Acitretin and Methotrexate Outperform Cyclosporine in Pediatric Psoriasis Maintenance: Study Shows
France: Researchers have found in a multinational study involving 506 pediatric psoriasis patients that acitretin and methotrexate demonstrated comparable 2-year drug survival rates, both significantly superior to cyclosporine. The analysis, which covered 683 treatment courses across five countries, highlighted better long-term maintenance with acitretin and methotrexate compared to cyclosporine.
The study, published in the Journal of the European Academy of Dermatology and Venereology, was conducted by Dr. Yunyun Miao and colleagues from the Department of Dermatology, Hôpital Victor Dupouy, Groupement Hospitalier de Territoire Sud Val d'Oise - Nord Hauts-de-Seine, Argenteuil, France. It represents the largest international real-world comparison of conventional systemic therapies used for severe childhood psoriasis to date.
Psoriasis in children can be particularly challenging to treat, and in many regions, systemic options such as acitretin, methotrexate, and cyclosporine remain the mainstay due to limited access to biologic therapies. However, there has been a lack of comparative data regarding their long-term effectiveness and tolerability in pediatric populations.
To address this gap, the researchers established the ACMe cohort, an international, multicenter, retrospective study that included data from 30 dermatology centers across France, Italy, Portugal, Canada, and the United Kingdom. Patient data collected between 2014 and 2024 were analyzed to evaluate the 2-year drug survival rates—defined as the duration a patient remained on a given therapy before discontinuation due to loss of efficacy, adverse events, or other reasons.
Among the 506 children included, a total of 683 treatment courses were reviewed—316 with acitretin, 245 with methotrexate, and 122 with cyclosporine.
The following were the key findings of the study:
- The median drug survival time at two years was nearly identical for acitretin (10.8 months) and methotrexate (10.9 months), while cyclosporine showed a significantly shorter median duration of 3.9 months.
- Inefficacy was the main reason for discontinuing cyclosporine (43%), whereas loss of effectiveness was the primary cause for stopping acitretin (27.2%) and methotrexate (31.8%).
- No demographic or clinical characteristics, including age, sex, or disease features, were found to predict better treatment maintenance at six months.
- Acitretin demonstrated significantly higher survival when used as first-line therapy (median 11.3 months) compared to when used after another treatment (median 5.5 months).
- For methotrexate and cyclosporine, treatment survival did not differ significantly based on treatment line.
- Adverse events led to treatment discontinuation in 13.8% of patients on acitretin, 23.1% on methotrexate, and 14.0% on cyclosporine.
- Only one serious adverse event—a case of hepatitis—was reported among patients treated with methotrexate.
The researchers noted that acitretin and methotrexate demonstrated similar long-term persistence and were both more durable than cyclosporine in children with severe psoriasis. Except for first-line use of acitretin, no specific predictors of treatment maintenance were identified.
The authors suggested that these findings could serve as a foundation for refining systemic treatment strategies and improving therapeutic algorithms in pediatric psoriasis management.
Reference:
Miao, Y., Beauchet, A., Piram, M., McPherson, T., Torres, T., Yesli, Y., Aubert, H., Bodemer, C., Bertoli, C., Tardieu, M., Hubiche, T., Bonniaud, B., Neri, I., Chessa, M. A., Lasek, A., Prignano, F., Barbarot, S., Bursztejn, C., Leducq, S., . . . Mahé, E. Drug survival of systemic treatments for severe paediatric psoriasis: An international retrospective study. Journal of the European Academy of Dermatology and Venereology. https://doi.org/10.1111/jdv.70108
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