Efficacy and safety of methotrexate in alopecia areata

Hammerschmidt, Mariana; Brenner, Fabiane Mulinari

doi:10.1590/abd1806-4841.20142869

Cited by 50 publications

(46 citation statements)

References 22 publications

(36 reference statements)

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“…A previous study found an 80% relapse rate and another recent study reported 33% relapse rate in patients with more than 50% regrowth1319 In our study, 9 patients (31.0%) with >75% hair regrowth experienced recurrent of disease. The difference between recurrence rates may be due to differences in the severity of disease, disease duration, cumulative MTX dose and concomitant medication.…”

Section: Discussionsupporting

confidence: 56%

Low-Dose Systemic Methotrexate Therapy for Recalcitrant Alopecia Areata

Lim

Kwon

et al. 2017

Ann Dermatol

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BackgroundAlopecia areata (AA) is an autoimmune skin disease difficult to manage and treat. The pathogenesis of AA features a T-cell-associated autoimmune process, and systemic immunosuppressive therapy is prescribed widely for AA.ObjectiveTo evaluate the efficacy and tolerance of systemic low-dose methotrexate (LD-MTX) therapy in treatment of recalcitrant AA multiplex.MethodsIn a retrospective, non-controlled study, we evaluated 29 patients with recalcitrant AA treated with LD-MTX and assessed the therapeutic response according to severity of disease, disease duration, cumulative dose of MTX, and drug safety.ResultsMTX was administered twice weekly, and the mean maximum weekly dose was 14.48 mg. The response was A5 (regrowth=100.0%) in 14 (48.3%) patients and A4 (regrowth of 75%~90%) in 12 (41.4%) patients. Three patients had poor response to LD-MTX treatment (A2: n=2 [6.9%], A1: n=1 [3.4%]). All three of the patients showing a poor response had disease durations exceeding 24 months. Relapse was observed in 31% of patients with more than 75% regrowth. Common side-effects were elevated liver enzyme levels and gastrointestinal discomfort.ConclusionLD-MTX appears to be an effective and well-tolerated treatment for recalcitrant AA multiplex.

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Section: Discussionsupporting

confidence: 56%

Low-Dose Systemic Methotrexate Therapy for Recalcitrant Alopecia Areata

Lim

Kwon

et al. 2017

Ann Dermatol

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“…This finding is similar to that in the series by Chartaux and Joly [17], who reported a relapse rate of 80%. In another series in Brazil of patients who received MTX, the relapse rate was 33% for patients with more than 50% of initial regrowth [20]. However, we found no clinical factor associated with later relapse.…”

Section: Discussioncontrasting

confidence: 51%

“…Hammerschmidt and Mulinari-Brenner [20] recently found that for patients receiving MTX, multifocal AA and disease duration <5 years were associated with a better response to treatment. In our study, treatment response was improved, although not significantly, for patients with reduced disease duration (3.5 and 7.8 years for responders and nonresponders, respectively) and multifocal AA (78% of responders).…”

Section: Discussionmentioning

confidence: 99%

“…Two studies conducted in the same department of dermatology have highlighted the effectiveness of treatment with methotrexate alone (MTX) or combined with oral corticosteroids (OC) for AA totalis [16,17]. MTX was also recently evaluated for the treatment of childhood AA, either alone [18] or in association with various other treatments [19,20]. …”

Section: Introductionmentioning

confidence: 99%

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

Anuset¹,

Perceau²,

Bernard³

et al. 2016

Dermatology

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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.

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“…Concordant with this hypothesis, a considerable proportion of AA patients have one or more accompanying autoimmune diseases . In this context, various kinds of immunosuppressive agents such as dinitrochlorobenzene, squaric acid dibutylester (SADBE), diphenylcyclopropenone (DPCP) and methotrexate (MTX) have thus far proven their effectiveness and efficacy for AA in many studies …”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of superficial cryotherapy for alopecia areata: A retrospective, comprehensive review of 353 cases over 22 years

Jun

Lee

2016

The Journal of Dermatology

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Alopecia areata (AA) affects anagen hair follicles, resulting in non-scarring hair loss. Since introduced by Huang et al., superficial cryotherapy has been accepted as a considerable primary therapeutic modality for AA. The aim of this study was to objectively clarify the therapeutic efficacy and safety of superficial hypothermic cryotherapy for treatment of AA. Medical records of 353 patients from 1993 to 2014 were retrospectively analyzed. According to the response to the superficial cryotherapy, patients were categorized into four groups: "marked", "partial", "poor" and "no recovery". The marked and partial recovery groups were considered as responders. The proportions of the responders among patient subgroups which were defined by various patients, disease, and treatment factors were compared. Of the patients, 60.9% were classified as responders after 3 months of superficial hypothermic cryotherapy. The proportion of the responders were higher when the treatment interval was 2 weeks or less and in the incipient disease stage, with statistical significance. No severe side-effects other than mild pain and pruritus were reported. In conclusion, superficial cryotherapy is an effective and safe therapeutic modality for AA. Especially when the treatment interval is 2 weeks or less and in the first occurrence of the disease, the therapeutic outcome is superior.

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Efficacy and safety of methotrexate in alopecia areata

Cited by 50 publications

References 22 publications

Low-Dose Systemic Methotrexate Therapy for Recalcitrant Alopecia Areata

Low-Dose Systemic Methotrexate Therapy for Recalcitrant Alopecia Areata

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

Efficacy and safety of superficial cryotherapy for alopecia areata: A retrospective, comprehensive review of 353 cases over 22 years

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