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.