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Caron AGM, Bloem M, El Khattabi H, de Waal AC, van Huizen AM, Denswil NP, Gerbens LAA, Spuls PI. The wide variety of methotrexate dosing regimens for the treatment of atopic dermatitis: a systematic review. J DERMATOL TREAT 2024; 35:2292962. [PMID: 38124505 DOI: 10.1080/09546634.2023.2292962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
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 and methods: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.
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Affiliation(s)
- Anouk G M Caron
- Dermatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, the Netherlands
| | - Manja Bloem
- Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Hajar El Khattabi
- Dermatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Ayla C de Waal
- Dermatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Astrid M van Huizen
- Dermatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, the Netherlands
| | - Nerissa P Denswil
- Medical Library, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Louise A A Gerbens
- Dermatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, the Netherlands
| | - Phyllis I Spuls
- Dermatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, the Netherlands
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Erduran F, Emre S, Hayran Y, Adışen E, Polat AK, Üstüner P, Öztürkcan S, Öztürk P, Ermertcan AT, Selçuk LB, Aksu EK, Akbaş A, Kalkan G, Demirseren D, Kartal SP, Topkarcı Z, Kılıç A, Yaldız M, Aytekin S, Hızlı P, Gharehdaghi S, Borlu M, Işık L, Botsalı BR, Solak EÖ, Albayrak H, Gönülal M, Balcı DD, Polat M, Daye M, Ataseven A, Yıldız S, Özer İ, Zorlu Ö, Doğan S, Erdemir VA, Dikicier BS. Analysis of factors influencing target PASI responses and side effects of methotrexate monotherapy in plaque psoriasis: a multicenter study of 1521 patients. Arch Dermatol Res 2024; 316:278. [PMID: 38796658 DOI: 10.1007/s00403-024-03066-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 01/06/2024] [Accepted: 04/26/2024] [Indexed: 05/28/2024]
Abstract
Methotrexate (MTX) is commonly used as first-line systemic treatment agent in psoriasis. We aimed to evaluate the clinical characteristics and treatment responses of patients with psoriasis undergoing MTX monotherapy. Data from adult patients with plaque psoriasis who received MTX monotherapy for at least 3 months between April 2012 and April 2022 were retrospectively evaluated in 19 tertiary care centers. Our study included 722 female and 799 male patients, a total of 1521 participants. The average age of the patients was 44.3 ± 15.5 years. Mode of treatment was oral in 20.4% of patients while in 79.4% it was subcutaneous. The median treatment duration was 8 months (IQR = 5-15). The median weekly dose was 15 mg (IQR = 11-15). 1448 (95.2%) patients were taking folic acid supplementation. At week 12, 16.3% of the patients achieved PASI (Psoriasis Area and Severity Index) 90 response while at week 24, 37.3% achieved it. Logistic regression analysis for week 12 identified the following independent factors affecting PASI 90 achievement positively: median weekly MTX dose ≤ 15 mg (P = 0.011), subcutaneous administration (P = 0.005), no prior systemic treatment (< 0.001) and folic acid use (0.021). In logistic regression analysis for week 24; median weekly MTX dose ≤ 15 mg (P = 0.001), baseline PASI ≥ 10 (P < 0.001), no prior systemic treatment (P < 0.004), folic acid use (P = 0.001) and absence of comorbidities (P = 0.009) were determined as independent factors affecting the achievement of PASI 90. Adverse effects were observed in 38.8% of the patients, with nausea/vomiting (23.9%) and transaminase elevation (13%) being the most common. The most common reasons for interruptions (15.3%) and discontinuations (27.1%) of the treatment were patient related individual factors. The use of MTX as the first systemic treatment agent, at doses ≤ 15 mg/week and concurrent folic acid application are positive predictive factors for achieving the target PASI response both at weeks 12 and 24. In our study, which is one of the most comprehensive studies on MTX treatment in psoriasis, we observed that MTX is an effective and safe treatment option.
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Affiliation(s)
- Funda Erduran
- Department of Dermatology TR, Ankara Bilkent City Hospital, Ankara, Türkiye.
| | - Selma Emre
- Department of Dermatology TR, Ankara Yıldırım Beyazıt University, Ankara, Türkiye
| | - Yıldız Hayran
- Department of Dermatology TR, Ankara Bilkent City Hospital, Ankara, Türkiye
| | - Esra Adışen
- Faculty of Medicine, Department of Dermatology TR, Gazi University, Ankara, Türkiye
| | - Asude Kara Polat
- Department of Dermatology TR, İstanbul Training and Research Hospital, İstanbul, Türkiye
| | - Pelin Üstüner
- Department of Dermatology TR, Nişantaşı University, İstanbul, Türkiye
| | - Serap Öztürkcan
- Department of Dermatology TR, Manisa Celal Bayar University, Manisa, Türkiye
| | - Perihan Öztürk
- Department of Dermatology TR, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Türkiye
| | | | - Leyla Baykal Selçuk
- Department of Dermatology TR, Karadeniz Technical University, Trabzon, Türkiye
| | - Esra Koku Aksu
- Department of Dermatology TR, İstanbul Training and Research Hospital, İstanbul, Türkiye
| | - Ayşe Akbaş
- Department of Dermatology TR, Ankara Bilkent City Hospital, Ankara, Türkiye
| | - Göknur Kalkan
- Department of Dermatology TR, Ankara Yıldırım Beyazıt University, Ankara, Türkiye
| | - Deniz Demirseren
- Department of Dermatology TR, Ankara Bilkent City Hospital, Ankara, Türkiye
| | | | - Zeynep Topkarcı
- Department of Dermatology TR, İstanbul Bakırköy Dr. Sadi Konuk Training and Reseach Hospital, İstanbul, Türkiye
| | - Arzu Kılıç
- Department of Dermatology TR, Balıkesir University, Balıkesir, Türkiye
| | - Mahizer Yaldız
- Department of Dermatology TR, Sakarya Training and Research Hospital, Sakarya, Türkiye
| | - Sema Aytekin
- Department of Dermatology TR, Tekirdağ Namık Kemal University, Tekirdağ, Türkiye
| | - Pelin Hızlı
- Department of Dermatology TR, Balıkesir University, Balıkesir, Türkiye
| | - Sheyda Gharehdaghi
- Faculty of Medicine, Department of Dermatology TR, Gazi University, Ankara, Türkiye
| | - Murat Borlu
- Department of Dermatology TR, Kayseri Erciyes University, Kayseri, Türkiye
| | - Lütfi Işık
- Department of Dermatology TR, Etlik City Hospital, Ankara, Türkiye
| | | | - Eda Öksüm Solak
- Department of Dermatology TR, Kayseri Erciyes University, Kayseri, Türkiye
| | - Hülya Albayrak
- Department of Dermatology TR, Tekirdağ Namık Kemal University, Tekirdağ, Türkiye
| | - Melis Gönülal
- Department of Dermatology TR, İzmir City Hospital, İzmir, Türkiye
| | | | - Mualla Polat
- Department of Dermatology TR, Abant İzzet Baysal University, Bolu, Türkiye
| | - Munise Daye
- Department of Dermatology TR, Necmettin Erbakan University, Konya, Türkiye
| | - Arzu Ataseven
- Department of Dermatology TR, Necmettin Erbakan University, Konya, Türkiye
| | - Sibel Yıldız
- Department of Dermatology TR, Necmettin Erbakan University, Konya, Türkiye
| | - İlkay Özer
- Department of Dermatology TR, Necmettin Erbakan University, Konya, Türkiye
| | - Özge Zorlu
- Department of Dermatology TR, Tekirdağ Namık Kemal University, Tekirdağ, Türkiye
| | - Sinan Doğan
- Department of Dermatology TR, Bakırçay University, İzmir Çiğli Training and Research Hospital, İzmir, Türkiye
| | - Vefa Aslı Erdemir
- Department of Dermatology TR, İstanbul Medeniyet University, İstanbul, Türkiye
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Chen H, Su Z, Pan X, Zheng X, Li H, Ye Z, Tang B, Lu Y, Zheng G, Lu C. Phytochemicals: Targeting autophagy to treat psoriasis. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2023; 120:155041. [PMID: 37678054 DOI: 10.1016/j.phymed.2023.155041] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/18/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Psoriasis is an immune-mediated chronic inflammatory skin disease characterized by well-defined erythema and white scales, which affects approximately 2% of the worldwide population and causes long-term distress to patients. Therefore, development of safe and effective therapeutic drugs is imminent. Autophagy, an evolutionarily conserved catabolic process, degrades intracellular constituents to maintain cellular energy homeostasis. Numerous studies have revealed that autophagy is closely related to immune function, such as removal of intracellular bacteria, inflammatory cytokine secretion, antigen presentation, and lymphocyte development. Phytochemicals derived from natural plants are often used to treat psoriasis due to their unique therapeutic properties and favorable safety. So far, a mass of phytochemicals have been proven to be able to activate autophagy and thus alleviate psoriasis. This review aimed to provide directions for finding phytochemicals that target autophagy to treat psoriasis. METHODS The relevant literatures were collected from classical TCM books and a variety of databases (PubMed, Google Scholar, ScienceDirect, Springer Link, Web of Science and China National Knowledge Infrastructure) till December 2022. Search terms were "Phytochemical", "Psoriasis" and "Autophagy". The retrieved data followed PRISMA criteria (preferred reporting items for systematic review). RESULTS Phytochemicals treat psoriasis mainly through regulating immune cell function, inhibiting excessive inflammatory response, and reducing oxidative stress. While the role and mechanism of autophagy in the pathogenesis of psoriasis have been confirmed in human trials, most of the evidence for phytochemicals that target autophagy to treat psoriasis comes from animal studies. The research focusing on the role of phytochemical-mediated autophagy in the prevention and treatment of psoriasis is limited, and the definite relationship between phytochemical-regulated autophagy and treatment of psoriasis still deserves further experimental confirmation. CONCLUSIONS Phytochemicals with autophagic activities will provide new insights into the therapeutic intervention for psoriasis.
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Affiliation(s)
- Haiming Chen
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China; Department of Pharmacology of Traditional Chinese Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China; Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Zuqing Su
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China; Department of Pharmacology of Traditional Chinese Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China; Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Xin Pan
- Department of Pharmacology of Traditional Chinese Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Xuwei Zheng
- Department of Pharmacology of Traditional Chinese Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Hongxia Li
- Department of Pharmacology of Traditional Chinese Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Zeting Ye
- Department of Pharmacology of Traditional Chinese Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Bin Tang
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China; Department of Pharmacology of Traditional Chinese Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China; Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Yue Lu
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China; Department of Pharmacology of Traditional Chinese Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China; Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Guangjuan Zheng
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China; Department of Pharmacology of Traditional Chinese Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China; Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China.
| | - Chuanjian Lu
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China; Department of Pharmacology of Traditional Chinese Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China; Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China.
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