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Consensus Treatment Guidelines for the Use of Methotrexate in Patients With Inflammatory Skin Diseases
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- This executive summary highlights the guidelines developed by an expert committee on the use of methotrexate in pediatric patients with inflammatory skin diseases. Treatment with methotrexate is indicated for pediatric patients with morphea, psoriasis, dermatomyositis, atopic dermatitis, lupus, sarcoidosis, and alopecia areata as well as the prevention of neutralizing antibodies associated with biologic therapy. Weight-based dosing is recommended, with a maximum dose of 1 mg/kg up to 25 mg/week. Methotrexate administered via the parenteral route likely has better bioavailability and efficacy. An initial "test dose" is not needed for pediatric patients with inflammatory skin diseases.
- These consensus guidelines provide recommendations for dosing, monitoring, and side-effect mitigation in pediatric patients with inflammatory skin diseases.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersMethotrexate (MTX) is an inexpensive and readily available medication that is used off-label for many inflammatory skin conditions in pediatric patients, with substantial variation in dosing and monitoring. To support optimal management of pediatric inflammatory skin diseases with low-dose MTX, a 27-member expert committee convened to establish evidence-based, consensus-driven guidelines. Five major subjects were assessed: 1) indications and contraindications, 2) dosing, 3) interactions with immunizations and medications, 4) adverse effects, and 5) monitoring.
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Executive summary: Consensus treatment guidelines for the use of methotrexate for inflammatory skin disease in pediatric patients
J Am Acad Dermatol 2024 Feb 08;[EPub Ahead of Print], HA Brandling-Bennett, LM Arkin, YE Chiu, AA Hebert, JP Callen, L Castelo-Soccio, DO Co, KM Cordoro, ML Curran, AM Dalrymple, C Flohr, KB Gordon, D Hanna, AD Irvine, S Kim, AY Kirkorian, I Lara-Corrales, J Lindstrom, AS Paller, M Reyes, WS Begolka, WL Tom, AS Van Voorhees, RA Vleugels, LW Lee, O Davies, EC SiegfriedFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Before the advent of FDA approval of biologic drugs for pediatric inflammatory skin diseases, methotrexate was the mainstay of treatment. Moreover, it remains the first-line therapy for many pediatric diseases such as morphea. The authors of this article report consensus guidelines regarding the use of methotrexate for inflammatory skin disease in pediatric patients, and, of note, 46 recommendations reached consensus. This was likely a challenging undertaking and is a valuable contribution to those of us prescribing methotrexate for pediatric patients. The guidelines highlighted in this summary include indications, weight-based dosing, monitoring, and side-effect mitigation. I plan to keep this article as a teaching guide for clinics.
Of note, data supporting vaccination safety and efficacy while on methotrexate and other systemic agents remain scant. This group agreed that the data were insufficient to recommend for or against primary measles, mumps, and rubella vaccination or varicella vaccination. Measles cases are on the rise, and vaccination decisions may require collaboration with pediatricians and other providers.