Mycophenolate mofetil as good as methotrexate for juvenile localized scleroderma

In the treatment of patients with juvenile localized scleroderma, mycophenolate mofetil (MMF) compares favourably with methotrexate (MTX) in terms of reducing clinical activity and flare rate, according to a retrospective study.

Researchers used data from the National Registry of Childhood Onset Scleroderma was conducted at UPMC Children’s Hospital of Pittsburgh. They identified patients whose disease occurred before age 18 years, had a localized scleroderma diagnosis, and received treatment with MTX monotherapy, MMF monotherapy, or combination of the two.

Treatment response was evaluated in relation to disease activity, which was measured using the Localized Scleroderma Cutaneous Assessment Tool.

A total of 114 patients (median age at disease onset 8.3 years, 67.5 percent female) were included in the analysis. Of these, 68 patients (59.6 percent) were treated with MTX, 28 (24.6 percent) with MMF, and 18 (15.8 percent) with the combination of MTX and MMF.

Baseline demographic characteristics, disease subtype, and disease severity were similar across the three treatment groups, although patients in the MMF group had longer disease duration.

Disease activity improved over time for patients in all treatment groups (β, −0.14, 95 percent confidence interval [CI], −0.62 to 0.33). Moreover, flare rates did not significantly differ across the three treatment groups (hazard ratio, 0.85, 95 percent CI, 0.51–1.33).

However, fatigue occurred more frequently in the MTX group than in the MMF group (47 percent vs 11 percent; p=0.001), as did nausea (60 percent vs 7 percent; p=0.001).