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Meta-analysis MTX (methotrexate) vs placebo in maintenance ulcerative colitis. The results for efficacy and safety outcomes between methotrexate and placebo, methotrexate and sulfasalazine, methotrexate and 6-mercaptopurine and methotrexate and 5-aminosalicylic acid were uncertain. Whether a higher dose or parenteral administration of methotrexate would be effective in quiescent ulcerative colitis is unknown. At present there is no evidence supporting the use of methotrexate for maintenance of remission in ulcerative colitis.

Gastroenterology 2018. Parenteral methotrexate (25 mg/week) was not superior to placebo in preventing relapses of UC in patients who achieved steroid-free response during induction therapy.

References:

Herfarth H, Barnes EL, Valentine JF, et al. Methotrexate Is Not Superior to Placebo in Maintaining Steroid-Free Response or Remission in Ulcerative Colitis. Gastroenterology. 2018;155(4):1098-1108.e9. doi:10.1053/j.gastro.2018.06.046

Wang Y, MacDonald JK, Vandermeer B, Griffiths AM, El-Matary W. Methotrexate for maintenance of remission in ulcerative colitis. Cochrane Database of Systematic Reviews 2015, Issue 8. Art. No.: CD007560. DOI: 10.1002/14651858.CD007560.pub3.