Methotrexate and azathioprine may be equally effective in treating severe atopic eczema in adults, according to a critical appraisal of a study published in the April issue of the British Journal of Dermatology.
Mandy Elvira Schram, M.D., of the University of Amsterdam, and colleagues randomly assigned (in a 1:1 ratio) 42 patients with severe atopic eczema to receive either methotrexate (10 to 22.5 mg weekly) or azathioprine (1.5 to 2.5 mg/kg−1 daily) for 12 weeks, followed by a 12-week follow-up period. Eczema severity was measured using various tools, including the SCORing of Atopic Dermatitis index (SCORAD).
The researchers found that, at week 12, patients in the methotrexate group had a relative reduction in SCORAD of 42 ± 18 percent compared with 39 ± 25 percent in the azathioprine group. Proportions of patients achieving at least mild disease and reductions in impact on quality of life and symptoms were similar in both groups at weeks 12 and 24. No statistically significant differences were observed in the number and severity of adverse events. Abnormalities in blood count were more common in the azathioprine group but no serious adverse events were reported in either group.
"Both methotrexate and azathioprine achieved clinically relevant improvement and were safe in the short term," the authors write.
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