TY - JOUR T1 - Methotrexate: a useful alternative in Crohn's disease? JF - Gut JO - Gut SP - 9 LP - 10 DO - 10.1136/gut.49.1.9 VL - 49 IS - 1 AU - A B HAWTHORNE Y1 - 2001/07/01 UR - http://gut.bmj.com/content/49/1/9.abstract N2 - The search goes on for safe and effective long term treatments that will modify the course of aggressive Crohn's disease and reduce the need for frequent surgery or long term corticosteroids. Azathioprine and 6-mercaptopurine remain the most widely used immunomodulators but there is a need for alternatives, particularly for the 10% of patients who cannot tolerate these drugs. Methotrexate has been used in Crohn's disease for many years1-3 and a controlled trial showed benefit in active corticosteroid dependent disease4 yet it is still not widely used. Likely reasons include concerns about toxicity (particularly liver fibrosis, hypersensitivity pneumonitis, and teratogenicity), the need for parenteral administration, and lack of evidence of long term benefit.The recent publication of Feagan and colleagues5 provides important information on the long term role of methotrexate. While not obvious from the paper's title, this was in fact a placebo controlled withdrawal study in 76 patients who had achieved remission (judged by Crohn's disease activity index) after methotrexate 25 mg intramuscularly weekly for 4–6 months. Forty patients then received methotrexate 15 mg intramuscularly every week, and the remainder received placebo injections for 40 … ER -