Chronic Urticaria Clinical Trial
Official title:
Randomized Clinical Trial Evaluating the Efficacy of Methotrexate in Addition to Anti-H1 Versus Placebo and Anti-H1 in the Treatment of Severe Chronic Idiopathic Urticaria
Chronic urticaria is defined by urticarial lesions persisting at 6 weeks. The cause is not found in about 75% of cases (chronic idiopathic urticaria). The gold standard treatment consists of anti-H1 molecules. In severe cases, refractory to anti-H1, few therapeutic alternatives exist. Methotrexate, which is not expensive and often prescribed by dermatologists, has been efficiently tried in an open study on severe chronic idiopathic urticaria, and also in few case reports.
Chronic urticaria, defined by its persistence beyond 6 weeks, is a common condition (0.1% to
3% of the general population), occurring at any age. The etiology is not found in nearly 75%
of cases (chronic idiopathic urticaria). Chronic idiopathic urticaria may resolve over
several months or years. The quality of life of patients is usually strongly spoiled. The
gold standard treatment consist of anti-H1 molecules. In severe cases, which are refractory
to anti-H1, few therapeutic alternatives exist. Two studies have shown a benefit when adding
to anti-H1, montelukast, anti-leukotriene, or cyclosporine. Methotrexate, which is another
immunosuppressive drug, cheap and commonly prescribed by dermatologists, has been efficient
in severe chronic urticaria, in an open study and in few case reports.
Methotrexate, an anti-metabolite drug which inhibits dihydrofolate reductase, is indicated in
hematologic malignancies and in autoimmune diseases. It may be given by oral or parenteral
administration, once a week, and requires regular monitoring of renal and hepatic function,
and blood count.
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