Methotrexate addition to phototherapy of no benefit in treating vitiligo patients

The research compared oral methotrexate with phototherapy in the treatment of vitiligo in comparison with single phototherapy treatment. The findings revealed that at 6 months, both treatments (methotrexate + phototherapy versus placebo + phototherapy) resulted in improvements; however, there was no significant difference in disease severity scores between the two groups at different follow-up periods.

Vitiligo is an acquired skin disease having a global prevalence of 0.5%–2% and a tendency to involve both genders. No clarity exists on the exact pathologic mechanism, but there is some evidence for the role of autoimmunity in the disease. Based on this theory, several immunosuppressive agents, such as systemic or topical corticosteroids and phototherapy (including narrowband ultraviolet B), are used.

Methotrexate is another immunosuppressant that has recently gained popularity as a single treatment for vitiligo, however, the synergistic effect and its superiority over other treatments are two crucial factors that are still obscure. Therefore, Sama Heidari, Department of Dermatology, RAZI Hospital, Tehran University of Medical Sciences, Tehran, Iran, and colleagues aimed to compare the efficacy of methotrexate+ NB-UVB versus placebo+ NB-UVB in vitiligo patients.

The double-blinded, randomized controlled trial included 42 patients with vitiligo. They were randomly allocated into two groups: the first group received three times weekly NB-UVB plus placebo, and the second group was treated with three times weekly NB-UVB in combination with a weekly dose of 12.5 mg MTX. The total treatment duration was 6 months, patients were followed up every 2 months, and the assessment tools were VIDA (disease activity indicator) and VASI (repigmentation indicator) scores.

The results demonstrated that during 6-month follow-up, both treatment groups showed improvement in VIDA and VASI scores, but found no statistical significance between the two treatment methods.

"This study demonstrated that both treatment modalities were equally effective, and there is a need for further studies to evaluate the efficacy of methotrexate with other medications with a larger sample size and longer follow-up," the researchers concluded.

Reference:

Lajevardi, V., Seyed Hosseini, Z. S., & Heidari, S. (2023). Efficacy of using oral methotrexate with phototherapy in the treatment of vitiligo in comparison with single phototherapy treatment: A double-blinded randomized controlled trial. Photodermatology, Photoimmunology & Photomedicine, 39(6), 657-662. https://doi.org/10.1111/phpp.12918