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

Sarah Law Ping Man 1 Guillaume Bouzillé 2, 3, 4 Nathalie Beneton 5 Gilles Safa 6 Alain Dupuy 7, 1 Catherine Droitcourt 3, 7, 1, *
* Corresponding author
1 Département de Dermatologie [CHU Rennes]
2 LTSI - Laboratoire Traitement du Signal et de l'Image
3 CIC - Centre d'Investigation Clinique [Rennes]
4 Clinical Data Center [CHU Rennes]
5 Département de Dermatologie [CH Le Mans]
6 Département de Dermatologie [CH Saint-Brieuc]
7 REPERES - Recherche en Pharmaco-épidémiologie et Recours aux Soins
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 '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.
Keywords : drug survival post-drug survival immunosuppressive treatment atopic dermatitis
Document type :
Journal articles
Complete list of metadatas
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01798651
Contributor : Laurent Jonchère <>
Submitted on : Thursday, September 20, 2018 - 10:30:07 AM
Last modification on : Thursday, April 11, 2019 - 10:18:11 AM
Long-term archiving on : Friday, December 21, 2018 - 2:06:45 PM

File

Law Ping Man et al_Drug surviv...
Files produced by the author(s)

Identifiers

Collections

UNIV-RENNES1 | UNIV-RENNES | REPERES | USPC | EHESP | UR1-UFR-SVE | BIOSIT | CIC203 | CIC | LTSI

Citation

Sarah Law Ping Man, Guillaume Bouzillé, Nathalie Beneton, Gilles Safa, Alain Dupuy, et al.. Drug survival and postdrug survival of first-line immunosuppressive treatments for atopic dermatitis comparison between methotrexate and cyclosporine: Drug survival and post-drug survival of immunosuppressive treatments for atopic dermatitis. Journal of the European Academy of Dermatology and Venereology, Wiley, 2018, 32 (8), pp.1327-1335. ⟨10.1111/jdv.14880⟩. ⟨hal-01798651⟩

Export

BibTeX TEI DC DCterms EndNote

Share

Metrics

Record views

336

Files downloads

83