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Oral methotrexate monotherapy for severe alopecia areata

Photo by Carolyn P Speranza

Researchers in Toronto found that methotrexate (MTX) monotherapy may be a suitable treatment option for patients with severe alopecia areata (AA) who fail other standard therapies or for patients who cannot be treated with corticosteroids.

The study, led by Sunnybrook Health Sciences Centre, and published online ahead of print in the Journal of Cutaneous Medicine and Surgery (March 9, 2021), aimed to evaluate the efficacy and safety of oral MTX monotherapy for the treatment of AA.

“Although several therapeutic options have been suggested for AA, none of them are consistently effective, thus making the management of severe or refractory cases challenging,” the study’s authors wrote. “Several studies have recently reported the usage of methotrexate (MTX) in AA; however, the pure effect of MTX monotherapy remains elusive.”

The investigators retrospectively reviewed the clinical course of AA patients treated with MTX monotherapy, including pediatric. They assessed the detailed clinical data including the original severity of AA, the final treatment outcome, the duration until the maximum response and side effects.

As well, the study’s authors statistically analyzed whether factors including the duration of current alopecia, age, the presence of body hair loss and sex were associated with treatment response.

All patients included in the study had severe AA and failed standard therapies. Thirteen out of 15 cases improved during the monotherapy and all the patients who responded to monotherapy demonstrated the maximum response within one year.

The researchers note that female patients had significantly better outcomes than male patients. Other factors did not significantly influence the treatment outcome. None of the patients experienced side effects that were severe enough to stop treatment.

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