A long-term follow-up study of methotrexate in juvenile localized scleroderma (morphea) - 14/11/12
, Cristina Vallongo, MD a, Annalisa Patrizi, MD b, Anna Belloni-Fortina, MD, PhD a, Mario Cutrone, MD c, Maria Alessio, MD d, Silvana Martino, MD, PhD e, Valeria Gerloni, MD f, Fabio Vittadello, MSc, DrPH a, Giorgia Martini, MD, PhD a
Reprint requests: Francesco Zulian, MD, Department of Pediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy.Abstract |
Background |
Recent studies report that methotrexate (MTX) is beneficial in the treatment of juvenile localized scleroderma (JLS) but little is known about its long-term effectiveness.
Objective |
We assessed the therapeutic role of MTX in children with JLS who were followed up for a prolonged period.
Methods |
A cohort of patients with JLS, previously enrolled in a double-blind, randomized controlled trial and treated with oral MTX (15 mg/m2/wk) and prednisone (1 mg/kg/d, maximum 50 mg) for the first 3 months, were prospectively followed up. Lesions were evaluated clinically, with infrared thermography, and by a computerized skin score. Response to treatment was defined as: (1) no new lesions; (2) skin score rate less than 1; and (3) decrease in lesion temperature by at least 10% compared with baseline. Clinical remission (CR) on medication was defined when response was maintained, on treatment, for at least 6 months, and complete CR when response was maintained, without treatment, for at least 6 months.
Results |
Of 65 patients treated with MTX, 48 (73.8%) were responders, 10 (15.4%) relapsed by 24 months since MTX start, and 7 (10.8%) were lost to follow-up. Among the responders, 35 (72.9%) maintained CR for a mean of 25 months and 13 (27.1%) were in CR on medication. Adverse effects seen in 28 patients (48.3%) were generally mild and never required treatment discontinuation.
Limitations |
The use of objective measures not widely available, such as infrared thermography and computerized skin score, makes it difficult to compare data from previous studies.
Conclusions |
Long-term MTX therapy is beneficial and well tolerated for JLS.
Le texte complet de cet article est disponible en PDF.Key words : localized scleroderma, methotrexate, morphea, outcome, prednisone, safety, thermography
Abbreviations used : CR, CRM, CSS, JLS, MTX, SSR, t0, tn, ΔTh%
Plan
| Funding sources: None. |
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| Conflicts of interest: None declared. |
Vol 67 - N° 6
P. 1151-1156 - décembre 2012 Retour au numéro
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