Elevation of transaminases after MMP® session with methotrexate for alopecia areata treatment – how much do we know about the risks of systemic absorption of the technique?

Comment related to the publication “Elevation of transaminases after MMP® session with methotrexate for alopecia areata treatment ‒ How much do we know about the risks of systemic absorption of the technique?” ‒ Answer

“…We agree with the consideration that, regarding the cause of the increase in transaminase levels in the described patient, there are no means of affirming with certainty the association with the MMP® technique. 1 We reinforce, however, that she had already shown an elevation of transaminase levels with the previous use of the medication when administered orally. We attributed it to the technique used after excluding other possible causes such as infections, alcohol consumption, physical activity, or use of any other medication, in addition to the transitoriness of transaminitis in relation to the procedure.…”

Comment on “Elevation of transaminases after MMP® session with methotrexate for alopecia areata treatment - how much do we know about the risks of systemic absorption of the technique?”

“…Considering the aforementioned facts, and the lack of other reports of possible drug toxicity related to methotrexate MMP® drug delivery, we must consider an alternative hypothesis for the findings described by Nogueira et al 1 It is possible that this patient’s mild transient increase in transaminases may have occurred by chance or have been caused by other factors unrelated to methotrexate MMP® drug delivery?…”

“…We read with interest Nogueira’s et al recent case report. 1 This is an important contribution to the limited evidence about the safety of drug delivery techniques.…”