Share on Facebook
Share on Twitter
Share on LinkedIn
Share by Email
Print
Use of methotrexate predicts longer drug survival in children with atopic dermatitis (AD), according to research findings from a French study published in the British Journal of Dermatology. The study also found several other predictors of longer and shorter postdrug survival in children with AD who discontinued their first-line systemic immunosuppressive treatment (IST) and started a second-line therapy.
Children with AD (mean age, 11±8.7 years) who received ≥1 IST from 2008 to 2018 were included in a drug survival analysis (n=83). The event of interest in this analysis was IST discontinuation. Participants who discontinued first-line IST were included in a postdrug survival analysis, of which the main event of interest was the initiation of a second-line IST (n=39). All data were censored because of loss to follow-up or absence of event after 24 months.
The researchers observed a significantly shorter median drug survival with first-line IST vs ciclosporin and methotrexate (11.5 months [interquartile range (IQR), 6.3–20.7] vs 22.3 months [IQR, 5.8–38.2], respectively; P =.01). Use of methotrexate was the only predictive factor for longer drug survival (hazard ratio [HR], 0.37; 95% CI, 0.17–0.80; P =.01).
In the children who were prescribed a second-line IST, the drugs included ciclosporin (n=10), methotrexate (n=13), dupilumab (n=13), mycophenolate mofetil (n=1), azathioprine (n=1), and acitretin (n=1). There was no difference between ciclosporin and methotrexate in the median drug survival for second-line IST (31.5 months [IQR, 8.5–78.3] vs 13.5 months [IQR, 5.5–50.1], respectively; P =.88). No significant difference was observed in terms of the median postdrug survival for ciclosporin and methotrexate (8.0 months vs 4.1 months, respectively; P =.58).
Significant predictors of longer postdrug survival included age at AD onset <2 years (HR, 0.23; 95% CI, 0.07–0.76; P =.01), respiratory allergy (HR, 0.22; 95% CI, 0.08–0.54), and controlled AD at the end of first-line IST (HR, 0.24; 95% CI, 0.08–0.66; P <.01). Variables predictive of shorter postdrug survival were high dose of first-line treatment (HR, 2.87; 95% CI, 1.09–7.57; P =.03) and male sex (HR, 2.48; 95% CI, 1.06–5.80; P =.03).
Limitations of the study included the small sample size as well as the inclusion of only children from France.
The study authors wrote that their findings “potentially illustrate a tendency to consider the methotrexate safety profile as identical for adults and children.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Reference
Chambrelan E, Barbarot S, Bekel L, et al. Drug survival and postdrug survival of systemic treatments in a national French cohort of children with atopic dermatitis [published online February 9, 2020]. Br J Dermatol. doi: 10.1111/bjd.18941
