How is methotrexate prescribed to treat inflammatory bowel disease?

Donna Hill Howes, RN
Family Practitioner

For Crohn's disease, methotrexate is most often given to people whose disease is in remission after treatment with corticosteroids. It is considered a second choice after thiopurines. It is sometimes given to people with active Crohn's disease that is not improved by corticosteroids, or those who cannot take corticosteroids. It is also sometimes given to people with active disease who have to stop taking a thiopurine because of side effects.

Methotrexate is rarely used to treat ulcerative colitis (UC) and is not recommended by current guidelines. Some small studies have not shown any benefit, but those studies used low doses or oral rather than injected methotrexate. Larger studies are currently being conducted. 

Methotrexate is used for children with Crohn's disease in similar situations as for adults. 

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