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In treating patients with Crohn disease, clinicians typically use anti–tumor necrosis factor (anti-TNF) agents and the immunomodulatory agents azathioprine and 6-mercaptopurine before methotrexate. Gastroenterologists tend to be concerned about the long-term risks of methotrexate, including liver fibrosis, although recent studies suggest that the risk for cirrhosis is considerably lower than previously thought. Now, investigators have retrospectively assessed the long-term response and safety of methotrexate for Crohn disease.
The study cohort of 174 patients (mean age, 35 years; median disease duration, 4 years) received intramuscular methotrexate monotherapy following thiopurine therapy, with 23% also having received but not responded to a…