Treatment with Methotrexate in Infants and Toddlers with Atopic Dermatitis: A Retrospective Multi-Center Study
Atopic dermatitis (AD) is a chronic inflammatory skin disease affecting up to 20% of children. Methotrexate (MTX) is used off-label as a systemic treatment for AD patients unresponsive to topical therapies, but limited data exist regarding its safety and efficacy in children, especially in those <...
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| Format: | Article |
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MDPI AG
2023-08-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/16/5409 |
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| author | Jen A. Barak Levitt Sima Alemi Ayelet Ollech Shiran Reiss-Huss Mohammad Sah Yael Renert-Yuval Rivka Friedland Shoshana Greenberger Eran Cohen Barak |
| author_facet | Jen A. Barak Levitt Sima Alemi Ayelet Ollech Shiran Reiss-Huss Mohammad Sah Yael Renert-Yuval Rivka Friedland Shoshana Greenberger Eran Cohen Barak |
| author_sort | Jen A. Barak Levitt |
| collection | DOAJ |
| description | Atopic dermatitis (AD) is a chronic inflammatory skin disease affecting up to 20% of children. Methotrexate (MTX) is used off-label as a systemic treatment for AD patients unresponsive to topical therapies, but limited data exist regarding its safety and efficacy in children, especially in those < 4 years old. To further investigate MTX in younger patients, we screened the medical records of three referral centers between 2016 and 2022 and identified 28 infants and toddlers < 4 years old with AD treated with MTX. Mean age upon MTX initiation was 2.7 ± 1.2 years and mean investigator global assessment (IGA) score was 3.78 ± 0.4. Median duration of MTX treatment was five months. Following 12 and 24 weeks of MTX treatment, the response rate was 50% and IGA 0/1 was achieved in 14.2% and 21.4% of patients, respectively. Most treatment cessations were attributed to a lack of efficacy or parental concern. Although adverse events were reported in 57.1% of patients, MTX was discontinued due to such adverse events only in two patients (7.1%). Taken together, MTX demonstrated a high safety profile in AD patients <4 years old. MTX efficacy was moderate and presumably underestimated by parents who opted for premature treatment cessation due to concerns associated with an immunomodulatory drug. |
| first_indexed | 2024-03-10T23:50:21Z |
| format | Article |
| id | doaj.art-54db0ddf33a6464cbfcb7c55daef8f9f |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T23:50:21Z |
| publishDate | 2023-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-54db0ddf33a6464cbfcb7c55daef8f9f2023-11-19T01:41:52ZengMDPI AGJournal of Clinical Medicine2077-03832023-08-011216540910.3390/jcm12165409Treatment with Methotrexate in Infants and Toddlers with Atopic Dermatitis: A Retrospective Multi-Center StudyJen A. Barak Levitt0Sima Alemi1Ayelet Ollech2Shiran Reiss-Huss3Mohammad Sah4Yael Renert-Yuval5Rivka Friedland6Shoshana Greenberger7Eran Cohen Barak8Department of Dermatology, Emek Medical Center, Afula 1834111, IsraelDepartment of Dermatology, Emek Medical Center, Afula 1834111, IsraelDepartment of Dermatology, Pediatric Dermatology Service, Sheba Medical Center, Ramat-Gan 5265601, IsraelFaculty of Medicine, Tel Aviv University, Tel Aviv 6997801, IsraelDepartment of Dermatology, Emek Medical Center, Afula 1834111, IsraelFaculty of Medicine, Tel Aviv University, Tel Aviv 6997801, IsraelFaculty of Medicine, Tel Aviv University, Tel Aviv 6997801, IsraelDepartment of Dermatology, Pediatric Dermatology Service, Sheba Medical Center, Ramat-Gan 5265601, IsraelDepartment of Dermatology, Emek Medical Center, Afula 1834111, IsraelAtopic dermatitis (AD) is a chronic inflammatory skin disease affecting up to 20% of children. Methotrexate (MTX) is used off-label as a systemic treatment for AD patients unresponsive to topical therapies, but limited data exist regarding its safety and efficacy in children, especially in those < 4 years old. To further investigate MTX in younger patients, we screened the medical records of three referral centers between 2016 and 2022 and identified 28 infants and toddlers < 4 years old with AD treated with MTX. Mean age upon MTX initiation was 2.7 ± 1.2 years and mean investigator global assessment (IGA) score was 3.78 ± 0.4. Median duration of MTX treatment was five months. Following 12 and 24 weeks of MTX treatment, the response rate was 50% and IGA 0/1 was achieved in 14.2% and 21.4% of patients, respectively. Most treatment cessations were attributed to a lack of efficacy or parental concern. Although adverse events were reported in 57.1% of patients, MTX was discontinued due to such adverse events only in two patients (7.1%). Taken together, MTX demonstrated a high safety profile in AD patients <4 years old. MTX efficacy was moderate and presumably underestimated by parents who opted for premature treatment cessation due to concerns associated with an immunomodulatory drug.https://www.mdpi.com/2077-0383/12/16/5409atopic dermatitis (AD)pediatric patientstoddlersinfantsmethotrexate |
| spellingShingle | Jen A. Barak Levitt Sima Alemi Ayelet Ollech Shiran Reiss-Huss Mohammad Sah Yael Renert-Yuval Rivka Friedland Shoshana Greenberger Eran Cohen Barak Treatment with Methotrexate in Infants and Toddlers with Atopic Dermatitis: A Retrospective Multi-Center Study Journal of Clinical Medicine atopic dermatitis (AD) pediatric patients toddlers infants methotrexate |
| title | Treatment with Methotrexate in Infants and Toddlers with Atopic Dermatitis: A Retrospective Multi-Center Study |
| title_full | Treatment with Methotrexate in Infants and Toddlers with Atopic Dermatitis: A Retrospective Multi-Center Study |
| title_fullStr | Treatment with Methotrexate in Infants and Toddlers with Atopic Dermatitis: A Retrospective Multi-Center Study |
| title_full_unstemmed | Treatment with Methotrexate in Infants and Toddlers with Atopic Dermatitis: A Retrospective Multi-Center Study |
| title_short | Treatment with Methotrexate in Infants and Toddlers with Atopic Dermatitis: A Retrospective Multi-Center Study |
| title_sort | treatment with methotrexate in infants and toddlers with atopic dermatitis a retrospective multi center study |
| topic | atopic dermatitis (AD) pediatric patients toddlers infants methotrexate |
| url | https://www.mdpi.com/2077-0383/12/16/5409 |
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