Curbside Consultation in IBD: 49 Clinical Questions, Second Edition

David T Rubin, MD; Sonia Friedman, MD; Francis A Farraye, MD MSc

Question 23: When In The Treatment Algorithm Should Methotrexate Be Considered For Treatment Of Crohn’S Disease? Is There A Role For Low-Dose Methotrexate For Immunogenicity Purposes? (continued)

Hilary Steinhart, MD

In recent decades, immunosuppressive medications have been increasingly used in the management of Crohn’s disease (CD). The two main classes of immunosuppressive medications used in this context are the thiopurine analogs (azathioprine [AZA] and 6-mercaptopurine [6-MP]) and the folic acid antagonist methotrexate (MTX). In general, there are two main decision points in deciding about the use of an immunosuppressive medication in a patient with CD. The first is deciding whether an immunosuppressive agent is required or indicated in the given clinical situation being considered. The…