TY - JOUR
T1 - High-dose intravenous pulse methotrexate in patients with eosinophilic fasciitis
AU - Mertens, Jorre S.
AU - Zweers, Manon C.
AU - Kievit, Wietske
AU - Knaapen, Hanneke K A
AU - Gerritsen, Martijn
AU - Radstake, Timothy R D J
AU - Van Den Hoogen, Frank H J
AU - Creemers, Marjonne C W
AU - De Jong, Elke M G J
PY - 2016/11/1
Y1 - 2016/11/1
N2 - 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 (4mg/kg) monthly for 5 months with folinic acid rescue 24 hours after MTX administration. MAIN OUTCOMES AND MEASURES The primary outcomewas 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.
AB - 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 (4mg/kg) monthly for 5 months with folinic acid rescue 24 hours after MTX administration. MAIN OUTCOMES AND MEASURES The primary outcomewas 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.
UR - http://www.scopus.com/inward/record.url?scp=84997605069&partnerID=8YFLogxK
U2 - 10.1001/jamadermatol.2016.2873
DO - 10.1001/jamadermatol.2016.2873
M3 - Article
C2 - 27541801
AN - SCOPUS:84997605069
SN - 2168-6068
VL - 152
SP - 1262
EP - 1265
JO - JAMA Dermatology
JF - JAMA Dermatology
IS - 11
ER -