title: A randomized, controlled trial of methotrexate versus placebo in early diffuse scleroderma.
abstract: OBJECTIVE
  Early diffuse scleroderma (systemic sclerosis; SSc) has no proven treatment. This study was undertaken to examine the efficacy of methotrexate (MTX) in improving the skin and other disease parameters in early diffuse SSc.
  
  
  METHODS
  Seventy-one patients with diffuse SSc of <3 years' duration were enrolled in a multicenter, randomized, placebo-controlled, double-blind trial. Thirty-five patients were treated with MTX and 36 with placebo. Treatment was administered for 12 months. The primary outcome measures were skin score (as determined with 2 different indices) and physician global assessment.
  
  
  RESULTS
  At baseline, there were no statistically significant differences in skin scores, carbon monoxide diffusing capacity (DLco), physician global assessment, or other secondary outcome measurements between the 2 treatment groups. At study completion, results slightly favored the MTX group (mean +/- SEM modified Rodnan skin score 21.4+/-2.8 in the MTX group versus 26.3+/-2.1 in the placebo group [P < 0.17]; UCLA skin score 8.8+/-1.2 in the MTX group versus 11.0+/-0.9 in the placebo group [P < 0.15]; DLco in the MTX group 75.7+/-4.6 versus 61.8+/-3.4 in the placebo group [P < 0.2]). In addition, physician global assessment results favored MTX (P < 0.035), whereas patient global assessment did not differ significantly between groups. When between-group differences for changes in scores from baseline to 12 months were examined using intent-to-treat methodology, MTX appeared to have a favorable effect on skin scores (modified Rodnan score -4.3 in the MTX group versus 1.8 in the placebo group [P < 0.009]; UCLA score -1.2 in the MTX group versus 1.2 in the placebo group [P < 0.02]), but differences in the degree of change in the DLco and physician global assessment were not significant. For the UCLA skin score, these differences in results were not statistically significant after adjustment for baseline differences in sex distribution and steroid use. Dropout rates were similar in the 2 groups.
  
  
  CONCLUSIONS
  Although results of this trial demonstrated a trend in favor of MTX versus placebo in the treatment of early diffuse SSc, the between-group differences were small and the power to rule out false-negative results was only 50%. Our findings do not provide evidence that MTX is significantly effective in the treatment of early diffuse SSc.
authors.affiliation: University of Western Ontario, London, Canada.
authors.forename: J E
authors.initials: JE
authors.lastname: Pope
authors.forename: N
authors.initials: N
authors.lastname: Bellamy
authors.forename: J R
authors.initials: JR
authors.lastname: Seibold
authors.forename: M
authors.initials: M
authors.lastname: Baron
authors.forename: M
authors.initials: M
authors.lastname: Ellman
authors.forename: S
authors.initials: S
authors.lastname: Carette
authors.forename: C D
authors.initials: CD
authors.lastname: Smith
authors.forename: I M
authors.initials: IM
authors.lastname: Chalmers
authors.forename: P
authors.initials: P
authors.lastname: Hong
authors.forename: D
authors.initials: D
authors.lastname: O'Hanlon
authors.forename: E
authors.initials: E
authors.lastname: Kaminska
authors.forename: J
authors.initials: J
authors.lastname: Markland
authors.forename: J
authors.initials: J
authors.lastname: Sibley
authors.forename: L
authors.initials: L
authors.lastname: Catoggio
authors.forename: D E
authors.initials: DE
authors.lastname: Furst
mesh_terms: D004185:Disability Evaluation; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006304:Health Status; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D012595:Scleroderma, Systemic / Q000188:drug therapy* / Q000473:pathology; D012720:Severity of Illness Index; D012867:Skin / Q000187:drug effects / Q000473:pathology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D008727:Methotrexate