The wide variety of methotrexate dosing regimens for the treatment of atopic dermatitis: a systematic review.
J Dermatolog Treat
; 35(1): 2292962, 2024 Dec.
Article
in En
| MEDLINE
| ID: mdl-38124505
ABSTRACT
Background:
Methotrexate is an off-label therapy for atopic dermatitis. A lack of consensus on dosing regimens poses a risk of underdosing and ineffective treatment or overdosing and increased risk of side effects. This systematic review summarizes the available evidence on dosing regimens.Materials andmethods:
A literature search was conducted, screening all randomized controlled trials (RCTs) and guidelines published up to 6 July 2023, in the MEDLINE, Embase, and Cochrane Library databases.Results:
Five RCTs and 21 guidelines were included. RCTs compared methotrexate with other treatments rather than different methotrexate dosing regimens. The start and maintenance doses in RCTs varied between 7.5-15 mg/week and 14.5-25 mg/week, respectively. Despite varied dosing, all RCTs demonstrated efficacy in improving atopic dermatitis signs and symptoms. Guidelines exhibited substantial heterogeneity but predominantly proposed starting doses of 5-15 mg/week for adults and 10-15 mg/m2/week for children. Maintenance doses suggested were 7.5-25 mg/week for adults and 0.2-0.7 mg/kg/week for children. One guideline suggested a test dose and nearly half advised folic acid supplementation.Conclusion:
This systematic review highlights the lack of methotrexate dosing guidelines for atopic dermatitis. It identifies commonly recommended and utilized dosing regimens, serving as a valuable resource for clinicians prescribing methotrexate off-label and providing input for an upcoming consensus study.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Methotrexate
/
Dermatitis, Atopic
Type of study:
Systematic_reviews
Limits:
Adult
/
Child
/
Humans
Language:
En
Journal:
J Dermatolog Treat
/
J. derm. treat
/
Journal of dermatological treatment
Journal subject:
DERMATOLOGIA
Year:
2024
Document type:
Article
Affiliation country:
Países Bajos
Country of publication:
Reino Unido