Methotrexate/prednisone combo may be effective in alopecia areata totalis, universalis

A combination of methotrexate and low-dose prednisone may be effective and cost-efficient in patients with alopecia areata totalis (AT) and universalis (AU), according to results of a randomized clinical trial.

In the study, 89 patients were randomized to receive methotrexate (n  =  45) or placebo (n  =  44). After 6 months, those who had >25% % hair regrowth (HR) continued treatment until 12 months, and those with <25% HR were rerandomized to receive methotrexate plus prednisone (20 mg/d for 3 months and 15 mg/d for 3 months) or methotrexate plus placebo of prednisone.

Complete or almost complete HR was seen in 1 patient who received methotrexate alone and no patients who placebo at 12 months. However, complete or almost complete HR was achieved in 20% of patients who received methotrexate (for 6 or 12 months) plus prednisone including 31.2% of patients treated with methotrexate for 12 months and prednisone for 6 months.

Fatigue was observed in 6.9% and nausea in 13.7% patients receiving methotrexate; 2 patients in the methotrexate group discontinued study due to these adverse effects.

Reference
Joly P, Lafon A, Houivet E, et al. Efficacy of Methotrexate Alone vs Methotrexate Plus Low-Dose Prednisone in Patients With Alopecia Areata Totalis or Universalis: A 2-Step Double-Blind Randomized Clinical Trial. JAMA Dermatol. Published online March 08, 2023. doi:10.1001/jamadermatol.2022.6687