Aim: 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.
Setting and design: This multicentre, parallel group (ratio 1 : 1), randomized controlled trial was conducted in a secondary care setting in Egypt.
Study exposure: 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.
Outcomes: 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.
Primary outcome measures: The primary outcome was the mean change in SCORAD after 12 weeks of treatment.
Results: 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.
Conclusions: 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.
© 2014 British Association of Dermatologists.