A new clinical trial has recommended methotrexate for children with severe atopic dermatitis, a condition that affects 1 in 5 children in Ireland. The findings of Trinity College researchers, published recently in the British Journal of Dermatology, are likely to change the treatment paradigm for the condition, according to the study authors.

 

The Trinity College researchers and collaborators in King's College London have conducted the largest paediatric trial using conventional immuno-modulatory treatments in severe atopic dermatitis.

 

For children and young people with atopic dermatitis, the main first-line conventional systemic treatments are methotrexate and ciclosporin, two immuno-modulatory drugs.

 

The team compared the safety and efficacy of ciclosporin with methotrexate in children and young people with this debilitating skin condition. They also examined whether the severity of the disease changed or returned after treatment ended. 

 

The trial assessed 103 children with severe atopic dermatitis age 2-16 years across 13 centres in the UK and Ireland. The patients were given oral doses of methotrexate or ciclosporin and assessed over nine months of treatment and six months after the therapy ended.  

 

The study found that ciclosporin works faster and reduces disease severity more at 12 weeks but was more expensive, whereas methotrexate was significantly cheaper and led to better objective disease control after 12 weeks and off therapy, with fewer participant-reported flares of atopic dermatitis after treatment had stopped. There were also no concerning safety signals. 

 

Based on the trial findings, methotrexate is a useful and safe treatment in paediatric patients with severe atopic dermatitis and a good alternative to ciclosporin, especially in settings where health care resources are limited.