{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T18:07:13Z","timestamp":1789236433344,"version":"build-2803163510"},"reference-count":114,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,7,30]],"date-time":"2024-07-30T00:00:00Z","timestamp":1722297600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2024,7,30]],"date-time":"2024-07-30T00:00:00Z","timestamp":1722297600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Methotrexate, an immunosuppressant used for the treatment of inflammatory bowel disease (IBD) for over 30\u2009years, remains underused compared to thiopurines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To review the efficacy, safety, optimal dosing and delivery regimens of methotrexate in adults with IBD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic review of studies involving patients with IBD treated with methotrexate from inception to August 2023. All studies were included from the MEDLINE database via PubMed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>For Crohn's disease, we included eight randomised controlled trials (RCTs) and 17 observational studies. Parenteral methotrexate effectively increased remission rates in steroid\u2010dependent patients at 25\u2009mg\/week for 16\u2009weeks and at 15\u2009mg\/week for maintenance. Methotrexate can be used in combination with anti\u2010tumour necrosis factor (TNF) agents to reduce immunogenicity. Data comparing thiopurines and methotrexate remain scarce. For ulcerative colitis (UC), we included five RCTs and 10 observational studies were included; there was no evidence to support the use of methotrexate in (UC). We extracted safety data from 17 studies; mild\u2010to\u2010moderate adverse effects were common. The incidence of liver fibrosis or cirrhosis was low.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Methotrexate is effective at inducing and maintaining remission in steroid\u2010refractory Crohn's disease and can reduce anti\u2010TNF\u2010induced immunogenicity when used in combination therapy. Data regarding tolerance and safety are reassuring. These findings challenge preconceived ideas on methotrexate and suggest that it is a valid first\u2010line conventional option for the treatment of mild\u2010to\u2010moderate Crohn's disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/apt.18194","type":"journal-article","created":{"date-parts":[[2024,7,30]],"date-time":"2024-07-30T04:53:01Z","timestamp":1722315181000},"page":"686-700","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Systematic review: Methotrexate\u2014A poorly understood and underused medication in inflammatory bowel disease"],"prefix":"10.1111","volume":"60","author":[{"given":"L\u00e9a","family":"Sequier","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology N\u00eemes University Hospital, Car\u00e9meau Hospital  N\u00eemes France"},{"name":"Department of Gastroenterology and Hepatology A Saint\u2010\u00c9loi Hospital  Montpellier 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