Methotrexate in Induction and Maintenance of Steroid Free Remission in Ulcerative Colitis

Inclusion Criteria:

- Signed informed consent.

- Man or woman between 18 and 70 years of age.

- UC diagnosed by routine clinical, radiographic, endoscopic, and pathological
criteria.

- Active UC with a Mayo score of 6 to 12 points and moderate-to severe active disease
on sigmoidoscopy (Mayo endoscopic subscore of at least 2)

and at least ONE of the following criteria:

- Steroid dependent UC *

- Primary failure or loss of response to an anti-TNF (infliximab, adalimumab,
golimumab) in the past

- Primary failure or loss of response to vedolizumab in the past

- Intolerance/failure of azathioprine/6-MP therapy in the past

- Failure of 5-ASA therapy

- Steroid dependence is defined as a clinical response to treatment with
prednisone 40 to 60 mg/day and relapse within 30 days after prednisone treatment
was completed or as a requirement for a daily dosage of not less than 10 mg of
prednisone and impossibility of weaning the patient off steroid without clinical
relapses (two attempts to discontinue the medication within the preceding six
months of the start of the study).

Exclusion Criteria:

- Failure to respond to 40 mg of prednisone or higher/day in the last 2 weeks before
inclusion

- Concomitant use of azathioprine (AZA) or 6-mercaptopurine (6-MP) must be discontinued
at least 2 weeks before inclusion into the study (Week 0 visit)

- Anti-TNF therapy in the 2 weeks before the Week 0 visit

- Failure of cyclosporine therapy in the previous 6 months prior to Screening visit

- Patients with serum albumin < 2.5 g/dl at baseline

- Low serum folate defined as decrease of >10% below normal range

- Patients with WBC< 3.0 x109th/L at baseline

- Patients with platelet count < 100 x109th/L

- Patients with an underlying infection with C. difficile at Screening visit

- Patients with pre-existing hepatic disease

- Patients with known non-alcoholic fatty liver disease (NAFLD)

- Patients with known Hepatitis B or Hepatitis C

- Patients with pre-existing renal dysfunction (creatinine >1.5 mg/dl).

- Patients with a pre-existing chronic lung disease other than well controlled asthma

- Patients with interstitial lung disease of unknown cause

- Patients with a BMI >35

- Known previous or concurrent malignancy (other than that considered surgically cured,
with no evidence for recurrence for 5 years - basal cell does not exclude)

- Existing pregnancy, lactation, or planned pregnancy* (men and women) within the next
12 months. (*Methotrexate should not be used for at least 3 months before planned
pregnancy for men and women and should not be used during pregnancy or breast
feeding)

- High alcohol consumption (more than seven drinks per week)

- Non - steroidal inflammatory medications (NSAIDs) as long-term treatment, defined as
use for at least 4 days a week each month

- Continuous treatment with one of the following drugs:

- Probenecid,

- Trimethoprim/sulfamethoxazole

- Sulfasalazine

- Acitretin

- Streptozocin

- Non-use of appropriate contraceptives in females of childbearing potential (e.g.
condoms, intrauterine device {IUD}, hormonal contraception, or other means considered
adequate by the responsible investigator) or in males with a child-fathering
potential (condoms, or other means considered adequate by the responsible
investigator during treatment

- Participation in another clinical trial within the last 30 days, simultaneous
participation in another clinical trial, or previous participation in this trial

- Well-founded doubt about the patient's cooperation.