Methotrexate, azathioprine show comparable safety, efficacy in pediatric atopic dermatitis

September 01, 2021

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The researchers report no relevant financial disclosures.

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Methotrexate and azathioprine provided similar risk-benefit ratios as first-line therapy for children with severe atopic dermatitis, according to a study.

“Systemic immunosuppressive treatments are central to the management of severe atopic dermatitis,” Stine Elsgaard, MBBS, from the department of dermatology at Aarhus University Hospital, in Aarhus, Denmark, and colleagues wrote.

However, they noted that there is little 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 from systemic immunosuppressive treatments.

The study included 63 patients treated with first-line methotrexate and 32 patients treated with first-line azathioprine.

The results showed a survival rate of 69% at 1 year for methotrexate. The drug survival rate was 50% at 2 years and 18% at 4 years. Methotrexate was associated with an overall median survival time of 1.58 years.

The survival rates for azathioprine were 63% at 1 year, 53% at 2 years, and 21% at 4 years, with an overall median survival time of 1.14 years.

According to the findings, no significant difference was observed in drug survival between methotrexate and azathioprine.

Adverse reactions accounted for 25% of methotrexate discontinuations and 41% of those discontinuing azathioprine. That said, according to the findings, 60% of patients treated with methotrexate and 53% of patients treated with azathioprine reported benefits of the drugs at the time of discontinuation or data-lock.

In addition, treatment with both drugs produced 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 second-line cyclosporine.

According to the findings, drug survival times for second-line therapies were 1.8 years for methotrexate, 0.2 years for azathioprine and 0.885 years for cyclosporine.

“As the prevalence of AD in children has increased and new therapies emerge, these results may guide clinical decision-making in the treatment of severe AD in children,” the researchers wrote.

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