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).


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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).

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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.

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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