title: Safety profile of methotrexate in inflammatory bowel disease.
abstract: BACKGROUND
  Methotrexate, which was initially developed in 1948 for the treatment of leukemia, is known to be an immunomodulatory and anti-inflammatory drug. It has been widely used for over 60 years as both a low and high-dose therapy in chronic inflammatory diseases. The aim of this review was to analyze and summarize the available data specifically on the safety of this drug in the management of inflammatory bowel diseases.
  
  
  METHODS
  A structured search of articles was conducted using the PubMed database up to April 2016. All articles in English with isolated or combined keywords were included according to their relevance to the aims of this study.
  
  
  CONCLUSIONS
  Numerous of studies have established the efficacy of parenteral methotrexate in the management of steroid-dependent and steroid-resistant Crohn's disease, either for inducing or maintaining remission. However, its efficacy in ulcerative colitis has not been properly investigated. Additionally, methotrexate has been shown to reduce the effect of immunization with anti-TNF agents when combined. The drug has potential advantages over thiopurines such as its weekly administration, a possible shorter time of action, low cost, decreased risk for malignancy and overall a comparable safety profile.
authors.affiliation: a Division of Gastroenterology , AOU Careggi University Hospital , Florence , Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Gabbani
authors.affiliation: a Division of Gastroenterology , AOU Careggi University Hospital , Florence , Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Deiana
authors.affiliation: b Division of Internal Medicine 4 , AOU Careggi University Hospital , Florence , Italy.
authors.forename: Sarah
authors.initials: S
authors.lastname: Lunardi
authors.affiliation: a Division of Gastroenterology , AOU Careggi University Hospital , Florence , Italy.
authors.forename: Natalia
authors.initials: N
authors.lastname: Manetti
authors.affiliation: a Division of Gastroenterology , AOU Careggi University Hospital , Florence , Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Annese
mesh_terms: D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003424:Crohn Disease / Q000188:drug therapy*; D004351:Drug Resistance; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012074:Remission Induction / Q000379:methods; D013256:Steroids / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids; D008727:Methotrexate
keywords: Crohn’s disease; Methotrexate; inflammatory bowel disease; safety; side effects