Details

Autor(en) / Beteiligte

• Law Ping Man, S.
• Bouzillé, G.
• Beneton, N.
• Safa, G.
• Dupuy, A.
• Droitcourt, C.

Titel

Drug survival and postdrug survival of first‐line immunosuppressive treatments for atopic dermatitis: comparison between methotrexate and cyclosporine

Ist Teil von

• Journal of the European Academy of Dermatology and Venereology, 2018-08, Vol.32 (8), p.1327-1335

Ort / Verlag

England: Wiley

Erscheinungsjahr

2018

Quelle

Wiley Blackwell Single Titles

Beschreibungen/Notizen

• Introduction Cyclosporine and methotrexate are the two preferred first‐line immunosuppressive treatments in atopic dermatitis. The aim of this study was to compare the treatment profiles of methotrexate and cyclosporine in daily practice as the first‐line immunosuppressive treatment in atopic dermatitis, using two survival analyses, ‘drug survival’ (time on the drug) and ‘postdrug survival’ (time between two drugs). Methods Retrospective study including patients with moderate‐to‐severe atopic dermatitis treated with methotrexate or cyclosporine as the first‐line immunosuppressive treatment. The reasons for discontinuation of treatment were collected as follows: controlled disease, treatment failure, side event pregnancy and non‐compliance. ‘Drug survival’ and ‘postdrug survival’ analyses were performed using the Kaplan–Meier method and predictive factors were analysed using uni‐ and multivariate Cox regression analyses. Results Fifty‐six patients, among whom 25 patients treated with cyclosporine and 31 with methotrexate (median age: 34 ± 15 years), were included between 2007 and 2016. Reasons for discontinuation were not significantly different between ‘controlled disease’ and other reasons (P = 0.11). The median ‘drug survival’ was significantly longer for methotrexate (23 months) than for cyclosporine (8 months) (P < 0.0001). Six months from baseline, 93% of patients treated with methotrexate were still being treated vs 63% among patients treated with cyclosporine. The median of ‘postdrug survival’ was significantly longer for methotrexate (12 months) than for cyclosporine (2 months). Only treatment with CYC was a predictive factor for decreased ‘drug survival’ and ‘postdrug survival’. Conclusion This is the first direct comparison between methotrexate and cyclosporine as first‐line immunosuppressive treatments for moderate‐to‐severe atopic dermatitis in daily practice. We evidenced two different treatment profiles: the duration of methotrexate administration is longer than that of cyclosporine. ‘Postdrug survival’ could be a new tool to assess the maintenance of effect of a drug after withdrawal in atopic dermatitis, and more broadly in chronic skin disease.