Background

Methotrexate has been used both as monotherapy and as an adjunct to corticosteroids in the treatment of alopecia areata (AA), though there exists a paucity of definitive evidence and guidelines in this setting.

Objectives

To 1) determine the efficacy and risks associated with methotrexate therapy for AA, 2) determine the differences in efficacy of combination (methotrexate plus corticosteroids) versus stand-alone (methotrexate) treatment, and 3) determine the relative efficacy of methotrexate in adult versus pediatric populations.

Methods

A systematic review and meta-analysis was performed according to recommended PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-Analyses] guidelines.

Results

Methotrexate has reasonable effectiveness in patients with severe AA; adults appear to be more responsive to methotrexate treatment than pediatric patients. Combination treatment results in a higher complete response rate than methotrexate stand-alone treatment. A large proportion of patients had recurrence in the setting of tapering treatment. Complication rates were acceptable and similar between adult and pediatric patients.

Limitations

The studies reviewed were retrospective observational studies with heterogeneity between centers in terms of methotrexate dosages and protocols in use for AA, and there was a lack of data beyond 1 year for the adjunctive treatments.

Conclusion

Methotrexate is an effective monotherapy or adjunct therapy in combination with corticosteroids in the treatment of severe AA.

中文翻译：

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甲氨蝶呤治疗斑秃：系统评价和荟萃分析

背景

甲氨蝶呤在斑秃（AA）的治疗中既被用作单一疗法，也被用作皮质类固醇的辅助药物，尽管在这种情况下缺乏确切的证据和指南。

目标

要1）确定与AA的甲氨蝶呤疗法相关的功效和风险，2）确定联合使用（甲氨蝶呤加皮质类固醇）与单药（甲氨蝶呤）治疗的疗效差异，以及3）确定甲氨蝶呤在成人与成人之间的相对疗效儿科人群。

方法

根据推荐的PRISMA [系统评价和荟萃分析的首选报告项目]指南进行了系统评价和荟萃分析。

结果

甲氨蝶呤在重症AA患者中具有合理的疗效；成年人似乎比小儿患者对甲氨蝶呤的治疗更敏感。联合治疗比甲氨蝶呤单药治疗具有更高的完全缓解率。大部分患者在逐渐减少治疗的条件下复发。成人和小儿患者的并发症发生率是可以接受的，并且相似。

局限性

所审查的研究是回顾性观察性研究，各中心之间在甲氨蝶呤剂量和用于AA的方案方面存在异质性，并且缺乏1年以上辅助治疗的数据。

结论

甲氨蝶呤是一种有效的单一疗法或辅助疗法，与皮质类固醇合用可治疗严重的AA。