Methotrexate in Severe Childhood Alopecia Areata: Long-term Follow-up

Lucas, P.; Bodemer, Christine; Barbarot, S.; Vabres, P.; Royer, Mathieu; Mazereeuw‐Hautier, J.

doi:10.2340/00015555-2173

Cited by 29 publications

(26 citation statements)

References 9 publications

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Section: Discussionmentioning

confidence: 99%

“…Nevertheless, a single systematic review reports that patients who responded to treatment had low relapse rates, suggesting that in patients with good prognostic factors pulse corticosteroid therapy may be beneficial (Shreberk-Hassidim, Ramot, Gilula, & Zlotogorski, 2016). The frequency of relapses could be potentially reduced with the addition of methotrexate, but more controlled studies are necessary (Landis & Pichardo-Geisinger, 2018;Lucas et al, 2016) AA is a chronic, relapsing autoimmune disease that, if treated with systemic corticosteroids, requires a reasonable cumulative dose for the suppression of inflammation and for hair regrowth initiation. 3-DP were more effective than 1-DP in the treatment of severe pediatric AA.…”

Section: Comparison Of 3-dp Group To the Available Literaturementioning

confidence: 99%

See 1 more Smart Citation

Combined intravenous pulse and topical corticosteroid therapy for severe alopecia areata in children: Comparison of two regimens

Lalošević¹,

Gajić-Veljić

Bonači-Nikolić

et al. 2019

Dermatologic Therapy

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There is no universally accepted treatment for severe pediatric alopecia areata (AA). This prospective study comprised 73 patients (aged 1–18 years) with severe AA (>30% of scalp surface area): 37 received 1‐day intravenous dexamethasone pulses (1‐DP) and 36 received 3‐day pulses (3‐DP), monthly, for 6–12 months. Also, all patients applied topical clobetasol propionate under plastic wrap occlusion. Patients achieving >50% regrowth were considered good responders (GR). All patients reached short term, while 65/73 were available for the long‐term follow‐up (mean 33.3 ± 15.3 vs. 27.7 ± 14.3 months, 1‐DP and 3‐DP, respectively). Relapses during therapy were more frequent in 1‐DP group. 3‐DP patients were more frequently GR in comparison with 1‐DP. 3‐DP patients with disease duration <6 months had better outcomes. Patients without Hashimoto thyroiditis (HT) had 9.8‐fold higher chance of being GR in comparison with HT patients. The best results were achieved in AA plurifocalis (AAP). No patient had severe short‐term side‐effects. At the long‐term follow‐up, 67% of 3‐DP patients had stable results. Only 14.2% AAP patients experienced relapses. Patients had no long‐term side‐effects. 3‐DP were more efficacious than 1‐DP. Short disease duration and no HT were good prognostic factors. 3‐DP protocol is well‐tolerated, with beneficial effects and long‐lasting results in severe pediatric AA.

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Section: Discussionmentioning

confidence: 99%

Section: Comparison Of 3-dp Group To the Available Literaturementioning

confidence: 99%

Combined intravenous pulse and topical corticosteroid therapy for severe alopecia areata in children: Comparison of two regimens

Lalošević¹,

Gajić-Veljić

Bonači-Nikolić

et al. 2019

Dermatologic Therapy

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“…Systemic corticosteroid therapy in AA was first reported in 1952 by Dillaha and Rothman and steroid pulse therapy by Burton and Shuster in 1975 . The use of contact irritants and steroid‐sparing agents started in the early 1990s . These therapies could have influenced the disease course and long‐term prognosis.…”

Section: Introductionmentioning

confidence: 99%

Alopecia areata: a long‐term follow‐up study of 104 patients

Lyakhovitsky

Aronovich

Gilboa

et al. 2019

Acad Dermatol Venereol

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Background Alopecia areata (AA) is a common autoimmune disease that considerably affects the quality of life. Although several studies have investigated the epidemiology, clinical characteristics and treatment of AA, limited recent data are available regarding its long‐term course. Objectives To evaluate the long‐term course of AA in different age groups. Methods A retrospective evaluation of patients who were newly diagnosed with AA from 2008 to 2011 and had at least 7 years of follow‐up. Data regarding the initial episode, treatment given, disease‐free interval and relapses were analysed. Results A total of 104 cases were analysed: 31 childhood‐onset, 63 adult‐onset and 10 late‐onset. At first episode, 88.5% of patients had mild, 3.8% moderate and 7.7% severe AA. Full or significant re‐growth was observed in 74%, 94% and 100% of childhood‐onset, adult‐onset and late‐onset AA patients, respectively. There was no re‐growth in 13%, 3% and 0% of childhood‐onset, adult‐onset and late‐onset patients, respectively. The duration of the initial episode and the disease‐free interval negatively correlated with age. Systemic steroids were the most effective treatment for the primary episode. The frequency of relapses was high overall (52%, 44% and 30% in childhood‐onset, adult‐onset and late‐onset, respectively), but significantly declined over time with a majority (79%) occurring within the first 4 years. The disease‐free interval and relapse rate were not correlated with gender, disease severity at onset or treatment given. Conclusions The prevalence of severe disease, duration of an initial episode and the rate of relapses decreased with an older age at onset. In addition, the outcome and the disease‐free interval improved with age at onset. The frequency of relapses declined over time and most appear early on. The current treatment modalities do not seem to influence the long‐term outcome.

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“…One responder stopped MTX with no relapse after 17 months, the others continued on treatment at the time of final assessment. A second article describing the same cohort reported that two of five responders maintained hair growth at 6 and 4 years after stopping MTX, and three others relapsed with no sustained growth on retreatment …”

Section: Critical Appraisal Of the Evidencementioning

confidence: 97%

“…A second article describing the same cohort reported that two of five responders maintained hair growth at 6 and 4 years after stopping MTX, and three others relapsed with no sustained growth on retreatment. 24 Hammerschmidt and Mulinari Brenner assessed 31 patients (unclear if they were consecutive) with multifocal alopecia, alopecia totalis or alopecia universalis who were treated with MTX alongside prednisolone or as monotherapy. 25 Success (> 50% regrowth) was reported in 17 of 22 on combination treatment and four of nine on MTX alone.…”

Section: Mtx Plus Prednisolonementioning

confidence: 99%

Is methotrexate an effective and safe treatment for maintaining hair regrowth in people with alopecia totalis? A Critically Appraised Topic

2018

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We found insufficient evidence to conclude whether MTX is useful for maintaining regrowth in extensive AA. We found some evidence to suggest that hair regrowth may be induced by MTX when used in combination with systemic corticosteroids, but it was difficult to attribute responses to any one treatment or spontaneous regrowth. Included case series were at a high risk of bias. Randomized controlled trials are needed to evaluate whether MTX alone, or in combination with corticosteroids, vs. placebo is useful for inducing and/or maintaining remission of hair regrowth. In the meantime, MTX may occasionally be considered in people with severe disease that significantly impacts on their quality of life.

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Methotrexate in Severe Childhood Alopecia Areata: Long-term Follow-up

Cited by 29 publications

References 9 publications

Combined intravenous pulse and topical corticosteroid therapy for severe alopecia areata in children: Comparison of two regimens

Combined intravenous pulse and topical corticosteroid therapy for severe alopecia areata in children: Comparison of two regimens

Alopecia areata: a long‐term follow‐up study of 104 patients

Is methotrexate an effective and safe treatment for maintaining hair regrowth in people with alopecia totalis? A Critically Appraised Topic

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