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Recent evidence suggests that thiopurines are not effective in inducing remission in Crohn disease but do have added benefit for induction when combined with anti–tumor necrosis factor agents in both Crohn disease and ulcerative colitis (NEJM JW Gastroenterol Nov 7 2013). Methotrexate is often considered to play a role similar to that of thiopurines in Crohn disease and is known to reduce the formation of antibodies to infliximab.
In the current double-blind trial, investigators compared the efficacy of methotrexate and infliximab with infliximab alone in inducing and maintaining remission in Crohn disease. They randomized 126 patients who had begun prednisone induction therapy in the preceding 6 weeks to receive either methotrexate (an init…