Long‐term effect of methotrexate for childhood atopic dermatitis

Abstract

Aim To evaluate methotrexate (MTX) for paediatric atopic dermatitis (AD) while on and post‐treatment. Methods Medical records of children prescribed MTX for AD between 2011 and 2016 at Starship Children's Hospital, Auckland, New Zealand, were reviewed for demographics, dose and duration of MTX and hospitalisations for AD. In the follow‐up by telephone in 2017, parents of the patients reported response on MTX, AD relapses and use of additional systemic treatment and completed a patient‐oriented eczema measure (POEM). Results Forty‐three patients aged 2–16 years were included. Four (9%) had previous systemic treatment, and 14 (33%) were hospitalised (28 admissions). MTX was given at median dose of 0.33 mg/kg (interquartile range (IQR) 0.26–0.40) for a median of 17 months (IQR 7.5–20). After initiating MTX, only six (14%) were hospitalised (nine admissions). Thirty (70%) parents of patients were followed up for a median of 29 months (IQR 14–45) after discontinuing MTX. Five (17%) reported ‘no change’, 2 (7%) ‘slightly better’ and 23 (77%) ‘a lot better’ AD on MTX. Of the 25 who responded to MTX, AD relapsed in 10 (40%) at a median of 24 months post‐MTX; only four (16%) restarted MTX. Median POEM at follow‐up was 6 (IQR 1–17). Eleven (37%) were clear (POEM 0–2), 11 (37%) had mild to moderate AD (POEM 3–16), and 8 (27%) had severe AD (POEM ≥17). Conclusions Although a natural resolution cannot be excluded, MTX for severe AD was effective and well tolerated. Improvement was reported by 83%, and AD hospitalisation reduced by half. At a median of 2 years after discontinuing MTX, one third were clear, and one third had mild to moderate AD, suggesting persistence of benefit post‐MTX.

Topical and Oral Therapies for Childhood Atopic Dermatitis and Plaque Psoriasis

“…Methotrexate (MTX) is considered an off-label, first-line systemic therapy for children with severe, erythrodermic, or recalcitrant psoriasis [42]. MTX can also be used for refractory AD [44]. Clinical improvement occurred in 76% of 55 moderate to severe AD pediatric patients with a decrease of mean Investigator’s Global Assessment from 4.2 to 3.0 after 6 to 9 months of MTX treatment.…”

Therapeutic Efficacy and Safety of Methotrexate in Moderate-to-Severe Atopic Dermatitis: A Retrospective Study of Korean Patients at Tertiary Referral Hospital

“…In dermatology, MTX has been used to treat psoriasis, AD, lymphoproliferative disorders (mycosis fungoides, lymphomatoid papulosis, and pityriasis lichenoides), connective tissue diseases (lupus erythematosus, dermatomyositis, and systemic sclerosis), autoimmune bullous diseases (pemphigus, bullous pemphigoid, and Hailey-Hailey disease) and others 7 . Interestingly, the abundance of evidence supporting the therapeutic efficacy of MTX suggests that MTX is a promising drug for the control of AD in children and adults [12][13][14] . However, MTX has not been rou-tinely prescribed by clinicians due to poor experience with the drug as well as the relatively higher possibility of adverse reactions.…”

“…Recently, 83% of severe AD patients showed improved response following MTX treatment with a median duration of 17 months. Furthermore, after discontinuation of MTX for approximately two years, one-third of AD patients were clear and one-third had mild-to-moderate AD, suggesting that MTX has a longterm effect in childhood AD 13 . Knöpfel et al 15 reported their experience with severe nummular eczema in children in that 96.4% of patients among 28 MTX-treated patients improved with MTX treatment: 35.7% (10/28 patients) exhibited complete or almost complete clearance of eczema (＞90% improvement); 46.4% (13/28 patients) showed marked improvement (50%∼89% improvement); and 14.3% (4/28 patients) had mild improvement (＜50% improvement).…”

Handlungsempfehlung zur Therapieumstellung von Immunsuppressiva auf Dupilumab bei Patienten mit atopischer Dermatitis

“…Arzneistoffe, die in der Indikation atopische Dermatitis "off label" angewendet werden [12]. Dies trifft insbesondere für die Anwendung im Kindesalter zu [13,[49][50][51]. Zudem liegen direkte Studienvergleichsdaten zu CSA und AZA vor [52][53][54].…”