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Methotrexate, cyclosporine effectively treated severe childhood atopic dermatitis

Low doses of methotrexate or cyclosporine were each effective, relatively safe and well tolerated as treatment for severe atopic dermatitis in children, according to study results.

Researchers in Egypt studied 40 children (26 boys) with severe atopic dermatitis (AD; mean disease duration, 6.80 years) who were randomly divided into two 20-patient treatment groups. One group (mean age, 11.6 years; 12 boys) was assigned 7.5 mg methotrexate (MTX) weekly; the other cohort (mean age, 10.3 years; 14 boys) was assigned 2.5 mg/kg per day of cyclosporine. Treatment efficacy was indicated by severity scoring for atopic dermatitis (SCORAD) at initiation, 4, 8 and 12 weeks when treatment ended.

In the MTX cohort, mean SCORAD was 57.90 at treatment start and was reduced to 29.35 at 12 weeks, with a mean absolute reduction of 26.25. Mean SCORAD at treatment start for the cyclosporine cohort was 56.54, which decreased to 31.35 at 12 weeks; mean absolute reduction was 25.02. At 24-week follow-up, mean absolute reduction was 24.90 in the MTX group and 21.01 in the cyclosporine group. Reduction in SCORAD showed no statistically significant differences between groups when treatment ended (P=.93) or at the conclusion of follow-up (P=.29).

Mild, temporary adverse events were reported by both cohorts. Patients assigned MTX experienced anemia (30%), fatigue (30%), abnormal liver function (25%), nausea and vomiting (20%) and glossitis with oral ulceration (20%). The cyclosporine treatment group’s complications included fatigue (45%), leukopenia (35%), headache (25%), anemia (20%) and flu-like symptoms (20%).

“Cyclosporine has the advantage of inducing a rapid response while methotrexate has the benefit of longer-lasting effect,” the researchers concluded.

“The low cost, easy administration and high safety of methotrexate may play a significant role in increasing the usage of the drug as an alternative method in the treatment of severe childhood AD.”