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Methotrexate for inflammatory bowel disease: the MICI-METHO multicenter retrospective cohort study
Bénédicte Caron1, Julien Kirchgesner2, Maria Nachury3
1Department of Gastroenterology, Nancy University Hospital, and INSERM, NGERE, University of Lorraine, Nancy F-54000, France.
Journal of Crohn'S & Colitis
|July 22, 2026
Summary
This study shows methotrexate is widely used in real-world inflammatory bowel disease (IBD) treatment, often with other drugs. Methotrexate demonstrated good persistence and safety in a large patient cohort.
Area of Science:
- Gastroenterology
- Immunology
- Pharmacology
Background:
- Methotrexate is effective for Crohn's disease (CD) and increasingly used in combination therapy.
- Real-world data on methotrexate use in a large inflammatory bowel disease (IBD) cohort is limited.
Purpose of the Study:
- To investigate the real-world use, persistence, and safety of methotrexate in a large cohort of IBD patients.
- To analyze factors influencing methotrexate persistence in CD and ulcerative colitis (UC).
Main Methods:
- Observational, retrospective, multicenter study of adult IBD patients treated with methotrexate (January 2015-December 2022).
- Included patients receiving methotrexate as monotherapy or combination therapy across 15 French centers.
- Data collected on patient demographics, disease characteristics, treatment regimens, and adverse events.
Main Results:
- 1115 IBD patients included; 77% had CD, 34.5% had extra-intestinal manifestations (EIM).
- Methotrexate was primarily used for IBD (81.5%) and in combination therapy (90.6%).
- Methotrexate persistence was 27.7 months in CD and 22.4 months in UC. Factors like female gender and EIM influenced persistence. 31.7% experienced adverse events, with 9 serious events.
Conclusions:
- The MICI-METHO study provides the first comprehensive real-world overview of methotrexate use in IBD.
- Methotrexate shows favorable persistence and a manageable safety profile in a large IBD patient population.
- Further research can optimize methotrexate use in IBD management based on these findings.
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