Methotrexate for severe nummular eczema in children: Efficacy and tolerability in a retrospective study of 28 patients

Knöpfel, Nicole; Noguera‐Morel, Lucero; Hernández‐Martín, Ángela; Torrelo, Antonio

doi:10.1111/pde.13568

Cited by 14 publications

(18 citation statements)

References 14 publications

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“…To date, published reports of MTX treatment for childhood AD and discoid eczema involve 220 children in seven studies, including our own, and support MTX being generally safe, effective and well tolerated. Doses used in other studies were similar to those used here.…”

Section: Discussionsupporting

confidence: 60%

“…Roberts et al reported that 84% of 25 children with discoid eczema were clear or almost clear at an average of 10.5 months (range 3–30 months) of MTX treatment (10 mg/week). Knopfel et al found that 82% of 28 children with discoid eczema were clear or had marked improvement after MTX (0.2–0.5 mg/kg/week) for a mean (±standard deviation (SD)) duration of 12.6 (+3.3) months.…”

Section: Discussionmentioning

confidence: 99%

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Long‐term effect of methotrexate for childhood atopic dermatitis

Purvis

Lee

Agnew

et al. 2019

J Paediatrics Child Health

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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.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Long‐term effect of methotrexate for childhood atopic dermatitis

Purvis

Lee

Agnew

et al. 2019

J Paediatrics Child Health

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“…268 Difficult-to-treat nummular forms of AD in children have also responded to MTX treatment. 269 Most systemic treatment of children and adolescents is expected to shift to dupilumab, once the expected licence for children is obtained.…”

Section: Specific Considerations For Childrenmentioning

confidence: 99%

“…Recently, low‐dose MTX was shown to have a good safety profile in children, 266,267 even for long‐term treatment, 147 and an effectiveness comparable to CyA 268 . Difficult‐to‐treat nummular forms of AD in children have also responded to MTX treatment 269 . Most systemic treatment of children and adolescents is expected to shift to dupilumab, once the expected licence for children is obtained.…”

Section: Specific Considerations For Childrenmentioning

confidence: 99%

ETFAD/EADV Eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children

Wollenberg

Christen-Zäch

Taı̈eb

et al. 2020

Acad Dermatol Venereol

303

360

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Atopic dermatitis (AD) is a highly pruritic, chronic inflammatory skin disease. The diagnosis is made using evaluated clinical criteria. Disease activity and burden are best measured with a composite score, assessing both objective and subjective symptoms, such as SCORing Atopic Dermatitis (SCORAD). AD management must take into account clinical and pathogenic variabilities, the patient's age and also target flare prevention. Basic therapy includes hydrating and barrierstabilizing topical treatment universally applied, as well as avoiding specific and unspecific provocation factors. Visible skin lesions are treated with anti-inflammatory topical agents such as corticosteroids and calcineurin inhibitors (tacrolimus and pimecrolimus), which are preferred in sensitive locations. Topical tacrolimus and some mid-potency corticosteroids are proven agents for proactive therapy, which is defined as the long-term intermittent anti-inflammatory therapy of frequently relapsing skin areas. Systemic anti-inflammatory or immunosuppressive treatment is a rapidly changing † See Appendix section.

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“…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). No SAEs were recorded except for gastrointestinal intolerance (21.4%) and no significant increase in liver enzymes (17.9%) was detected.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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.

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Methotrexate for severe nummular eczema in children: Efficacy and tolerability in a retrospective study of 28 patients

Abstract: Methotrexate is an effective, well-tolerated treatment in children with moderate to severe nummular eczema that has failed to respond to conventional topical therapy.

Cited by 14 publications

References 14 publications

Long‐term effect of methotrexate for childhood atopic dermatitis

Long‐term effect of methotrexate for childhood atopic dermatitis

ETFAD/EADV Eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children

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

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