Methotrexate vs Azathioprine in Atopic Dermatitis: A 5 year follow up study.

1. Subject is 18 years of age or older at baseline; both genders;

2. Subject has a diagnosis of AD for at least 6 months based on millennium criteria (with or without IgE) and UK-criteria;

3. Subject has a score of 8-9 on the Rajka and Langeland Criteria which corresponds with a severity of ‘severe’;

4. Subject is candidate for systemic treatment for AD or clinical in-hospital treatment;

5. Subject is unresponsive, contra-indicated or intolerant to CsA treatment;

6. Female subject is either not of childbearing potential, defined as postmenopausal or surgically sterile or is of childbearing potential and practicing one of the following methods of birth control throughout the study until 3 months after receiving the last study agent:

A. Intrauterine device (IUD);

B. Contraceptives (oral, parenteral, patch) for three months prior to study drug administration;

C. A vasectomized partner.

7. Female subjects of childbearing potential must have a negative serum pregnancy test at the Screening visit and a negative urine pregnancy test at Baseline. Female subjects must not be nursing;

8. Sexually active male subjects are able to participate in the study if they / their partner use effective contraception (see 5) during the study and 3 months after discontinuation of the study drug;

9. Screening clinical laboratory analysis don’t show any of the following laboratory results: Aspartate transaminase (AST) or alanine transaminase (ALT) > 1.5 upper limit of normal (ULN), serum creatinine > 30 % of ULN and leucocytes or total white blood cell count < 3.0 x 10E9/L and Thiopurine methyltransferase below 48,9 µmol/gram of protein /hour only in treatment arm 2;

10. Subject has voluntarily signed and dated an informed consent prior to any study related procedure and is willing to comply with the requirements of this study protocol which has been approved by an Institutional Review Board (IRB/Independent Ethics Committee (IEC)).

1. Subject is pregnant, nursing, or planning pregnancy (men and women) while enrolled in the study and until 3 months after discontinuation of the study;

2. Subject has used any investigational drug within the previous 4 weeks or 5 times the half-life of the investigational agent prior to the first administration of study agent, whichever is longer;

3. Subject has ever used AZA or MTX before;

4. Subject has received phototherapy or any systemic medications/treatments that could affect AD evaluation (including, but not limited to, oral or injectable corticosteroids) within the last 4 weeks of the first administration of study agent;

5. Subject has used very potent topical medications/treatments that could affect AD evaluation within 2 weeks of the first administration of study agent;

6. A history of chronic or recurrent infectious diseases, including but not limited to chronic renal infection, chronic chest infection (eg, bronchiectasis), recurrent urinary tract infection (recurrent pyelonephritis or chronic nonremitting cystitis), or open, draining or infected skin wounds or ulcers;

7. A history of alcohol abuse;

8. A history of latent or active granulomatous infection, including TB, histoplasmosis or coccodioidomycosis;

9. Subject has or had herpes zoster infection within 2 months of study day 0;

10. Subject is known to be infected with HIV, hepatitis B, or hepatitis C;

11. Subject has a history or current signs or symptoms of severe, progressive, or uncontrolled renal, hepatic, hematological, gastrointestinal, endocrine, pulmonary, cardiac, neurological, cerebral, or psychiatric disease;

12. Subject has a transplanted organ (with exception of a corneal transplant > 3 months prior to the first administration of study agent);

13. A history of lymphoproliferative disease, including lymphoma, or signs and symptoms suggestive of possible lymphoproliferative disease, such as lymphadenopathy and/or splenomegaly;

14. Subject has any known malignancy or has a history of malignancy;

15. Subject has undergone allergy immunotherapy previously for prevention of anaphylactic reactions;

16. Subject participates in another trial using an investigational agent or procedure during participation in the trial;

17. Subject is dependent of a concomitant medication that has interaction with the study medication and thereby should be avoided. (APPENDIX M.);

18. For any reason, subject is considered by the local investigator to be an unsuitable candidate to participate in this trial.