Wenzel J, Brähler S, Bauer R, Bieber T, Tüting T
Department of Dermatology, University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany.
Br J Dermatol. 2005 Jul;153(1):157-62. doi: 10.1111/j.1365-2133.2005.06552.x.
The therapy of cutaneous lupus erythematosus (CLE) is often challenging, especially in patients resistant to topical treatment and established first-line systemic drugs such as antimalarials. Systemic corticosteroids are effective, but their use is limited due to well-known side-effects, especially in long-term treatment. In recent years several other immunosuppressive agents have been successfully applied in CLE. However, there are no large studies or explicit guidelines on the use of these drugs in CLE.
To perform a retrospective investigation of the efficacy of low-dose methotrexate (MTX) in the treatment of CLE.
One hundred and thirty-nine patients with CLE were seen at our department between 2001 and 2003, of whom 43 patients required low-dose MTX. All had histologically confirmed CLE lesions. Clinical data including disease activity, additional treatment, laboratory parameters and side-effects were recorded carefully at the time of presentation. Statistical analyses were performed by paired nonparametric Wilcoxon test and Student's t-test using SPSS 11 software.
MTX led to a highly significant (P < 0.01) decline in disease activity. An improvement of the cutaneous lesions was recorded in nearly all patients treated with MTX (42 of 43; 98%). Severe side-effects necessitating discontinuation of MTX treatment were recorded in seven patients (16%), which quickly resolved when MTX was discontinued. Life-threatening complications were not observed. Intravenous application was tolerated better than oral administration. Interestingly, we observed a significant increase in circulating lymphocyte numbers in patients with lymphopenia (< 1.0 x 10(9) cells L(-1)) prior to MTX treatment.
Our study supports earlier findings reporting the efficacy of low-dose MTX in CLE lesions, particularly in recalcitrant clinical courses. MTX treatment appears to be safe if patients are carefully selected and monitored, with particular attention to side-effects and contraindications.
皮肤红斑狼疮（CLE）的治疗通常具有挑战性，尤其是对于那些对局部治疗以及抗疟药等一线系统性药物耐药的患者。系统性糖皮质激素虽有效，但因其众所周知的副作用，尤其是在长期治疗中，其使用受到限制。近年来，其他几种免疫抑制剂已成功应用于CLE。然而，关于这些药物在CLE中的使用，尚无大型研究或明确的指南。
对低剂量甲氨蝶呤（MTX）治疗CLE的疗效进行回顾性研究。
2001年至2003年间，我们科室共诊治了139例CLE患者，其中43例患者需要低剂量MTX治疗。所有患者均经组织学确诊为CLE病变。在就诊时仔细记录临床数据，包括疾病活动度、额外治疗、实验室参数和副作用。使用SPSS 11软件通过配对非参数Wilcoxon检验和Student's t检验进行统计分析。
MTX导致疾病活动度显著下降（P < 0.01）。几乎所有接受MTX治疗的患者（43例中的42例；98%）皮肤病变均有改善。7例患者（16%）出现严重副作用，需要停用MTX治疗，停用MTX后副作用迅速缓解。未观察到危及生命的并发症。静脉应用比口服耐受性更好。有趣的是，我们观察到MTX治疗前淋巴细胞减少（< 1.0×10⁹个细胞/L⁻¹）的患者循环淋巴细胞数量显著增加。
我们的研究支持了早期关于低剂量MTX对CLE病变疗效的报道，尤其是在难治性临床病程中。如果仔细选择和监测患者，特别注意副作用和禁忌证，MTX治疗似乎是安全的。
