Methotrexate in the management of Crohn's disease: A practice survey of gastroenterologists in France.

Background: Second-line treatment of Crohn's disease (CD) commonly involves immunosuppressants such as azathioprine, mercaptopurine, or methotrexate (MTX), used either alone or in combination.

Aim: To investigate the current use of MTX among French gastroenterologists.

Methods: An online questionnaire was distributed between March and August 2023 to 116 French gastroenterologists managing CD. A total of 87 respondents completed the survey and were included in the analysis.

Results: Respondents reported a mean annual caseload of 140 CD patients (median: 50). Overall, 71% prescribed MTX, predominantly in injectable form (92%), either as monotherapy or in combination with biologics or cyclosporin. MTX was prescribed for mild-to-moderate CD by 64% of respondents, and for severe CD by 58%, often in combination with an anti-tumor necrosis factor agent (89% and 94%, respectively). Injectable MTX was favored (84%) in specific clinical scenarios: Patients with articular manifestations (77%), Epstein-Barr virus-negative status (65%), or aged over 65 years (58%). Among the 29% of non-prescribers, the primary reason cited was lack of familiarity with MTX use (60%). Both prescribers and non-prescribers expressed the need for clearer guidelines and real-world data to support MTX use.

Conclusion: Regardless of prescribing habits, most respondents had a favorable opinion of MTX and recognized its good long-term safety profile. French learned societies and medical associations should provide consensus guidelines on MTX use, supported by validated real-world safety and effectiveness data.