Methotrexate

Through a variety of mechanisms, including folate-independent pathways, once weekly low-dose methotrexate, either oral or parenteral, has been demonstrated to exert immune-modifying effects. For the treatment of inflammatory bowel disease, there are prospective data supporting the use of methotrexate to treat adult Crohn disease. Notably, well-designed clinical trials in ulcerative colitis did not show efficacy of this therapy. The current data in pediatric Crohn disease are largely retrospective but consistently encouraging. Large pediatric registry data clearly demonstrate that the rate of use of methotrexate in pediatric Crohn disease has risen, including its use in combination with anti-tumor necrosis factor (TNF) agents.