Barak Levitt Jen A, Alemi Sima, Ollech Ayelet, Reiss-Huss Shiran, Sah Mohammad, Renert-Yuval Yael, Friedland Rivka, Greenberger Shoshana, Cohen Barak Eran
Department of Dermatology, Emek Medical Center, Afula 1834111, Israel.
Department of Dermatology, Pediatric Dermatology Service, Sheba Medical Center, Ramat-Gan 5265601, Israel.
J Clin Med. 2023 Aug 20;12(16):5409. doi: 10.3390/jcm12165409.
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.
特应性皮炎（AD）是一种慢性炎症性皮肤病，影响着高达20%的儿童。甲氨蝶呤（MTX）被用于局部治疗无效的AD患者的全身治疗，但关于其在儿童尤其是4岁以下儿童中的安全性和有效性的数据有限。为了进一步研究MTX在较年轻患者中的情况，我们筛查了2016年至2022年间三个转诊中心的病历，确定了28名4岁以下接受MTX治疗的AD婴幼儿。开始使用MTX时的平均年龄为2.7±1.2岁，平均研究者整体评估（IGA）评分为3.78±0.4。MTX治疗的中位持续时间为五个月。在MTX治疗12周和24周后，缓解率分别为50%，达到IGA 0/1的患者分别为14.2%和21.4%。大多数治疗中断归因于缺乏疗效或家长的担忧。尽管57.1%的患者报告了不良事件，但仅两名患者（7.1%）因这些不良事件停用MTX。综上所述，MTX在4岁以下的AD患者中显示出较高的安全性。MTX疗效中等，可能被因担心免疫调节药物而选择过早停止治疗的家长低估了。
