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Reductions in serum IgE levels with methotrexate and azathioprine treatment in patients with atopic dermatitis
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  • Soo-Ray Wang,
  • Min-Sho Ku,
  • Yu-Hsun Wang,
  • Shan-Ming Chen,
  • Kun-Lin Lee,
  • Pui-Ying Leong,
  • Liang-Tian You
Soo-Ray Wang
Chung Shan Medical University

Corresponding Author:a0989220210@gmail.com

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Min-Sho Ku
Chung Shan Medical University
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Yu-Hsun Wang
Chung Shan Medical University Hospital
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Shan-Ming Chen
Chung Shan Medical University
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Kun-Lin Lee
Cheng Hsin General Hospital
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Pui-Ying Leong
Chung Shan Medical University
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Liang-Tian You
Tungs' Taichung MetroHarbor Hospital
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Abstract

Background: Moderate to severe atopic dermatitis (AD) is difficult to treat. There are rare reports on the treatment of moderate to severe AD by lowering serum IgE with a combination of methotrexate (MTX) and azathioprine (AZA) and hence improving symptoms. Objective: This study aimed to improve AD symptoms by lowering serum IgE with a combination therapy of MTX and AZA. Design: Retrospective cohort study of patients treated during 2013 and 2019. Setting: Patients recruited from a tertiary care university hospital in Taiwan. Participants: Sixty-five (case group) and 36 (control group) patients with moderate to severe AD, aged between 10 and 77 years. Measurements: Patients in the case group received a combination of MTX (15 mg weekly) and AZA (150 mg daily) for 1 to 5 years. Patients in the control group received any therapies other than this combination. Serum total IgE levels were checked periodically in both groups. Results: Serum total IgE was markedly reduced in the case group. For example, the cumulative success rates of a 50% IgE reduction in the case group in year 1 and year 5 were 69.2% and 98.5%, respectively, compared to 10.0% and 18.2% in the control group (hazard ratio 14.8; p < 0.001). At the end of year 4, the cumulative success rate of IgE reduction to below the normal range was 41.1% in the case group and 3.4% in the control group (hazard ratio 6.71; p = 0.033). Regarding adverse events, the rates of abnormal white blood cell counts, hemoglobin, platelet counts, and alanine aminotransferase were not increased in the case group compared to the control group. Conclusion: Combination therapy with MTX and AZA was effective in treating patients with intractable AD by reducing their serum total IgE levels.