We describe the evolution of patients with perineal Crohn's disease (PCD) treated with immunomodulators (IM): the purine anti-metabolites or methotrexate (MTX) in the absence of biotherapy. This was a retrospective descriptive study including all patients with (PCD) treated with (IM) and who cannot get biotherapy. The evaluation of the response was based on clinical response and / or morphology. Overall, 62 patient were under (IM). a good result was observed in 63% with complete healing in 79.2% and a partial response in 20.8%. The response time was variable with a median of 4 [2-24] months. Our study shows that despite the progress of biotherapy, the purine anti-metabolites retain their place in the treatment of Crohn's disease in general and in (PCD) more specifically.