1
|
Barak Levitt JA, Alemi S, Ollech A, Reiss-Huss S, Sah M, Renert-Yuval Y, Friedland R, Greenberger S, Cohen Barak E. Treatment with Methotrexate in Infants and Toddlers with Atopic Dermatitis: A Retrospective Multi-Center Study. J Clin Med 2023; 12:5409. [PMID: 37629451 PMCID: PMC10455795 DOI: 10.3390/jcm12165409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
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.
Collapse
Affiliation(s)
| | - Sima Alemi
- Department of Dermatology, Emek Medical Center, Afula 1834111, Israel
| | - Ayelet Ollech
- Department of Dermatology, Pediatric Dermatology Service, Sheba Medical Center, Ramat-Gan 5265601, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Shiran Reiss-Huss
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Pediatric Dermatology Unit, Schneider Children’s Medical Center of Israel, Petah Tikva 4920235, Israel
| | - Mohammad Sah
- Department of Dermatology, Emek Medical Center, Afula 1834111, Israel
| | - Yael Renert-Yuval
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Pediatric Dermatology Unit, Schneider Children’s Medical Center of Israel, Petah Tikva 4920235, Israel
| | - Rivka Friedland
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Pediatric Dermatology Unit, Schneider Children’s Medical Center of Israel, Petah Tikva 4920235, Israel
| | - Shoshana Greenberger
- Department of Dermatology, Pediatric Dermatology Service, Sheba Medical Center, Ramat-Gan 5265601, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Eran Cohen Barak
- Department of Dermatology, Emek Medical Center, Afula 1834111, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa 3200003, Israel
| |
Collapse
|