Clinical and pathogenetic justification of the use of methotrexate in the treatment of progressive non-segmental vitiligo

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Abstract

BACKGROUND: Vitiligo is an urgent problem both for patients and for the scientific community of dermatologists. There are many studies aimed at finding new methods of therapy for this disease, but there are no effective schemes for repigmentation of foci and stabilization of the process in modern dermatology. In this regard, the search for means that have a pathogenetic effect is relevant.

AIMS: Clinical and laboratory evaluation of the effectiveness of methotrexate in vitiligo.

MATERIALS AND METHODS: Preliminary results of a study of the effectiveness of methotrexate in the treatment of vitiligo are presented. Clinical effects were assessed using the VES index (Vitiligo extent score). The dynamics of immunological parameters and the influence of vitiligo on the quality of life were also determined.

The study included 77 patients suffering from non-segmental vitiligo. All the subjects were divided into 2 groups. Patients of group 1 (39 patients) received methotrexate in combination with phototherapy, patients of group 2 (38 patients) underwent a course of UVB-311nm. The area of depigmentation was determined, and after treatment – repigmentation, relative to the surface area of the body. The dynamics of the immune status against the background of therapy was analyzed. The correlation of the prevalence of the process with the quality of life was evaluated. The duration of the study was 4 months.

RESULTS: There were no statistically significant differences in clinical and laboratory parameters among the groups before treatment. Patients included in group 1 and receiving combination therapy with methotrexate and medium-wave narrow-band therapy with UVB-311nm demonstrated more active repigmentation of vitiligo foci than the studied 2 groups. Also, patients of this group demonstrated the most active positive dynamics of the dermatological quality of life index, correlating with the prevalence of the process. Analysis of the dynamics of immune status indicators allowed us to conclude that the best tendency to normalize cytokine levels among group 1 patients.

CONCLUSIONS: Our study demonstrated the clinical and pathogenetic efficacy of methotrexate. Small doses of the drug are well tolerated, which allows a long-term effect on pathogenetic mechanisms, stabilizing the skin process.

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About the authors

Alana R. Tavitova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: alatavitova@mail.ru
ORCID iD: 0000-0003-1930-0073
SPIN-code: 2113-9091

MD, Graduate Student

Russian Federation, Moscow

Konstantin M. Lomonosov

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: lamclinic@yandex.ru
ORCID iD: 0000-0002-4580-6193
SPIN-code: 4784-9730

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

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Supplementary files

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1. Fig. 1. Scattering diagrams of absolute changes of the DLQI and VES with approximation by linear dependence in each group.

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2. Fig. 2. Scattering diagrams of disease duration and absolute changes in VES with approximation by logarithmic dependence in each group.

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3. Fig. 3. Shares with 95% confidence intervals of patients with different treatment outcomes in both groups.

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4. Fig. 4. Results of methotrexate therapy in combination with NB UVB-311 nm (under the rays of Wood’s fluorescent lamp): a ― before treatment; b ― during treatment (after 3 months of therapy).

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5. Fig. 5. results of methotrexate therapy in combination with NB UVB-311 nm; a ― before treatment, b ― after treatment.

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