High-Dose Intravenous Pulse Methotrexate in Patients With Eosinophilic Fasciitis.

Autor:	Mertens JS; Department of Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands2Laboratory of Translational Immunology, University Medical Centre Utrecht, Utrecht, the Netherlands., Zweers MC; Department of Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands., Kievit W; Department of Epidemiology, Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands., Knaapen HK; Department of Rheumatology, Radboud University Medical Centre & Sint Maarstenskliniek, Nijmegen, the Netherlands., Gerritsen M; Department of Rheumatology, Westfriesgasthuis, Hoorn, the Netherlands., Radstake TR; Laboratory of Translational Immunology, University Medical Centre Utrecht, Utrecht, the Netherlands6Department of Rheumatology and Clinical immunology, University Medical Centre Utrecht, Utrecht, the Netherlands., van den Hoogen FH; Department of Rheumatology, Radboud University Medical Centre & Sint Maarstenskliniek, Nijmegen, the Netherlands., Creemers MC; Department of Rheumatology, Jeroen Bosch Hospital-Hertogenbosch, the Netherlands., de Jong EM; Department of Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands.
Jazyk:	angličtina
Zdroj:	JAMA dermatology [JAMA Dermatol] 2016 Nov 01; Vol. 152 (11), pp. 1262-1265.
DOI:	10.1001/jamadermatol.2016.2873
Abstrakt:	Importance: Eosinophilic fasciitis (EF) is a connective tissue disorder in which conventional treatment leads to disappointing results in a proportion of patients. Therefore, we investigated high-dose intravenous (IV) pulse methotrexate (MTX) as a treatment for EF. Objective: To examine safety and effects of monthly high-dose IV pulse MTX in EF. Design, Setting, and Participants: For this prospective single-arm study, we recruited 12 patients diagnosed with biopsy specimen-proven EF between 2006 and 2009 from the Department of Dermatology and Rheumatology at the Radboud University Medical Centre. Interventions: Intravenous MTX (4 mg/kg) monthly for 5 months with folinic acid rescue 24 hours after MTX administration. Main Outcomes and Measures: The primary outcome was improvement of the modified skin score at month 5 vs baseline. Secondary outcomes were durometry, range of motion, visual analog scale scores for disease activity, and 36-Item Short Form Survey health questionnaires. Results: Overall, 12 patients (11 women between 37-69 years old) received a median (range) monthly dose of 288 (230-336) mg MTX. Median (range) modified skin score improved from 17.5 (8.0-24.0) at baseline to 8.5 (1.0-20.0) at month 5 (P = .001). Secondary outcome measures improved significantly, except for durometer scores and range of motion of the elbows. Adverse events included gastrointestinal symptoms (n = 9), mild stomatitis (n = 5), and alopecia (n = 4). Conclusions and Relevance: High-dose IV pulse MTX is a safe and effective treatment option in EF. Trial Registration: clinicaltrials.gov Identifier: NCT00441961.
Databáze:	MEDLINE
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