Azathioprine in combination with methotrexate: a therapeutic alternative in severe and recalcitrant forms of alopecia areata?

Mascia, Paola; Milpied, B.; Darrigade, Anne‐Sophie; Sénéschal, Julien; Eyraud, A.; Bonamonte, Domenico; Taı̈eb, Alain

doi:10.1111/jdv.15834

Cited by 8 publications

(11 citation statements)

References 11 publications

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“…The association with MTX should be carried out carefully, considering the increase in side effects. 59 The recommendations on immunosuppressants are summarized in Table 15 .…”

Section: Pre-treatment Considerationsmentioning

confidence: 99%

Consensus on the treatment of alopecia areata – Brazilian Society of Dermatology

Ramos¹,

Anzai²,

Duque‐Estrada³

et al. 2020

Anais Brasileiros de Dermatologia

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Background Alopecia areata is a highly frequent disease with an impact on quality of life and several treatment options with little clinical confirmatory evidence. Objective To disseminate the recommendations of Brazilian dermatologists with expertise in the treatment of alopecia areata. Methods Eight specialists with expertise in alopecia areata from different university centers were appointed by the Brazilian Society of Dermatology to reach a consensus on its treatment. Based on the adapted DELPHI methodology, the relevant elements were considered; then, an analysis of recent literature was carried out and the consensus was written down. Consensus on the management of alopecia areata was defined with the approval of at least 70% of the panel. Results/Conclusions Intralesional injectable corticotherapy was considered the first option for localized disease in adults. In extensive cases with signs of activity, systemic corticosteroid therapy should be considered and can be used together with immunosuppressants (corticosteroid-sparing agents). The use of an immunosensitizer (diphencyprone) is an option for stable long-term cases. Evaluation of side effects is as important as the rate of hair regrowth.

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“…The association with MTX should be carried out carefully, considering the increase in side effects. 59 The recommendations on immunosuppressants are summarized in Table 15 .…”

Section: Pre-treatment Considerationsmentioning

confidence: 99%

Consensus on the treatment of alopecia areata – Brazilian Society of Dermatology

Ramos¹,

Anzai²,

Duque‐Estrada³

et al. 2020

Anais Brasileiros de Dermatologia

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“…Azathioprine (100 mg/day) combined with methotrexate or anthralin was described to be effective in children with alopecia areata 61,62 . No side effects or relapses were reported in children with alopecia areata treated with azathioprine.…”

Section: Resultsmentioning

confidence: 99%

“…It was established that azathioprine impaired T-cell function as well as the essential components of T-cell activation (interleukin-2). 61 The main disadvantage of azathioprine therapy is the delayed onset of action. Its benefits may be unobservable for 2-3 months after the introduction of the treatment.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic management in paediatric alopecia areata: A systematic review

Waśkiel‐Burnat

Kołodziejak

Sikora

et al. 2021

Acad Dermatol Venereol

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Alopecia areata is the third most common cause of dermatology consultations in children but the treatment of paediatric alopecia areata remains challenging. A systematic review of the literature about the treatment of alopecia areata in children (≤18 years old) was performed on 11 May 2020 by searching the PubMed, Scopus and EBSCO databases.The terms used for the search were: 'alopecia areata', 'alopecia totalis' or 'alopecia universalis' combined with 'paediatric', 'children' or 'childhood'. A total of 89 articles were included in final evaluation. The most commonly assessed treatment options in paediatric alopecia areata were topical immunotherapy (response rate in monotherapy: 54%; 187/ 345) intralesional glucocorticosteroids (75%; 211/280), systemic glucocorticosteroids (73%; 102/140), and anthralin (42%; 31/74). Topical glucocorticosteroids (81%; 35/43), systemic Janus kinase (JAK) inhibitors (90%; 27/30), topical calcineurin inhibitors (42%; 8/19), topical JAK inhibitors (65%; 11/17), PUVA therapy (56%; 9/16) and 308-nm excimer laser (77%; 10/13) were also evaluated. Additionally, evaluation in smaller numbers of paediatric patients included methotrexate (100%; 10/10), topical minoxidil (44%; 4/9) and cyclosporine (83%; 5/6). There were limited data considering children with alopecia areata treated with azathioprine, hydroxychloroquine, topical sildenafil, topical prostaglandin analogues, fractional carbon dioxide laser, leflunomide, mesalazine, apremilast, dupilumab, ustekinumab, efalizumab, botulinum toxin, and compound glycyrrhizin. On the basis of the limited data available glucocorticosteroids (systemic, intralesional or topical) and JAK inhibitors (systemic or topical) may be considered the best documented and most effective treatment options in alopecia areata in children. There are no sufficient paediatric data to compare treatment safety and relapse rates in these therapeutic modalities.

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“…Finally, there is enough variability in the assessment parameters used across different studies but still, SALT score is considered the standard method for assessment of AA and its frequent use thus lends generalizability to the results of any study 8 . In the discussed study, 1 only 3 out of 18 (16.6%) patients achieved simplified global score (SGS) of 3 (50 to 74% regrowth) at the end of one year, and out of them only two were on MTX. Overall response seems suboptimal at 6 months, and 55.5% achieved any hair growth and 11% achieved 25–49% hair regrowth.…”

mentioning

confidence: 94%

“…We went through the article with great interest, and we appreciate the innovative effort of the authors 1 . Authors found that a combination of methotrexate (MTX) and azathioprine (AZA) showed encouraging results in a series of patients with severe, recalcitrant and cosmetically unacceptable multiple alopecia areata (AA) and alopecia totalis (AT).…”

mentioning

confidence: 99%

Azathioprine in combination with methotrexate may not be a good therapeutic alternative in severe and recalcitrant forms of alopecia areata

Ansari

Singh

2020

Acad Dermatol Venereol

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Azathioprine in combination with methotrexate: a therapeutic alternative in severe and recalcitrant forms of alopecia areata?

Cited by 8 publications

References 11 publications

Consensus on the treatment of alopecia areata – Brazilian Society of Dermatology

Consensus on the treatment of alopecia areata – Brazilian Society of Dermatology

Therapeutic management in paediatric alopecia areata: A systematic review

Azathioprine in combination with methotrexate may not be a good therapeutic alternative in severe and recalcitrant forms of alopecia areata

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