Methotrexate, azathioprine show comparable safety, efficacy in pediatric atopic dermatitis
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Methotrexate and azathioprine yielded similar risk-benefit ratios as first-line therapy for children with severe atopic dermatitis, according to a study.
“Systemic immunosuppressive treatments are central in the treatment of severe atopic dermatitis,” Stine Elsgaard, MBBS, of the department of dermatology at Aarhus University Hospital, in Aarhus, Denmark, and colleagues wrote.
However, they noted that there are few comparative data demonstrating the performance of these drugs in pediatric patients with severe AD.
In the current retrospective analysis, the researchers looked at 135 cases of severe AD in pediatric patients with the aim of assessing drug survival of systemic immunosuppressive treatments.
The study included 63 patients treated with first-line methotrexate and 32 patients treated with first-line azathioprine.
Results showed a drug survival rate of 69% at 1 year for methotrexate. The drug survival rate was 50% after 2 years and 18% after 4 years. Methotrexate was associated with an overall median drug survival time of 1.58 years.
The drug survival rates for azathioprine were 63% at 1 year, 53% at 2 years and 21% at 4 years, with an overall median drug survival time of 1.14 years.
No significant difference was observed in drug survival between methotrexate and azathioprine, according to the findings.
Adverse events accounted for 25% of methotrexate discontinuations and 41% of those who discontinued azathioprine. That said, 60% of patients treated with methotrexate and 53% of those treated with azathioprine reported benefits of the drugs at the time of discontinuation or data-lock, according to the findings.
In addition, treatment with both drugs yielded significant improvements in sleep quality (P = .001).
The study also included findings for second-line treatments. Twelve patients were treated with methotrexate, seven were treated with azathioprine and five were treated with cyclosporine in the second line.
Drug survival times for second-line therapies were 1.8 years for methotrexate, 0.2 years for azathioprine and 0.885 years for cyclosporine, according to the findings.
“As the prevalence of AD amongst children has been increasing and new therapies are emerging, these results may guide clinical decision-making in the treatment of severe AD in children,” the researchers wrote.
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