Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions
Long-Term Effect of Methotrexate on Childhood AD
In a study of pediatric patients, methotrexate (MTX) for severe atopic dermatitis (AD) was effective and well tolerated both during treatment and post-treatment. Medical records of children prescribed MTX for AD between 2011‒2016 in New Zealand were reviewed for demographics, dose, and duration for MTX and hospitalizations for AD. In the follow-up by phone in 2017, parents of the patents reported response on MTX, AD relapses, and use of additional systemic treatment and completed a patient-oriented eczema measure (POEM). Among the details:
- 43 patients aged 2‒16 years were included.
- MTX was given at median dose of 0.33 mg/kg for a median of 17 months.
- Improvement in AD was reported by 83%.
- AD hospitalization was reduced by half.
- At a median of 2 years after discontinuing MTX, one-third of patients were clear, and one-third had mild-to-moderate AD.
Purvis D, Lee M, Agnew K, Birchall N, Dalziel SR. Long-term effect of methotrexate for childhood atopic dermatitis. [Published online ahead of print April 23, 2019]. J Paediatr Child Health. doi:10.1111/jpc.14478.
Methotrexate has been used for a variety of conditions in dermatology, most notably psoriasis and dermatitis. Long-term safety and efficacy have rarely been evaluated. This report gives us good insight into the effective use of MTX in young people across the severity spectrum of AD. It shows that the drug has at least some benefit in the majority of patients and that the benefits may persist after discontinuation. In the upcoming age of biologics and other novel treatments for AD, it is good to know an older and less expensive option is useful. — Joseph Fowler, Jr., MD, Clinical Professor of Dermatology, University of Louisville, KY