Low-Dose Systemic Methotrexate Therapy for Recalcitrant Alopecia Areata
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초록
Background: Alopecia areata (AA) is an autoimmune skin disease difficult to manage and treat. The pathogenesis of AA features a T-cell-associated autoimmune process, and systemic immunosuppressive therapy is prescribed widely for AA. Objective: To evaluate the efficacy and tolerance of systemic low-dose methotrexate (LD-MTX) therapy in treatment of recalcitrant AA multiplex. Methods: In a retrospective, non-controlled study, we evaluated 29 patients with recalcitrant AA treated with LD-MTX and assessed the therapeutic response according to severity of disease, disease duration, cumulative dose of MTX, and drug safety. Results: MTX was administered twice weekly, and the mean maximum weekly dose was 14.48 mg. The response was A5 (regrowth=100.0%) in 14 (48.3%) patients and A4 (regrowth of 75%∼90%) in 12 (41.4%) patients. Three patients had poor response to LD-MTX treatment (A2: n=2 [6.9%], A1: n=1 [3.4%]). All three of the patients showing a poor response had disease durations exceeding 24 months. Relapse was observed in 31% of patients with more than 75% regrowth. Common side-effects were elevated liver enzyme levels and gastrointestinal discomfort. Conclusion: LD-MTX appears to be an effective and well-tolerated treatment for recalcitrant AA multiplex.
Abstract
Background: Alopecia areata (AA) is an autoimmune skin disease difficult to manage and treat. The pathogenesis of AA features a T-cell-associated autoimmune process, and systemic immunosuppressive therapy is prescribed widely for AA. Objective: To evaluate the efficacy and tolerance of systemic low-dose methotrexate (LD-MTX) therapy in treatment of recalcitrant AA multiplex. Methods: In a retrospective, non-controlled study, we evaluated 29 patients with recalcitrant AA treated with LD-MTX and assessed the therapeutic response according to severity of disease, disease duration, cumulative dose of MTX, and drug safety. Results: MTX was administered twice weekly, and the mean maximum weekly dose was 14.48 mg. The response was A5 (regrowth=100.0%) in 14 (48.3%) patients and A4 (regrowth of 75%∼90%) in 12 (41.4%) patients. Three patients had poor response to LD-MTX treatment (A2: n=2 [6.9%], A1: n=1 [3.4%]). All three of the patients showing a poor response had disease durations exceeding 24 months. Relapse was observed in 31% of patients with more than 75% regrowth. Common side-effects were elevated liver enzyme levels and gastrointestinal discomfort. Conclusion: LD-MTX appears to be an effective and well-tolerated treatment for recalcitrant AA multiplex.
참고문헌 (19)
- Safavi K, "Prevalence of alopecia areata in the first national health and nutrition examination survey", Arch Dermatol, 128, pp.702~ (1992)
- Chang KH, "Treatment of severe alopecia areata with intralesional steroid injections", J Drugs Dermatol, 8, pp.909~912 (2009)
- Kar BR, "Placebo-controlled oral pulse prednisolone therapy in alopecia areata", J Am Acad Dermatol, 52, pp.287~290 (2005)
- Luggen P, "High-dose intravenous corticosteroid pulse therapy in alopecia areata: own experience compared with the literature", J Dtsch Dermatol Ges, 6, pp.375~378 (2008)
- Goddard CJ, "Alopecia totalis in a patient with Crohn's disease and its treatment with azathioprine", Postgrad Med J, 65, pp.188~189 (1989)
- Farshi S, "Could azathioprine be considered as a therapeutic alternative in the treatment of alopecia areata? A pilot study", Int J Dermatol, 49, pp.1188~1193 (2010)
- Açıkgöz G, "The effect of oral cyclosporine in the treatment of severe alopecia areata", Cutan Ocul Toxicol, 33, pp.247~252 (2014)
- Cipriani P, "Methotrexate: an old new drug in autoimmune disease", Expert Rev Clin Immunol, 10, pp.1519~1530 (2014)
- Haustein UF, "Methotrexate in psoriasis: 26 years'experience with low-dose long-term treatment", J Eur Acad Dermatol Venereol, 14, pp.382~388 (2000)
- Spring P, "Prurigo nodularis:retrospective study of 13 cases managed with methotrexate", Clin Exp Dermatol, 39, pp.468~473 (2014)
- Olsen EA, "Alopecia areata investigational assessment guidelines--part II. national alopecia areata foundation", J Am Acad Dermatol, 51, pp.440~447 (2004)
- Royer M, "Efficacy and tolerability of methotrexate in severe childhood alopecia areata", Br J Dermatol, 165, pp.407~410 (2011)
- Chartaux E, "Long-term follow-up of the efficacy of methotrexate alone or in combination with low doses of oral corticosteroids in the treatment of alopecia areata totalis or universalis", Ann Dermatol Venereol, 137, pp.507~513 (2010)
- Droitcourt C, "Interest of high-dose pulse corticosteroid therapy combined with methotrexate for severe alopecia areata: a retrospective case series", Dermatology, 224, pp.369~373 (2012)
- Kurosawa M, "A comparison of the efficacy, relapse rate and side effects among three modalities of systemic corticosteroid therapy for alopecia areata", Dermatology, 212, pp.361~365 (2006)
- Joly P, "The use of methotrexate alone or in combination with low doses of oral corticosteroids in the treatment of alopecia totalis or universalis", J Am Acad Dermatol, 55, pp.632~636 (2006)
- 여인권, "Comparison of High-Dose Corticosteroid Pulse Therapy and Combination Therapy Using Oral Cyclosporine with Low-Dose Corticosteroid in Severe Alopecia Areata", Annals of Dermatology, 27(6), pp.676~681 (2015), 대한피부과학회
- Friedland R, "Pulse corticosteroid therapy for alopecia areata in children:a retrospective study", Dermatology, 227, pp.37~44 (2013)
- Hammerschmidt M, "Efficacy and safety of methotrexate in alopecia areata", An Bras Dermatol, 89, pp.729~734 (2014)