低剂量甲氨蝶呤治疗泛发性及顽固性扁平苔藓的疗效与安全性：一项三级医疗中心的回顾性研究

Efficacy And Safety Of Low-Dose Methotrexate In Generalized And Recalcitrant Lichen Planus: A Retrospective Study At A Tertiary Care Center.

作者信息

Khurana Ananta, Sharath Savitha, Sardana Kabir

机构信息

Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, Delhi, India.

出版信息

Dermatol Pract Concept. 2024 Oct 30;14(4):e2024220. doi: 10.5826/dpc.1404a220.

DOI:10.5826/dpc.1404a220

PMID:39652930

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11619939/

Abstract

INTRODUCTION

Methotrexate (MTX) acts by suppressing multiple immune pathways involved in the pathogenesis of lichen planus (LP). Trials assessing the efficacy and relapse rates of methotrexate in LP are lacking.

OBJECTIVES

Our objective was to analyze the efficacy and safety of low-dose methotrexate in generalized and recalcitrant LP patients retrospectively and to assess the relapse rates in patients after stopping MTX therapy.

METHODS

We analyzed clinical and therapeutic details of LP patients treated with low-dose MTX at our center. The cumulative dose and duration of MTX was calculated, and the time to achieve disease control was noted. We analyzed duration of remission and time after which recurrences were seen post-treatment.

RESULTS

Records of 42 generalized and recalcitrant LP patients treated with MTX were analyzed. The starting dose of MTX was 7.5 mg (n=7) or 10 mg (n= 35) once weekly, increased to 10/15 mg weekly in patients with inadequate response. Ten patients were lost to follow-up. Complete resolution was achieved in 30/32 (93%) patients within a mean duration of 14.76 weeks (4-32 weeks), and the cumulative dose of MTX to achieve remission was 153.58 mg (50-375 mg). Only minor side effects were noted in 12/32 (37.5%) patients, and none required treatment discontinuation. The mean duration of remission was 29.43 months (5-60 months).

CONCLUSION

MTX demonstrated high efficacy and a good safety profile in extensive cutaneous LP and may be a safer alternative to steroids for this condition.

摘要

引言

甲氨蝶呤（MTX）通过抑制扁平苔藓（LP）发病机制中涉及的多种免疫途径发挥作用。目前缺乏评估甲氨蝶呤在LP中的疗效和复发率的试验。

目的

我们的目的是回顾性分析低剂量甲氨蝶呤在泛发性和顽固性LP患者中的疗效和安全性，并评估停用MTX治疗后患者的复发率。

方法

我们分析了在我们中心接受低剂量MTX治疗的LP患者的临床和治疗细节。计算MTX的累积剂量和疗程，并记录达到疾病控制的时间。我们分析了缓解期的持续时间以及治疗后复发的时间。

结果

分析了42例接受MTX治疗的泛发性和顽固性LP患者的记录。MTX的起始剂量为每周一次7.5mg（n = 7）或10mg（n = 35），对反应不足的患者增加至每周10/15mg。10例患者失访。30/32（93%）例患者在平均14.76周（4 - 32周）内完全缓解，达到缓解的MTX累积剂量为153.58mg（50 - 375mg）。12/32（37.5%）例患者仅出现轻微副作用，无一例需要停药。平均缓解期为29.43个月（5 - 60个月）。