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Evidence summaries

Interventions for Morphea

Oralmethotrexate plus prednisone may be more effective than placebo plus prednisone in the global improvement of disease activity or damage for treating active juvenile morphea. Level of evidence: "C"

The quality of evidence is downgraded by study limitations (unclear allocation concealment) and by imprecise results (few patients and outcome events).

Summary

A Cochrane review [Abstract] 1 included 14 studies with a total of 429 subjects aged between 3 and 76 years. The majority of participants had circumscribed morphea, followed by linear scleroderma. Heterogenous therapies for different types of morphea were evaluated. Seven studies investigated topical medications, 2 intralesional medications, and 5 systemic medications. The study duration ranged from 7 weeks to 15 months. It was not possible to conduct any meta-analyses.

Global improvement of disease activity or damage after treatment was higher with oral methotrexate plus oral prednisone compared to placebo plus oral prednisone in children and adolescents with active morphea (RR 2.31, 95% CI 1.20 to 4.45; NNTB=3; 1 study, n=70). There was no difference in the number of participants experiencing at least one adverse event with oral methotrexate or placebo (RR 1.23, 95% CI 0.75 to 2.04; 1 study, n=70). Adverse events related to methotrexate included alopecia, nausea, headache, fatigue and hepatotoxicity, and related to prednisone (given in both groups) included weight gain and striae rubrae.

One three-armed study (including children and adults with active morphea, generalised morphea, or mixed morphea) compared medium-dose (50 J/cm²) UVA-1, low-dose (20 J/cm²) UVA-1, and narrowband UVB phototherapy 5 times a week, for 8 weeks. There was little or no difference between treatments in global improvement of disease activity or damage, as assessed through the modified skin score. Safety data showed that treatment with UVA-1 phototherapy caused mild tanning compared to narrowband UVB (narrowband UVB versus medium-dose UVA-1: RR 0.03, 95% CI 0.00 to 0.42; n=35; narrowband UVB versus low-dose UVA-1: RR 0.03, 95% CI 0.00 to 0.41; n=45). There was no difference in the number of participants reporting mild tanning when comparing medium and low dose UVA-1 phototherapy. Transient erythema was reported in 3 participants with narrowband UVB and no participants in the low- or medium-dose UVA-1 groups.

Clinical comments

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Date of latest search:

References

  • Albuquerque JV, Andriolo BN, Vasconcellos MR et al. Interventions for morphea. Cochrane Database Syst Rev 2019;(7):CD005027. [PubMed]

Primary/Secondary Keywords