A randomized trial of methotrexate versus azathioprine for severe atopic eczema

Journal of Allergy and Clinical Immunology

Volumn 128, Issue 2, 2011, Pages 353-359

  Schram, Mandy Elvira ^a   Roekevisch, Evelien ^a   Leeflang, Mariska Maria Geertruida ^a   Bos, Jan Dositheus ^a   Schmitt, Jochen ^b   Spuls, Phyllis Ira ^a  

^a UNIVERSITY OF AMSTERDAM   (Netherlands)

^b UNIVERSITY HOSPITAL CARL GUSTAV CARUS   (Germany)

Author keywords

atopic dermatitis; Atopic eczema; azathioprine; methotrexate; off label; trial

Indexed keywords

AZATHIOPRINE; METHOTREXATE; THYMUS AND ACTIVATION REGULATED CHEMOKINE;

ADULT; ANEMIA; ARTICLE; ATOPIC DERMATITIS; CLINICAL ARTICLE; COMMON COLD; CONTROLLED STUDY; DISEASE SEVERITY; DRUG DOSE INCREASE; DRUG EFFICACY; DRUG SAFETY; DRUG WITHDRAWAL; FEMALE; FOLLOW UP; GASTROINTESTINAL TOXICITY; HUMAN; LYMPHOCYTOPENIA; MALE; NAUSEA; PRIORITY JOURNAL; QUALITY OF LIFE; RANDOMIZED CONTROLLED TRIAL; SIDE EFFECT; SINGLE BLIND PROCEDURE; SKIN INFECTION; TREATMENT OUTCOME; UPPER RESPIRATORY TRACT INFECTION; VOMITING;

ADULT; AZATHIOPRINE; DERMATITIS, ATOPIC; FEMALE; HUMANS; IMMUNOSUPPRESSIVE AGENTS; MALE; METHOTREXATE; MIDDLE AGED; QUALITY OF LIFE; SEVERITY OF ILLNESS INDEX; TREATMENT OUTCOME;

EID: 79961006747     PISSN: 00916749     EISSN: 10976825     Source Type: Journal    
DOI: 10.1016/j.jaci.2011.03.024     Document Type: Article

References (28)

1. Williams H, Robertson C, Stewart A, it-Khaled N, Anabwani G, Anderson R, et al. Worldwide varia;tions in the prevalence of symptoms of atopic eczema in the International Study of Asthma and Allergies in Childhood. J Allergy Clin Immunol 1999;103:125-38. (Pubitemid 29063202)
2. Schmitt J, Romanos M, Pfennig A, Leopold K, Meurer M. Psychiatric comorbidity in adult eczema. Br J Dermatol 2009;161:878-83.
3. Schmitt J, Schmitt N, Meurer M. Cyclosporin in the treatment of patients with atopic eczema - a systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2007;21:606-19. (Pubitemid 46916758)
4. Behnam SM, Behnam SE, Koo JY. Review of cyclosporine immunosuppressive safety data in dermatology patients after two decades of use. J Drugs Dermatol 2005;4:189-94.
5. Schmitt J, Schakel K, Schmitt N, Meurer M. Systemic treatment of severe atopic eczema: a systematic review. Acta Derm Venereol 2007;87:100-11. (Pubitemid 46521989)
6. Schmitt J, Schakel K, Folster-Holst R, Bauer A, Oertel R, Augustin M, et al. Prednisolone vs. ciclosporin for severe adult eczema. An investigator-initiated double-blind placebo-controlled multicentre trial. Br J Dermatol 2010;162:661-8.
7. 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;156:346-51. (Pubitemid 46095964)
8. 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;10: 413-4.
9. Goujon C, Berard F, Dahel K, Guillot I, Hennino A, Nosbaum A, et al. Methotrexate for the treatment of adult atopic dermatitis. Eur J Dermatol 2006;16: 155-8.
10. Shaffrali FC, Colver GB, Messenger AG, Gawkrodger DJ. Experience with lowdose methotrexate for the treatment of eczema in the elderly. J Am Acad Dermatol 2003;48:417-9. (Pubitemid 36337078)
11. Berth-Jones J, Takwale A, Tan E, Barclay G, Agarwal S, Ahmed I, et al. Azathioprine in severe adult atopic dermatitis: a double-blind, placebo-controlled, crossover trial. Br J Dermatol 2002;147:324-30.
12. 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;367:839-46. (Pubitemid 43363371)
13. Schram ME, Borgonjen RJ, Bik CJMJ, van der Schroeff JG, van Everdingen JJE, Spuls PhI. Off-label use of azathioprine in dermatology: a systematic review. Arch Dermatol 2011;147:474-88.
14. Brenninkmeijer EE, Schram ME, Leeflang MM, Bos JD, Spuls PhI. Diagnostic criteria for atopic dermatitis: a systematic review. Br J Dermatol 2008;158:754-65. (Pubitemid 351415721)
15. Rajka G, Langeland T. Grading of the severity of atopic dermatitis. Acta Derm Venereol Suppl (Stockh) 1989;144:13-4. (Pubitemid 19228703)
16. Hoekstra M, van Ede AE, Haagsma CJ, van de Laar MA, Huizinga TW, Kruijsen MW, et al. Factors associated with toxicity, final dose, and efficacy of methotrexate in patients with rheumatoid arthritis. Ann Rheum Dis 2003;62:423-6. (Pubitemid 36469732)
17. Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology 1993;186:23-31.
18. Oranje AP, Glazenburg EJ, Wolkerstorfer A, de Waard-van der Spek FB. Practical issues on interpretation of scoring atopic dermatitis: the SCORAD index, objective SCORAD and the three-item severity score. Br J Dermatol 2007;157:645-8. (Pubitemid 47389896)
19. Tofte SJ, Graeber M, Cherill R, Omoto M, Thurston M, Hanifin JM. Eczema area and severity index (EASI): A new tool to evaluate atopic dermatitis. J Eur Acad Dermatol Venereol 1998;11(suppl 2):S197.
20. Charman CR, Venn AJ, Williams HC. The patient-oriented eczema measure: development and initial validation of a new tool for measuring atopic eczema severity from the patients' perspective. Arch Dermatol 2004;140:1513-9. (Pubitemid 39627446)
21. Nijsten TE, Sampogna F, Chren MM, Abeni DD. Testing and reducing skindex-29 using Rasch analysis: Skindex-17. J Invest Dermatol 2006;126:1244-50. (Pubitemid 43997903)
22. Hijnen D, De Bruin-Weller M, Oosting B, Lebre C, De Jong E, Bruijnzeel-Koomen C, et al. Serum thymus and activation-regulated chemokine (TARC) and cutaneous T cell- attracting chemokine (CTACK) levels in allergic diseases: TARC and CTACK are disease-specific markers for atopic dermatitis. J Allergy Clin Immunol 2004;113:334-40. (Pubitemid 38210559)
23. Kakinuma T, Nakamura K, Wakugawa M, Mitsui H, Tada Y, Saeki H, et al. Thymus and activation-regulated chemokine in atopic dermatitis: Serum thymus and activation-regulated chemokine level is closely related with disease activity. J Allergy Clin Immunol 2001;107:535-41. (Pubitemid 32210037)
24. Pocock SJ, Simon R. Sequential treatment assignment with balancing for prognostic factors in the controlled clinical trial. Biometrics 1975;31:103-15.
25. Paul C, Lahfa M, Bachelez H, Chevret S, Dubertret L. A randomized controlled evaluator-blinded trial of intravenous immunoglobulin in adults with severe atopic dermatitis. Br J Dermatol 2002;147:518-22. (Pubitemid 35015288)
26. Schmitt J, Meurer M, Schwanebeck U, Grahlert X, Schakel K. Treatment following an evidence-based algorithm versus individualised symptom-oriented treatment for atopic eczema. A randomised controlled trial. Dermatology 2008;217:299-308.
27. Schmitt J, Williams H. Harmonising Outcome Measures for Eczema (HOME). Report from the First International Consensus Meeting (HOME 1), 24 July 2010, Munich, Germany. Br J Dermatol 2010;163:1166-8.
28. Schmitt J, Langan S, Williams HC. What are the best outcome measurements for atopic eczema? A systematic review. J Allergy Clin Immunol 2007;120:1389-98. (Pubitemid 350216596)