Author: Pauline HoeltPublisher:
ISBN:
Category :
Languages : en
Pages : 42
Book Description
Approximately 55% of adults with atopic dermatitis (AD) present a moderate-to-severe disease. For these patients, phototherapy and systemic anti-inflammatory agents may be considered when topical therapy has failed. Having previously shown the efficacy and the tolerance of methotrexate (MTX) in AD, we wondered whether specific clinical profiles could be predictive of MTX response. This was a retrospective study of a cohort of 49 patients identified with moderate to severe AD in Lyon University Hospital (SCORing Atopic Dermatitis-SCORAD >20 and/or Physician Global Assessment-PGA >3) and treated with MTX. We collected epidemiological, clinical and biological data from the whole cohort. Then, we compared these features between MTX responder and non-responder AD patients. A MTX response was defined when the patient experienced at least 50% reduction of his initial SCORAD (SCORAD 50) and/or reached a PGA score of 2, 1 or 0, meaning a mild, minimal, or no disease. The MTX response was evaluated at 3 and 12 months under treatment and we looked for factors that could be associated with good response. A total of 29 males and 20 females, mean age 41.4 years, was selected. AD was frequently associated with rhinoconjonctivitis and/or asthma, and presented an early-, childhoodor adolescent/adult-onset in respectively, 22, 37 and 29% of patients. Tobacco use was reported in 13/36 patients (36%). AD lesions were mainly diffuse (55%) or localized to head and neck (22%). A total of 32/32 patients exhibited an increased of total IgE level (> 150 kU/L), and among them, 18 patients (60%) showed high total IgE level > 5000 kU/L. Before MTX initiation, 55% of patients had already been treated with systemic therapies (cyclosporine or phototherapy). However, they were scored as very severe with a SCORAD at 55 ± 18.7 and DLQI (Dermatology Lige Quality Index) at 16 ± 6.8. They were also suffering from a long-lasting disease, evolving for approximately 33 years ± 16. Thus, MTX was started at a mean dose of 0,3 mg/kg/week and by subcutaneous route in 69% of patients. Under MTX treatment, 20/42 patients (48%) and 20/28 patients (71%) experienced a therapeutic response after 3 and 12 months with MTX, respectively. Methotrexate was discontinued due to adverse effects in 11 patients (55%). No significant difference was found between the MTX responders and non-responders regarding medical history items and baseline characteristics at MTX initiation (p > 0.05). MTX could be a first-line systemic treatment in association with local treatments, for patients with moderate-to-severe AD, whatever the clinical AD phenotype.
