Methotrexate treatment in severe atopic dermatitis; results from daily practice

Klaziena Politiek, J. Van Der Schaft, W.A. Christoffers, M.S. De Bruin-Weller, M.L.A. Schuttelaar

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Abstract

Background: The efficacy and safety of methotrexate has been reported in a few clinical studies. The aim of this study was to identify the course of treatment with methotrexate in daily practice in patients with severe atopic dermatitis, with respect to reasons for discontinuation of treatment and side-effects. In addition we evaluated the effectiveness. Methods: Patient data (UMCG/UMCU, January 1997 - October 2013) were recorded in an Access database: patient characteristics; start/stop dates; subjective side-effects; objective side-effects (laboratory assessment); reasons to stop; retrospective Physician's Global Assessment (patients treated for at least 8 weeks). Results: A total of 46 patients (UMCG n=34; UMCU n=12) were treated with methotrexate (mean age 48.2 years). Eighteen patients still use methotrexate. The median treatment duration was 188.5 (11.0-1382.0) days, with a mean maintenance dose of 12.9 mg/week. The main reason for discontinuation of treatment was side-effects in 14/28 (50.0%) patients: 3 patients with objective side-effects (increased liver enzymes); 11 patients with subjective sideeffects. Other reasons for discontinuation were nonresponsiveness 6/28 (21.4%) and remission 2/28 (7.1%). Overall, gastrointestinal symptoms were the most common side-effects in 13/46 patients. A good clinical response to treatment was found in 20/38 (52.6%) patients; moderate response in 11/38 (29.0%) patients; no response in 7/38 (18.4%) patients. Conclusion: Results of methotrexate therapy in daily practice are not as good as the results from clinical trials. A substantial percentage of patients discontinued treatment, mainly due to side-effects. More results from daily practice are needed to appoint risk factors for discontinuation and treatment failure.
Original languageEnglish
Pages (from-to)47
Number of pages1
JournalNederlands Tijdschrift voor Dermatologie en Venereologie
Volume24
Issue number1
Publication statusPublished - 1-Jan-2014

Keywords

  • methotrexate
  • liver enzyme
  • atopic dermatitis
  • human
  • patient
  • side effect
  • data base
  • remission
  • therapy
  • treatment failure
  • laboratory
  • patient coding
  • maintenance drug dose
  • treatment duration
  • physician
  • gastrointestinal symptom
  • clinical trial (topic)
  • risk factor
  • clinical study
  • safety

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