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Methotrexate (methotrexate)
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Oral or injection
Daily
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Available by Prescription
As Low as $0
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  • 40-50% improvement in eczema severity
  • Results visible within 3-7 weeks
  • Long-term treatment possible (average 23 months)
  • Maintains effectiveness after stopping treatment
  • Requires regular monitoring
  • Shouldn't be used during pregnancy
“So after years and years of severe eczema and steroids creams, I finally was able to see a derm instead of my GP. The derm was AWEOSME. She fully understood …”
- Patient review
How well does Methotrexate work?
Methotrexate is below average for atopic dermatitis "Immunosuppressants" treatments.
What is the evidence behind Methotrexate?
Methotrexate is slower to work but can be effective for long-term control of atopic dermatitis. It typically takes at least 6 weeks to see effects. The medication works by decreasing inflammation through inhibiting cell division and lymphocyte proliferation.
What does the research say?
Study Summary

Newer treatments for atopic dermatitis (like dupilumab, tralokinumab, lebrikizumab, and JAK inhibitors) are showing better results with fewer side effects compared to older medications. High dose cyclosporine and dupilumab work better than methotrexate and azathioprine. While high-dose upadacitinib was most effective, it had more side effects.

Comparison of Old and New Systemic Treatments for Moderate to Severe Atopic Dermatitis
Study Type
Review
Studied Population
Severity: moderate to severe
Age: not available
Results
High dose cyclosporine and dupilumab showed superior efficacy compared to methotrexate and azathioprine. High-dose upadacitinib showed highest efficacy but with more adverse events.
Study Summary

This study compared two medications for moderate-to-severe eczema: methotrexate and cyclosporine. While cyclosporine worked better at 8 weeks, increasing the dose of methotrexate led to similar effectiveness by 20 weeks. Cyclosporine had more side effects than methotrexate.

Methotrexate Versus Cyclosporine in Adults with Moderate-to-Severe Atopic Dermatitis: A Phase III Randomized Noninferiority Trial.
Study Type
Clinical Trial
Studied Population
Total Patients: 97
Results
Cyclosporine was more effective than methotrexate at 8 weeks
What are other patients saying?
Common side effects include nausea, vomiting, diarrhea, and fatigue. More serious but rare side effects include liver toxicity and low blood counts, which requires regular blood test monitoring. Taking folic acid supplements helps reduce these side effects.
What does the research say?
Study Summary

Newer treatments for atopic dermatitis (like dupilumab, tralokinumab, lebrikizumab, and JAK inhibitors) are showing better results with fewer side effects compared to older medications. High dose cyclosporine and dupilumab work better than methotrexate and azathioprine. While high-dose upadacitinib was most effective, it had more side effects.

Comparison of Old and New Systemic Treatments for Moderate to Severe Atopic Dermatitis
Study Type
Review
Studied Population
Severity: moderate to severe
Age: not available
Results
High dose cyclosporine and dupilumab showed superior efficacy compared to methotrexate and azathioprine. High-dose upadacitinib showed highest efficacy but with more adverse events.
What are other patients saying?
When compared to other treatments, methotrexate shows lower effectiveness than cyclosporine and dupilumab in the short term (8 weeks), but may have better long-term outcomes. In children, methotrexate shows better drug survival rates than cyclosporine but lower than dupilumab.
What does the research say?
Study Summary

This study compared two medications for moderate-to-severe eczema: methotrexate and cyclosporine. While cyclosporine worked better at 8 weeks, increasing the dose of methotrexate led to similar effectiveness by 20 weeks. Cyclosporine had more side effects than methotrexate.

Methotrexate Versus Cyclosporine in Adults with Moderate-to-Severe Atopic Dermatitis: A Phase III Randomized Noninferiority Trial.
Study Type
Clinical Trial
Studied Population
Total Patients: 97
Results
Cyclosporine was more effective than methotrexate at 8 weeks
Study Summary

This study compared how long children with severe eczema stayed on different medications (dupilumab, methotrexate, and cyclosporine). Dupilumab showed the best long-term results, with 84% of patients still using it after 1 year, compared to 61% for methotrexate and 44% for cyclosporine. The main reasons patients stopped treatments were because they weren't working well enough or because of side effects.

Drug Survival of Dupilumab, Methotrexate, and Cyclosporine A in Children With Atopic Dermatitis.
Study Type
Comparative Study
Studied Population
Total Patients: 362
Severity: moderate to severe
Age: 2-17 years
Results
Dupilumab showed consistently better long-term continuation rates compared to methotrexate and cyclosporine
What are other patients saying?
The medication can be used as a maintenance therapy for longer-term control of atopic dermatitis, unlike cyclosporine which is typically limited to one year of use due to side effects.
What does the research say?
Study Summary

Newer treatments for atopic dermatitis (like dupilumab, tralokinumab, lebrikizumab, and JAK inhibitors) are showing better results with fewer side effects compared to older medications. High dose cyclosporine and dupilumab work better than methotrexate and azathioprine. While high-dose upadacitinib was most effective, it had more side effects.

Comparison of Old and New Systemic Treatments for Moderate to Severe Atopic Dermatitis
Study Type
Review
Studied Population
Severity: moderate to severe
Age: not available
Results
High dose cyclosporine and dupilumab showed superior efficacy compared to methotrexate and azathioprine. High-dose upadacitinib showed highest efficacy but with more adverse events.
Study Summary

Both cyclosporine and methotrexate were effective in treating severe eczema in children and young people. Cyclosporine worked faster, but methotrexate's effects lasted longer after stopping treatment.

Efficacy and safety of ciclosporin versus methotrexate in the treatment of severe atopic dermatitis in children and young people (TREAT): a multicentre, parallel group, assessor-blinded clinical trial.
Study Type
Randomized Controlled Trial
Studied Population
Total Patients: 103
Severity: severe
Age: 2-16 years
Results
What are other patients saying?
Is Methotrexate Right For Me?
What is Methotrexate?
Methotrexate is a medication that works by blocking an enzyme called dihydrofolic acid reductase. It's used to treat several conditions including severe psoriasis, rheumatoid arthritis, and certain types of cancer.
What are the requirements for taking Methotrexate?
Methotrexate might be right for you if:

  • You have severe psoriasis that hasn't responded to other treatments

  • You have rheumatoid arthritis

  • Other treatments haven't worked or aren't suitable for you

How does Methotrexate work?
Methotrexate works by blocking the production of folate, which cells need to make DNA. This affects rapidly growing cells in the body. In conditions like psoriasis and rheumatoid arthritis, while the exact mechanism isn't fully understood, it helps reduce inflammation and control the overactive immune system.
Is it safe for children?
Methotrexate has been proven safe and effective in children for certain conditions, particularly juvenile idiopathic arthritis (JIA). The dosing needs to be carefully adjusted based on the child's body surface area.
Is it safe for elderly patients?
There isn't enough data to determine if elderly patients respond differently to methotrexate compared to younger patients. Careful monitoring may be needed as elderly patients may be more sensitive to side effects.
Is it safe during pregnancy?
Methotrexate is strictly contraindicated during pregnancy for non-cancer conditions. It can cause serious birth defects and fetal death. Women must avoid becoming pregnant during treatment and for 6 months after stopping the medication.
Is it safe during breastfeeding?
Breastfeeding is not recommended during methotrexate treatment and for 1 week after the final dose. The medication can pass into breast milk and may harm the baby.