Efficacy and Tolerability of Methotrexate in the Treatment of Severe Paediatric Alopecia Areata

<b><i>Introduction:</i></b> Alopecia areata (AA) is a chronic, autoimmune condition affecting hair follicles, and its occurrence in the paediatric population is associated with poorer prognosis and limited treatment options compared to adults. Treatment with oral methotrexate (MTX) has been documented in adults, but there is a paucity of data for its use in the paediatric population. We aimed to study the efficacy and tolerability of MTX in severe paediatric AA. <b><i>Methods:</i></b> We performed a retrospective review on paediatric patients with severe AA who were treated with MTX in our centre from January 2019 to December 2020. <b><i>Results:</i></b> Thirteen patients were included (6 boys and 7 girls) aged between 4 and 16 years at the initiation of MTX (mean age of 8.8 years). The interval from diagnosis of AA to commencement of MTX was between 8 months and 9 years (mean duration of 3.3 years). Oral MTX was administered once weekly with a mean maximal dose of 0.4 mg/kg/dose. Out of 12 assessable patients, 5 were considered treatment success as they had more than 50% regrowth, while the other 7 were treatment failures. No serious side effects were reported. <b><i>Conclusion:</i></b> MTX was shown to have variable efficacy for the treatment of paediatric AA with overall good tolerability. MTX can be considered in the treatment of severe refractory AA for children.

Diffuse surgically induced scleritis following strabismus surgery: A case report

A 30 years old woman was diagnosed as surgically induced diffuse scleritis following an uneventful strabismus surgery. The disease was stable with topical and systemic steroid but did not completely recover. So, immunomodulatory therapy with Oral Methotrexate was started.

Effectiveness and tolerability of oral versus subcutaneous methotrexate in patients with rheumatoid arthritis

Objectives The aim of this study was to compare the effectiveness and tolerability between oral methotrexate (MTX) and subcutaneous MTX in a large group of rheumatoid arthritis (RA) patients in a real-life setting. Methods In this retrospective cohort study, adult patients with clinical diagnosis of RA who started MTX treatment (monotherapy or combined with hydroxychloroquine), either started with oral or subcutaneous MTX. The primary outcome was superiority testing of between group difference in change in DAS28CRP between baseline and 3–6 months, and subsequent non inferiority testing (NI margin 0.6) analyses in case of non-superiority. Secondary outcomes included MTX dose, side effects, laboratory abnormalities, and use of comedication. Results 640 RA patients were included: 259 started with oral MTX and 381 with subcutaneous. There was no significant difference in ΔDAS28CRP, after adjusting for confounding, 0.13 (95%-CI: -0.14, 0.40), and oral MTX strategy was non inferior to subcutaneous. The mean MTX dose was slightly lower for the oral strategy (18.0 SD6.9 vs 19.9 SD8.2, p= 0.002), which was accompanied by a lower cumulative incidence of adverse events (41% vs 52%, p= 0.005). No differences were seen in use of other comedication. Conclusions Starting with oral MTX in RA in a real-life setting is non inferior to a subcutaneous MTX treatment with regard to disease activity control, at least when used in dosages up to 25 mg and on a background of HCQ cotreatment and a treat-to-target approach. In addition, tolerability was better. This supports the strategy of starting with oral MTX.

Management of Chronic Noninfectious Uveitis with Low-Dose Methotrexate

Purpose To evaluate the effectiveness of low-dose oral methotrexate(5mg/week) among chronic noninfectious uveitis patients who were unresponsive to conventional steroids therapy. Methods 27 patients with chronic noninfectious uveitis who were treated with low-dose methotrexate (MTX) at ophthalmology department of Pyongyang University of Medical Science Hospital from 2017 to 2020 were participated in this study.Each patient received oral MTX at dose of 5mg/week except that 2 patients were given 7.5mg/week MTX for the first 4 weeks. The treatment effects were evaluated based on ratio of inflammation control, Log MAR visual acuity, mean number of relapses and steroid-sparing effect. Every adverse effect associated with drug use was recorded. Results Control of inflammation was achieved in 92.6% of patients. Visual acuity was improved in 82.9% (29 eyes among 35 eyes) and maintained in 5.7% (2 eyes). The mean number of relapses was decreased from 4.2 (before therapy) to 1.9 (after therapy). Steroid-sparing effect was achieved in 85.2% patients. There was no serious side effect requiring discontinuation of therapy but some adverse reactions were recorded in 22.2% of patients. Conclusions Low-dose methotrexate(5mg/week) is supposed to be able to successfully control chronic noninfectious uveitis and has a steroid-sparing effect. It is also safer because it shows less adverse effects.

Oral Methotrexate Monotherapy for Severe Alopecia Areata: A Single Center Retrospective Case Series

Background Although several therapeutic options have been suggested for alopecia areata (AA), none of them are consistently effective, thus making the management of severe or refractory cases challenging. Several studies have recently reported the usage of methotrexate (MTX) in AA; however, the pure effect of MTX monotherapy remains elusive. Objective To evaluate efficacy and safety of oral methotrexate monotherapy for AA. Methods We retrospectively reviewed the clinical course of AA patients including pediatric cases treated with MTX monotherapy. Their detailed clinical data including original severity of AA, final treatment outcome, the duration until the maximum response, and side effects, were assessed. Statistical analysis was performed to evaluate if the clinical factors including the duration of current alopecia, age, the presence of body hair loss, and sex were associated with treatment response. Results All included patients had severe AA and failed standard therapies. Thirteen out of 15 cases demonstrated improvement during the monotherapy, and all responders demonstrated the maximum response within 1 year. Female patients had significantly better outcomes than male patients. Other factors did not significantly influence on the treatment outcome. None of the patients experienced side effects that were severe enough to terminate the treatment. Conclusions Our results support MTX monotherapy as a feasible option for severe AA patients who fail other standard therapies or for whom systemic corticosteroids are contraindicated.