Drug survival and post-drug survival of first-line immunosuppressive treatments for atopic dermatitis: comparison between methotrexate and cyclosporine

Abstract

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 "post-drug 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: controlled disease, treatment failure, side event pregnancy and non-compliance. "Drug survival" and "post-drug survival" analyses were performed using the Kaplan Meier method and predictive factors were analyzed using uni- and multivariate Cox regression analyses.

Results

56 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 "post-drug 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 "post-drug 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. "Post-drug 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.

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