Meta-analysis: methotrexate effective for severe alopecia areata

  • J Am Acad Dermatol

  • Brian Richardson, PhD
  • Clinical Essentials
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Takeaway

  • A systematic review and meta-analysis indicates that methotrexate treatment is effective as monotherapy or in combination with corticosteroid for patients with alopecia areata (AA).

Why this matters

  • Treatment of AA is challenging, and there is a lack of high-quality evidence to guide treatment.

Key results

  • 35.8% of methotrexate patients experienced complete response (100% regrowth of hair), whereas 63.2% exhibited good/complete response (50%-100% regrowth of hair).
  • Adults had significantly higher complete and good/complete response rates compared with pediatric patients (P=.001 for both).
  • Methotrexate combined with corticosteroids was associated with higher odds of good/complete response compared with methotrexate alone (OR, 2.73; P=.018).
  • The pooled recurrence rate was 47.7% (52.0% in adults vs 31.7% in pediatric patients; P=.19).
  • The pooled complication rate was 22.1% (24.2% in adults vs 14.5% in pediatric patients; P=.31).

Study design

  • Systematic review and meta-analysis of 16 studies according to recommended PRISMA guidelines.
  • Funding: None.

Limitations

  • Meta-analysis was based on retrospective, observational studies with heterogeneity.