A Scoping Review of the Efficacy and Safety of Methotrexate Compared to Mycophenolate Mofetil in the Treatment of Juvenile Localized Scleroderma in Children and Young Adults

Juvenile localised scleroderma (JLS) is a condition that results in inflammation and fibrosis of the skin in children and young people. Systemic treatment with immunomodulation is most commonly with Methotrexate (MTX) or Mycophenolate Mofetil (MMF). Other treatments include DMARDs, biologic therapies, topical treatments and phototherapy. This scoping review considers the available information on the relative safety and efficacy of MTX and MMF. A scoping review was conducted in accordance with PRISMA-ScR guidelines. A search was conducted in three bibliographic databases (Cochrane Library, Medline (OVID) and Embase (OVID)) to identify relevant studies for inclusion . A single reviewer identified published articles eligible for the review based on the inclusion and exclusion criteria. The relevant key findings were summarised in a word document by the first reviewer and then checked by a second reviewer. From 1233 unique references, 109 were identified as meeting the inclusion criteria. MTX is the most commonly used first-line systemic treatment for JLS with the greatest evidence for its use in JLS. The evidence for the efficacy of MMF is restricted to a small number of retrospective studies. Both MTX and MMF are described to be relatively safe medications with a low rate of adverse events. Information regarding the tolerability of these medications is limited. The rarity of JLS and the paucity of validated measures of disease activity makes comparison between these two treatments challenging and should be reflected in the design of future studies.