Is monthly high-dose intravenous pulse methotrexate a safe and effective treatment option for eosinophilic fasciitis (EF)?
In this open prospective study that included 12 adults with eosinophilic fasciitis, the modified skin score improved significantly at month 5 compared with baseline. Adverse events were relatively mild and could be managed accordingly, and no serious adverse events were reported.
High-dose intravenous pulse methotrexate is a safe and effective treatment option in patients with EF.
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.
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.
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.
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.
clinicaltrials.gov Identifier: NCT00441961
Mertens JS, Zweers MC, Kievit W, Knaapen HKA, Gerritsen M, Radstake TRDJ, van den Hoogen FHJ, Creemers MCW, de Jong EMGJ. High-Dose Intravenous Pulse Methotrexate in Patients With Eosinophilic Fasciitis. JAMA Dermatol. 2016;152(11):1262-1265. doi:10.1001/jamadermatol.2016.2873