Methotrexate for IBD: How Do GIs Use It? - Medscape

What To Know

New real-world data: A retrospective multicenter French cohort of 1,115 adults with IBD (mostly Crohn’s disease) starting methotrexate between 2015–2022 found methotrexate was used mainly as an add-on to biologics (≈90.6% of cases), most commonly at 15 mg/week and more often given subcutaneously than orally. Median treatment duration was about 12 months.

Adverse events were reported by about one-third of patients, but serious toxicity was uncommon (0.8%). Reasons for stopping included inefficacy, intolerance/side effects, and stopping combination therapy. What this means: This study reports prescribing patterns, persistence, and safety from routine clinical practice rather than a randomized trial.

It supports that methotrexate is still used mainly alongside biologics (often anti-TNF agents) and gives a realistic sense of duration and common side effects in a large cohort.

Talking points for clinic visits: If you or your clinician are considering methotrexate, expect discussion about route (subcutaneous vs oral), typical dosing around 15 mg/week, and monitoring for gastrointestinal symptoms and liver toxicity.

The data come from retrospective records and describe associations with persistence rather than proving comparative effectiveness.