Comparison of efficacy of methotrexate and azathioprine in chronic resistant atopic eczema
Keywords:
eczema, atopic dermatitis, chronic ecezmaAbstract
Background Atopic dermatitis is a common dermatological problem in children and adults. It is associated with poor quality of life, significant financial burdens, and poor mental health. There are many topical and systemic treatment modalities for chronic atopic eczema. Systemic treatment like Methotrexate and azathioprine is indicated in chronic atopic eczema patients resistant to topical steroids. Objective To assess the efficiency of methotrexate versus azathioprine in chronic resistant eczema. Methods This study was conducted in the Department of Dermatology in Nishtar Hospital, Multan from January 2012 to July 2012. 270 patients with clinically resistant atopic eczema were included and detailed history and examinations were done. 135 patients were given weekly oral methotrexate and 135 were given oral azathioprine weekly. Patients were followed up for 12 weeks. All data were recorded in a predesigned proforma. Results MTX treated group showed statistically significant better efficacy of (51%) when compared to AZA (36%) at 12 weeks. Conclusion Methotrexate is more efficacious compared to azathioprine for the treatment of patients with chronic resistant atopic eczema.References
Lee JH, Yun SJ, Lee JB, Lee SC. Therapeutic Efficacy and Safety of Methotrexate in Moderate-to-Severe Atopic Dermatitis: A Retrospective Study of Korean Patients at Tertiary Referral Hospital. Ann Dermatol. 2020 Oct;32(5):402-408.10.5021/ad.2020.32.5.402
Johansson SG, Bieber T, Dahl R, et al.: Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol. 2004 May;113(5):832-6.10.1016/j.jaci.2003.12.591
Flohr C, Mann J. New insights into the epidemiology of childhood atopic dermatitis. Allergy. 2014 Jan;69(1):3-16.10.1111/all.12270
Mortimer K, Lesosky M, García-Marcos L, et al.: Global Asthma Network Phase I Study Group. The burden of asthma, hay fever and eczema in adults in 17 countries: GAN Phase I study. Eur Respir J. 2022 Sep 15;60(3):2102865.10.1183/13993003.02865-2021.
Blome C, Radtke MA, Eissing L, Augustin M. Quality of Life in Patients with Atopic Dermatitis: Disease Burden, Measurement, and Treatment Benefit. Am J Clin Dermatol. 2016 Apr;17(2):163-9. 10.1007/s40257-015-0171-3
Simpson EL. Atopic dermatitis: a review of topical treatment options. Curr Med Res Opin. 2010 Mar;26(3):633-40.10.1185/03007990903512156
Wollenberg A, Kinberger M, Arents B, et al.: European guideline (EuroGuiDerm) on atopic eczema: part I - systemic therapy. J Eur Acad Dermatol Venereol. 2022 Sep;36(9):1409-1431.10.1111/jdv.18345
Gerbens LAA, Hamann SAS, Brouwer MWD, Roekevisch E, Leeflang MMG, Spuls PI. Methotrexate and azathioprine for severe atopic dermatitis: a 5-year follow-up study of a randomized controlled trial. Br J Dermatol. 2018 Jun;178(6):1288-1296.10.1111/bjd.16240
Shen S, O'Brien T, Yap LM, Prince HM, McCormack CJ. The use of methotrexate in dermatology: a review. Australas J Dermatol. 2012 Feb;53(1):1-18.10.1111/j.1440-0960.2011.00839.x
Schram ME, Roekevisch E, Leeflang MM, Bos JD, Schmitt J, Spuls PI. A randomized trial of methotrexate versus azathioprine for severe atopic eczema. J Allergy Clin Immunol. 2011 Aug;128(2):353-9.10.1016/j.jaci.2011.03.024
Weatherhead SC, Wahie S, Reynolds NJ, Meggitt SJ. An open-label, dose-ranging study of methotrexate for moderate-to-severe adult atopic eczema. Br J Dermatol. 2007 Feb;156(2):346-51.10.1111/j.1365-2133.2006.07686.x
Zoller L, Ramon M, Bergman R. Low dose methotrexate therapy is effective in late-onset atopic dermatitis and idiopathic eczema. Isr Med Assoc J. 2008 Jun;10(6):413-4. https://pubmed.ncbi.nlm.nih.gov/18669134/.
Hughes R, Collins P, Rogers S. Further experience of using azathioprine in the treatment of severe atopic dermatitis. Clin Exp Dermatol. 2008 Nov;33(6):710-1.10.1111/j.1365-2230.2008.02832.x
Meggitt SJ, Gray JC, Reynolds NJ. Azathioprine dosed by thiopurine methyltransferase activity for moderate-to-severe atopic eczema: a double-blind, randomised controlled trial. Lancet. 2006 Mar 11;367(9513):839-46.10.1016/S0140-6736(06)68340-2
Bracho-Borro M, Franco-Ruiz PA, Magaña M. The use of azathioprine in atopic dermatitis: A review. Dermatol Ther. 2022 Sep;35(9):e15665.10.1111/dth.15665
Drucker AM, Ellis AG, Bohdanowicz M, et al.: Systemic Immunomodulatory Treatments for Patients With Atopic Dermatitis: A Systematic Review and Network Meta-analysis. JAMA Dermatol. 2020 Jun 1;156(6):659-667.10.1001/jamadermatol.2020.0796
Mortz CG, Andersen KE, Dellgren C, Barington T, Bindslev-Jensen C. Atopic dermatitis from adolescence to adulthood in the TOACS cohort: prevalence, persistence and comorbidities. Allergy. 2015 Jul;70(7):836-45.10.1111/all.12619
Liu W, Cai J, Sun C, Zou Z, Zhang J, Huang C. Time-trends for eczema prevalences among children and adults from 1985 to 2015 in China: a systematic review. BMC Public Health. 2022 Jul 5;22(1):1294.10.1186/s12889-022-13650-7
Goujon C, Viguier M, Staumont-Sallé D, et al.: Methotrexate Versus Cyclosporine in Adults with Moderate-to-Severe Atopic Dermatitis: A Phase III Randomized Noninferiority Trial. J Allergy Clin Immunol Pract. 2018 Mar-Apr;6(2):562-569.e3.10.1016/j.jaip.2017.07.007
Shaffrali FC, Colver GB, Messenger AG, Gawkrodger DJ. Experience with low-dose methotrexate for the treatment of eczema in the elderly. J Am Acad Dermatol. 2003 Mar;48(3):417-9.10.1067/mjd.2003.137
Shah N, Alhusayen R, Walsh S, Shear NH. Methotrexate in the Treatment of Moderate to Severe Atopic Dermatitis: A Retrospective Study. J Cutan Med Surg. 2018 Sep/Oct;22(5):484-487.10.1177/1203475418781336
Syed AR, Aman S, Nadeem M, Kazmi AH. The efficacy and safety of oral methotrexate in chronic eczema. J Pak Assoc Dermatol. https://www.jpad.com.pk/index.php/jpad/article/view/549
Berth-Jones J, Takwale A, Tan E, et al.: Azathioprine in severe adult atopic dermatitis: a double-blind, placebo-controlled, crossover trial. Br J Dermatol. 2002 Aug;147(2):324-30.10.1046/j.1365-2133.2002.04989.x
