RCT: Randomized controlled trial, IFX: Infliximab, MTX: Methotrexate, CD: Crohn's disease, UC: Ulcerative colitis, IBD: Inflammatory bowel disease

**Figure 2**
A proposed approach for considering methotrexate or thiopurines in patients with Crohn's disease. MTX: Methotrexate, IM: Intramuscular, SC: Subcutaneous, EBV: Epstein–Barr virus, HSTL: Hepatosplenic T-cell lymphoma

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Methotrexate in inflammatory bowel disease: A primer for gastroenterologists - PubMed