Kevin Phan1, Vignesh Ramachandran2, Deshan Frank Sebaratnam3. 1. Department of Dermatology, Liverpool Hospital, Liverpool, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia. 2. Baylor College of Medicine, Houston, Texas. 3. Department of Dermatology, Liverpool Hospital, Liverpool, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia; Departments of Dermatology, Sydney Children's Hospitals Network, Sydney, Australia. Electronic address: deshan@unsw.edu.au.
Abstract
BACKGROUND: Methotrexate has been used both as monotherapy and as an adjunct to corticosteroids in the treatment of alopecia areata (AA), though there exists a paucity of definitive evidence and guidelines in this setting. OBJECTIVES: To 1) determine the efficacy and risks associated with methotrexate therapy for AA, 2) determine the differences in efficacy of combination (methotrexate plus corticosteroids) versus stand-alone (methotrexate) treatment, and 3) determine the relative efficacy of methotrexate in adult versus pediatric populations. METHODS: A systematic review and meta-analysis was performed according to recommended PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-Analyses] guidelines. RESULTS: Methotrexate has reasonable effectiveness in patients with severe AA; adults appear to be more responsive to methotrexate treatment than pediatric patients. Combination treatment results in a higher complete response rate than methotrexate stand-alone treatment. A large proportion of patients had recurrence in the setting of tapering treatment. Complication rates were acceptable and similar between adult and pediatric patients. LIMITATIONS: The studies reviewed were retrospective observational studies with heterogeneity between centers in terms of methotrexate dosages and protocols in use for AA, and there was a lack of data beyond 1 year for the adjunctive treatments. CONCLUSION: Methotrexate is an effective monotherapy or adjunct therapy in combination with corticosteroids in the treatment of severe AA.
BACKGROUND:Methotrexate has been used both as monotherapy and as an adjunct to corticosteroids in the treatment of alopecia areata (AA), though there exists a paucity of definitive evidence and guidelines in this setting. OBJECTIVES: To 1) determine the efficacy and risks associated with methotrexate therapy for AA, 2) determine the differences in efficacy of combination (methotrexate plus corticosteroids) versus stand-alone (methotrexate) treatment, and 3) determine the relative efficacy of methotrexate in adult versus pediatric populations. METHODS: A systematic review and meta-analysis was performed according to recommended PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-Analyses] guidelines. RESULTS:Methotrexate has reasonable effectiveness in patients with severe AA; adults appear to be more responsive to methotrexate treatment than pediatric patients. Combination treatment results in a higher complete response rate than methotrexate stand-alone treatment. A large proportion of patients had recurrence in the setting of tapering treatment. Complication rates were acceptable and similar between adult and pediatric patients. LIMITATIONS: The studies reviewed were retrospective observational studies with heterogeneity between centers in terms of methotrexate dosages and protocols in use for AA, and there was a lack of data beyond 1 year for the adjunctive treatments. CONCLUSION:Methotrexate is an effective monotherapy or adjunct therapy in combination with corticosteroids in the treatment of severe AA.
Authors: Daniela Mikhaylov; Jacob W Glickman; Ester Del Duca; John Nia; Peter Hashim; Giselle K Singer; Alba L Posligua; Aleksandra G Florek; Erin Ibler; Erika L Hagstrom; Yeriel Estrada; Stephanie M Rangel; Maria Colavincenzo; Amy S Paller; Emma Guttman-Yassky Journal: Arch Dermatol Res Date: 2022-03-01 Impact factor: 3.017