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

Abstract

Background: Methotrexate (MTX) has been prescribed to suppress atopic dermatitis (AD) symptoms and flares in moderate-to-severe cases. Objective: The purpose of this study was to evaluate the therapeutic efficacy and safety of MTX as well as the suppressive activity of MTX to reduce flares in moderate-to-severe AD patients. Methods: Patients with moderate-to-severe AD who were treated with MTX at the Chonnam National University Hospital were retrospectively studied. Results: Total 102 patients (79 males, 23 females) with a median age of 22.0±10.3 years were studied. The median initial dose of MTX was 10.3±2.6 mg/week, and the MTX-weekly dose was increased by 2.5 to 5 mg at an interval of 2 to 4 weeks to a maximum dose of 17.5±2.7 mg/week. The median maintenance dose was 11.7±2.1 mg/week; the median duration of treatment with MTX was 34.0±38.8 weeks. The initial response was noted after 5.8±3.7 weeks. Of the 102 patients, 60.8% (62/102) showed successful treatment response and 39.2% (40/102) showed mild or no improvement. MTX therapy effectively suppressed the frequency of AD flares by more than 50% in 71.1% (32/45) of the patients who responded among the MTX responders group. The most common adverse events were transient liver abnormality (5.9%, 6/102) and gastrointestinal discomfort (3.9%, 4/102), but no serious adverse events occurred. Conclusion: Our results reveal that MTX is a relatively safe drug to control moderate-to-severe AD with satisfactory therapeutic efficacy and inhibitory activity against AD flares.

Revolutionizing Pediatric Dermatology: Dupilumab’s Impact on Atopic Dermatitis in Kids

“…For AD, Methotrexate is administered at a starting dose of 10.3-2.6 mg/week, which can be changed according to the patient's tolerance and reaction. Weekly increases are possible, with maintenance dosages of about "11.7 mg" (Lee et al, 2020;Shah et al, 2018).…”

Expert consensus on the systemic treatment of atopic dermatitis in special populations

“…While there are publications on the use of traditional systemics in AD, the majority are either retrospective reviews [50][51][52][53] or RCTs with a small number of patients [54][55][56] that do not report any ocular AEs. Given that there is a baseline incidence of OSD in the AD population, 35 the lack of ocular AE reporting in studies of traditional systemics suggest possible deficiencies in data collection and highlights the increased focus on OSD in patients treated with biologics targeting IL-4 and/or IL-13.…”

Preliminary Clinical Study of the Effects and Safety of 308-nm Excimer Light Treatment in Patients with Atopic Dermatitis

“…The treatment of AD depends on its severity. For severe AD, systemic immune-modulating agents are effective options 3 . Recently, a systemic biological immunomodulator has been developed and widely adapted owing to its profile of favorable side effects 4 .…”