1
|
Caron AGM, Bloem M, El Khattabi H, de Waal AC, van Huizen AM, Denswil NP, Gerbens LAA, Spuls PI. The wide variety of methotrexate dosing regimens for the treatment of atopic dermatitis: a systematic review. J DERMATOL TREAT 2024; 35:2292962. [PMID: 38124505 DOI: 10.1080/09546634.2023.2292962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
Background:Methotrexate is an off-label therapy for atopic dermatitis. A lack of consensus on dosing regimens poses a risk of underdosing and ineffective treatment or overdosing and increased risk of side effects. This systematic review summarizes the available evidence on dosing regimens.Materials and methods:A literature search was conducted, screening all randomized controlled trials (RCTs) and guidelines published up to 6 July 2023, in the MEDLINE, Embase, and Cochrane Library databases.Results:Five RCTs and 21 guidelines were included. RCTs compared methotrexate with other treatments rather than different methotrexate dosing regimens. The start and maintenance doses in RCTs varied between 7.5-15 mg/week and 14.5-25 mg/week, respectively. Despite varied dosing, all RCTs demonstrated efficacy in improving atopic dermatitis signs and symptoms. Guidelines exhibited substantial heterogeneity but predominantly proposed starting doses of 5-15 mg/week for adults and 10-15 mg/m2/week for children. Maintenance doses suggested were 7.5-25 mg/week for adults and 0.2-0.7 mg/kg/week for children. One guideline suggested a test dose and nearly half advised folic acid supplementation.Conclusion:This systematic review highlights the lack of methotrexate dosing guidelines for atopic dermatitis. It identifies commonly recommended and utilized dosing regimens, serving as a valuable resource for clinicians prescribing methotrexate off-label and providing input for an upcoming consensus study.
Collapse
Affiliation(s)
- Anouk G M Caron
- Dermatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, the Netherlands
| | - Manja Bloem
- Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Hajar El Khattabi
- Dermatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Ayla C de Waal
- Dermatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Astrid M van Huizen
- Dermatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, the Netherlands
| | - Nerissa P Denswil
- Medical Library, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Louise A A Gerbens
- Dermatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, the Netherlands
| | - Phyllis I Spuls
- Dermatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
2
|
Færk G, Ahlström MG, Lura VHE, Reventlow S, Johansen JD, Thyssen JP, Hansen KS, Skov L. Referral Pathways for Children with Atopic Diseases in Denmark. Acta Derm Venereol 2024; 104:adv34961. [PMID: 38828609 PMCID: PMC11161810 DOI: 10.2340/actadv.v104.34961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/18/2024] [Indexed: 06/05/2024] Open
Abstract
Atopic diseases such as atopic dermatitis, food allergy, allergic rhinoconjunctivitis, and/or asthma are common. In Denmark, however, there are multiple referral pathways for these diseases in the healthcare system and they are poorly understood. To describe how children with atopic diseases navigate their way through the Danish healthcare system, a questionnaire was distributed to children aged ≤ 17 years, who were being treated for atopic diseases between August 2020 and June 2021, either by a practising specialist or a hospital department, in the Capital Region of Denmark. A total of 279 children completed the questionnaire and most were referred to a specialist or to a hospital by their general practitioner. No "common track" to hospital existed for patients with ≥ 3 atopic diseases. These patients were more often referred to a hospital compared with children with 2 atopic diseases or fewer (odds ratio [OR] 3.79; 95% CI 2.07-7.24). The primary determinants for hospital treatment were food allergy (OR 4.69; 95% CI 2.07-10.61) and asthma (OR 2.58; 95% CI 1.18-5.63). In conclusion, children with multiple atopic diseases were more likely to be referred to hospital departments than to practising specialists, mainly due to food allergies.
Collapse
Affiliation(s)
- Gitte Færk
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Denmark, The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark, and National Allergy Research Center, Copenhagen University Hospital - Herlev and Gentofte, Denmark.
| | - Malin Glindvad Ahlström
- National Allergy Research Center, Copenhagen University Hospital - Herlev and Gentofte, Denmark
| | - Viktoria Helt-Eggers Lura
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Denmark
| | - Susanne Reventlow
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark
| | - Jeanne Duus Johansen
- National Allergy Research Center, Copenhagen University Hospital - Herlev and Gentofte, Denmark
| | - Jacob P Thyssen
- Department of Dermatology and Venereology, Copenhagen University Hospital - Bispebjerg, Denmark
| | - Kirsten Skamstrup Hansen
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Denmark and Department of Pediatrics, Copenhagen University Hospital - Herlev and Gentofte, Denmark
| | - Lone Skov
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Denmark and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|