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

Autor: Guillaume Bouzillé, S. Law Ping Man, Catherine Droitcourt, Nathalie Beneton, G. Safa, Alain Dupuy
Přispěvatelé: Service de Dermatologie [Rennes] = Dermatology [Rennes], CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Clinical Data Center [CHU Rennes], Service de dermatologie [CH Le Mans], Centre Hospitalier Le Mans (CH Le Mans), Département de Dermatologie [CH Saint-Brieuc], CHU de Saint-Brieuc, Recherche en Pharmaco-épidémiologie et Recours aux Soins (REPERES), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP), Jonchère, Laurent, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Drug
Adult
Male
medicine.medical_specialty
Time Factors
media_common.quotation_subject
Dermatology
Alphavirus
Kaplan-Meier Estimate
Gastroenterology
Dermatitis
Atopic
030207 dermatology & venereal diseases
03 medical and health sciences
Young Adult
0302 clinical medicine
drug survival
Internal medicine
medicine
Humans
media_common
Proportional Hazards Models
Retrospective Studies
Pregnancy
atopic dermatitis
Proportional hazards model
business.industry
Retrospective cohort study
immunosuppressive treatment
Atopic dermatitis
[SDV.IMM.IMM]Life Sciences [q-bio]/Immunology/Immunotherapy
[SDV.MHEP.DERM] Life Sciences [q-bio]/Human health and pathology/Dermatology
medicine.disease
3. Good health
Discontinuation
Drug survival
Infectious Diseases
Methotrexate
030220 oncology & carcinogenesis
[SDV.SP.PHARMA] Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology
Cyclosporine
[SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology
Female
[SDV.IMM.IMM] Life Sciences [q-bio]/Immunology/Immunotherapy
business
post-drug survival
Immunosuppressive Agents
[SDV.MHEP.DERM]Life Sciences [q-bio]/Human health and pathology/Dermatology
medicine.drug
Zdroj: Journal of the European Academy of Dermatology and Venereology
Journal of the European Academy of Dermatology and Venereology, Wiley, 2018, 32 (8), pp.1327-1335. ⟨10.1111/jdv.14880⟩
Journal of the European Academy of Dermatology and Venereology, 2018, 32 (8), pp.1327-1335. ⟨10.1111/jdv.14880⟩
ISSN: 0926-9959
1468-3083
DOI: 10.1111/jdv.14880⟩
Popis: International audience; IntroductionCyclosporine 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).MethodsRetrospective 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.ResultsFifty-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’.ConclusionThis 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.
Databáze: OpenAIRE
Externí odkaz: