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

doi:10.3748/wjg.v31.i33.108872

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Sep 7, 2025 (publication date) through Sep 7, 2025

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Sep 7, 2025; 31(33): 108872
Published online Sep 7, 2025. doi: 10.3748/wjg.v31.i33.108872

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

Guillaume Bonnaud, Jennifer Becker, Myriam Chebbah, Agnès Courbeyrette, Patrick Faure

Guillaume Bonnaud, Cabinet Gastro-entérologie, Clinique Ambroise Paré, Toulouse 31100, France

Jennifer Becker, Agnès Courbeyrette, Affaires Médicales, Nordic Pharma France, Paris 75017, France

Myriam Chebbah, Department of Medical Affairs, Public Health Expertise, Paris 75004, France

Patrick Faure, Hépato-Gastro-Entérologie, Clinique Pasteur, Toulouse 31076, France

Co-corresponding authors: Myriam Chebbah and Patrick Faure.

Author contributions: Bonnaud G, Becker J, Chebbah M, Courbeyrette A, Faure P contributed to the development of the questionnaire, participated in data interpretation and were involved in drafting the manuscript and/or critically revising it for important intellectual content; Chebbah M conducted the survey data analysis; All authors have approved the final version of the manuscript for publication.

Institutional review board statement: According to French regulations, surveys involving physicians do not require ethics committee approval, as this study does not fall under deliberation No. 2018-154 of May 3, 2018 (JORF No. 0160 of the 13^th of July 2018).

Informed consent statement: Prior to accessing the survey, each physician was required to confirm their consent to participate. All responses were collected anonymously and analyzed in aggregate in September 2023. Descriptive statistics were used to summarize the findings.

Conflict-of-interest statement: Bonnaud G and Faure P did not received fees for the publication; However, they have received fees for board membership fees, as well as consulting and speaker fees, from Nordic Pharma. Becker J and Courbeyrette A are employees of Nordic Pharma and have not received any fees. Chebbah M, an employee of Public Health Expertise, received fees for analyzing the survey results and assisting with manuscript writing.

STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.

Data sharing statement: Data are available on reasonable request to the corresponding author or PHE team.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Patrick Faure, MD, Doctor, Hépato-Gastro-Entérologie, Clinique Pasteur, 45 Av. de Lombez BP, Toulouse 31076, France. pfaure@clinique-pasteur.com

Received: April 30, 2025
Revised: June 27, 2025
Accepted: August 12, 2025
Published online: September 7, 2025
Processing time: 124 Days and 18.5 Hours

Abstract

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.

Keywords: Methotrexate; Crohn’s disease; Combination therapy; Immunosuppressant; Azathioprine; Guidelines; France; Practice survey; Real-world evidence

Core Tip: This practice survey among French gastroenterologists reveals a growing confidence in methotrexate (MTX) for managing Crohn’s disease (CD), particularly in combination with biologics for specific patient profiles such as those with joint involvement or Epstein-Barr virus negativity. While MTX is often underutilized compared to azathioprine, respondents acknowledged its favorable long-term safety profile. The study highlights variability in prescribing habits and underlines the need for clearer clinical guidelines and more real-world evidence to support optimal use of MTX in CD.