Efficacy and Safety of Methotrexate Combined with Low- to Moderate-Dose Corticosteroids for Severe Alopecia Areata

Abstract

Background: In severe alopecia areata (AA), spontaneous recovery is unlikely, and treatment is not standardized. Objective: To evaluate the efficacy and safety of methotrexate (MTX) used alone or combined with low- to moderate-dose oral corticosteroids (OC) for treating severe AA (totalis, universalis and severe multifocal). Methods: Retrospective monocentric study of all consecutive patients receiving this treatment between 2006 and 2012. Efficacy was defined as achieving a total regrowth of terminal hair. Results: 26 patients were included (17 with AA universalis or totalis and 9 with severe multifocal AA). Total regrowth was noted in 15/26 patients. After 3 months of treatment, hair regrowth >80% was associated with further complete regrowth, and hair regrowth <30% was associated with later treatment failure (p = 0.0014). When treatment was tapered, 11/15 patients with initial complete efficacy experienced AA relapse. Conclusion: MTX combined with low- to moderate-dose OC may be an efficient and well-tolerated treatment for severe AA. However, long-term maintenance treatment is usually required.

Alopecia areata

“…A response to methotrexate (an immune suppressant) has been reported in several case series 162–164 . However, many patients also received systemic corticosteroids, and owing to the lack of controls, this makes it difficult to assess the magnitude of any benefit.…”

Methotrexate in alopecia areata: A report of three cases

“…Focusing on the pediatric patients, three out of four achieved a complete regrowth, but a later relapse was observed in two of them. [10]…”

“…[2] However, the need for a maintenance treatment with MTX after achieving a successful hair growth rate has also been proposed. [610] If there is no response after 6–9 months, MTX should be stopped. [2]…”

Methotrexate-induced pneumonia: A dermatologist wake up call

“…Albeit rare, MIP can occasionally evolve to pulmonary fibrosis following acute as well as chronic therapy, with subsequent increase in mortality rate (Ameen, Taylor, Williams, Wells, & Barkert, 2001;Anuset, Perceau, Bernard, & Reguiai, 2016;Mazokopakis et al, 2004). MIP has no apparent correlation with age, sex, total dosage of the drug, or duration of treatment.…”