Therapy-Switching Patterns in Children, Adolescents With Psoriasis

Approximately one-third of pediatric and adolescent patients with mild to severe psoriasis who are treated with topical therapy are not receiving adequate intensive therapy to control disease, and the median time for these patients to switch to systemic therapy may be less than ideal, according to study research published in the British Journal of Dermatology.

This prospective study used data from the longitudinal Child-CAPTURE registry, which included 448 patients <18 years of age with pediatric onset psoriasis from a single center who were followed into young adulthood from 2008 to 2018. The investigators prospectively collected treatment characteristics from time of registry inclusion.

Treatment characteristics before inclusion in the registry were retrospectively collected at the child’s first visit. Type of treatment – including topical, day-care dithranol, phototherapy, and systemic treatment – and date of treatment initiation or switch were identified. In a Cox regression analysis, the investigators assessed which patient characteristics were associated with switch to systemic therapy. The patient characteristics collected by the researchers at baseline included sex, date of psoriasis onset, and family history of psoriasis.

The mean age at psoriasis onset was 8.3 years, and the mean age at the last follow-up visit was 13.5 (range, 2.0-24.4) years. In addition, the total median and mean follow-up times were 4.2 years and 5.2 years, respectively.

In was found that 62.3% (n=279) of the Child-CAPTURE registry cohort remained on solely topical treatment until data-lock. Conversely, 14.3% (n=64) of patients switched from solely topical therapy to phototherapy, whereas 23.4% (n=105) of patients switched from topical to systemic therapy, including methotrexate (66.7%; n=70) and fumaric acid esters (21.0%; n=22).

The overall median time from the onset of psoriasis to discontinuation of solely topical therapy was 7.3 (95% CI 5.2 – 9.4) years, with a switching rate reaching 27.4% after 3 years. The median time from the onset of psoriasis to discontinuation of solely topical therapy was shorter for patients with moderate to severe psoriasis (5.8 years; 95% CI4.9–6.7) vs for patients with mild psoriasis (11.2 years; 95% CI, 8.6–13.9) at their first visit (P <.001).

During follow up, 105 patients switched to systemic therapy. The overall median time to switch to first systemic therapy was 10.8 years (95% CI, 9.8–11.9). In the group of patients with moderate to severe psoriasis, the median time to the start of the first systemic treatment was significantly shorter vs patients who presented with mild psoriasis at their first visit (P =.001).

According to the multivariable Cox regression analysis, factors independently associated with switching to systemic therapy included higher Psoriasis Area and Severity Index (hazard ratio [HR], 1.26; 95% CI, 1.13–1.42; P <.001) and a Children’s Dermatology Life Quality Index >5 (HR, 4.50; 95% CI, 2.58-7.84; P <.001).

A limitation of the study included the enrollment of patients from a single center in the Netherlands, which the investigators suggest leads to uncertainty as to whether the population was fully representative of the general psoriasis patient population.

Based on their findings, the investigators concluded that young patients with psoriasis “might benefit most of earlier intervention in terms of limiting life course impairment by uncontrolled psoriasis.”

Disclosure: This clinical trial was supported by Eli Lilly. Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Bruins FM, Bronckers IMGJ, Cai R, et al. Treatment persistence in paediatric and adolescent psoriasis patients followed into young adulthood: from topical to systemic treatment – a prospective, longitudinal, observational cohort study of 448 patients [published online June 8, 2020]. Br J Dermatol. doi: 10.1111/bjd.19301.