Methotrexate vs. ciclosporin in the treatment of severe atopic dermatitis in children: a critical appraisal

Abstract

El-Khalawany et al. (Eur J Pediatr 2012; 172: 351-6) aimed to compare the efficacy and safety of methotrexate vs. ciclosporin in the treatment of children with severe atopic eczema. This multicentre, parallel group (ratio 1 : 1), randomized controlled trial was conducted in a secondary care setting in Egypt. Children with severe atopic eczema were randomly assigned to receive either methotrexate (7.5 mg weekly) or ciclosporin (2.5 mg kg(-1) daily) for 12 weeks, followed by a 12-week follow-up period. Eczema severity was measured using the SCORing of Atopic Dermatitis (SCORAD) index. The authors also recorded the number of patients on each therapy experiencing adverse effects. The primary outcome was the mean change in SCORAD after 12 weeks of treatment. Forty patients with a mean age of 11.6 ± 1.52 years were included in the trial. At week 12, patients in the methotrexate group had a mean ± SD absolute reduction in SCORAD of 26.25 ± 7.03, compared with 25.02 ± 8.21 in the ciclosporin group (P = 0.93). Both drugs were associated with minor adverse effects, none of which necessitated changing the treatment regimen. El-Khalawany et al. conclude that both methotrexate and ciclosporin in low doses are clinically effective, relatively safe, and well tolerated as treatments for severe atopic eczema in children.