Affiliation:
1. Department of Rheumatology, Second Affiliated Hospital, College of Medicine Zhejiang University Hangzhou China
2. Department of Endocrinology, Fourth Affiliated Hospital, College of Medicine Zhejiang University Yiwu China
Abstract
AbstractOf the 15 eligible studies identified via electronic searches in MEDLINE, EMBASE and CENTRAL in November 2022 for methotrexate therapy of moderate‐to‐severe atopic dermatitis, 12 were non‐randomized controlled trial (non‐RCT) studies with data from 437 patients (235 adults and 202 children). The response rates for short‐term therapy were 77% [95% CI 55‐99] (four studies; adults) – comparable to 81% [54‐100] of RCTs (two studies; adults) (p = 0.63) – and 61% [43‐79] (two studies; children), and for medium/long‐term therapy were 88.9% [74.3‐100.0] (four studies; adults) and 77.7% [61.5–94.0] (three studies; children). Children had a markedly lower rate of treatment discontinuation due to side effects [2.0% (five studies; children) vs. 14.9% (six studies; adults)], but were more likely to experience gastrointestinal disorders {relative risk (RR) 2.0 [1.44‐2.71]}, fatigue (RR 2.3 [1.35‐3.72]), headache (RR 2.8 [1.23‐5.61]), and infections (RR 2.9 [2.18‐3.58]). Other adverse events (children vs. adults) included hepatic disorders (32/176 vs. 35/305) and blood and lymphatic system/bone marrow disorders (25/148 vs. 19/184). Four serious adverse events were reported (children). Evidence from daily practice was limited by bias in the selection of participants in the study.