Use of methotrexate in inflammatory bowel disease in 2014: A User’s Guide

Abstract

Methotrexate has been used an immunomodulator in many autoimmune diseases, including inflammatory bowel disease. However, many physicians are unfamiliar or uncomfortable with its use in the management of inflammatory bowel disease. We summarize the data for use of methotrexate in common clinical scenarios: (1) steroid dependant Crohn’s disease (CD); (2) maintenance of remission in steroid free CD; (3) azathioprine failures in CD; (4) in combination therapy with Anti-TNF agents in CD; (5) decreasing antibody formation to Anti-TNF therapy in CD; (6) management of fistulizing disease in CD; and (7) as well as induction and maintenance of remission in ulcerative colitis. An easy to use algorithm is provided for the busy clinician to access and safely prescribe methotrexate for their inflammatory bowel disease patients.

Keywords: Methotrexate; Inflammatory bowel disease; Crohn’s disease; Ulcerative colitis; Immunomodulators; Methotrexate user’s guide

Core tip: Methotrexate can a be a useful adjunct to the treatment of inflammatory bowel disease, but many practitioners are unfamiliar with it’s use. Here, we have provided a succinct summary of the data behind the use of methotrexate and a short “user’s guide” and algorithm to allow for the busy clinician to become quickly familiar with the drug and information to help prescribe it safely.