The therapeutic role of methotrexate in chronic urticaria: A systematic review

Abstract

Background: Chronic urticaria, in many cases, has an unsatisfactory response to antihistamines. The current recommendations in urticaria do not mention the dose and duration for methotrexate. Aims: This study aims to systematically review the use/efficacy of methotrexate in chronic urticaria. Methods: A systematic search in four databases, that is, PubMed/Medline, Cochrane central, Google Scholar and Clinicaltrials.gov was done to identify studies on the use of methotrexate in chronic urticaria using key words “methotrexate [MeSH terms]” and “urticaria” or “urticaria, chronic” or “urticaria, chronic spontaneous.” Results: Nine articles (study participants 127), including three randomized control trials, one prospective interventional trial without control, three retrospective reviews and two case reports, were identified and finally included in the systematic review. There was a paucity of literature and the three randomized control trials did not show any benefit of methotrexate over antihistamines alone. However, in studies where steroid-dependent cases were given methotrexate, marked benefit was reported with steroid-sparing effect, particularly on methotrexate dose escalation. Limitations: Due to a paucity of published literature on methotrexate in urticaria, a meta-analysis could not be done. Conclusion: In chronic recalcitrant or steroid-dependent cases, methotrexate may be a therapeutic agent of interest; however, current evidence does not point to any added advantage in efficacy over antihistamines. More evidence based on larger, well-executed randomized control trials is needed in the future to get more definitive answers.

An Overview of Methotrexate Indications in Skin Diseases

“…The effect of MTX on adenosine and its capacity to inhibit cytokines, leucocyte chemotaxis, and free radicals leads to the improvement of skin lesions from chronic urticaria. A recent meta-analysis, based on data published in the literature between 2000 and 2021, which studied the effectiveness of immunosuppressive therapy in patients with refractory chronic urticaria, highlighted the fact that the therapeutic action of MTX proved to be weaker in patients with chronic urticaria compared to placebo [42,43]. The current recommendation in urticaria does not detail the dose, nor duration treatment, with MTX.…”

Methotrexate-Polymer Nanocomposites for Targeted Pulmonary Drug Delivery

“…MTX is used to treat a variety of illnesses, including cancer, autoimmune disease, ectopic pregnancy, and asthma [10,[17][18]. Low doses suppress neutrophil chemotaxis, which has antiinflammatory benefits [19]. Because oral corticosteroids have so many side effects, various trials have looked into using MTX as an oral corticosteroid-sparing treatment in severe asthma.…”

“…Because oral corticosteroids have so many side effects, various trials have looked into using MTX as an oral corticosteroid-sparing treatment in severe asthma. MTX appears to be an effective oral corticosteroid-sparing medication, according to studies [19][20]. There are many problems related to MTX, such as short half-life, toxic side effects, and poor water solubility.…”

Combination Therapy for Psoriasis with Methotrexate and Other Oral Disease-Modifying Antirheumatic Drugs: A Systematic Review

“…By modulating cell-specific signaling pathways, MTX is involved in multiple crucial pro-inflammatory properties of different cell lineages [5]. Owing to its anti-inflammatory and anti-proliferative properties, MTX has been used in a variety of skin disorders, including psoriasis [6], pityriasis rubra pilaris [7], chronic urticaria (CU) [8], atopic dermatitis (AD) [9], blistering disorders [10], localized scleroderma [11], dermatomyositis [12], cutaneous sarcoidosis [13], etc.…”