WEDNESDAY, Oct. 16, 2024 -- For pediatric patients with atopic dermatitis, one-, two-, and three-year drug survival is superior for dupilumab versus methotrexate (MTX) and cyclosporin A (CsA), according to a study published online Oct. 16 in JAMA Dermatology.

Lisa P. van der Rijst, M.D., from the University Medical Center Utrecht in the Netherlands, and colleagues examined drug survival of dupilumab, MTX, and CsA and assessed associated predictors among patients with AD aged 2 to 17 years. Data were extracted from the prospective BioDay and TREAT Netherlands registries.

The analyses included 502 treatment episodes in 362 unique patients, including 192 dupilumab episodes, 94 MTX episodes, and 216 CsA episodes. The researchers found that overall drug survival rates were 84.1, 72.3, and 62.0 percent at one, two, and three years for dupilumab; 60.7, 39.3, and 25.3 percent for MTX; and 43.9, 21.5, and 10.4 percent for CsA, respectively. The most frequent reason for drug discontinuation was ineffectiveness, accounting for 35.5 percent of episodes, mainly in patients treated with CsA, followed by adverse effects (18.7 percent). Independent associations were seen for treatment with MTX and CsA versus dupilumab with a higher risk for drug discontinuation due to ineffectiveness (hazard ratios, 4.45 and 10.88, respectively) and adverse effects (hazard ratios, 4.39 and 3.83, respectively). Independent associations were seen for patients aged 12 to 17 years starting systemic treatment with a higher risk for drug discontinuation due to ineffectiveness and adverse effects (hazard ratios, 1.55 and 2.39).

"These results have provided new insight into drug survival resulting from the effectiveness, safety, and tolerability of these systemic treatments, contributing to the optimization of patient outcomes in pediatric patients with AD," the authors write.

Several authors disclosed ties to the biopharmaceutical industry; the BioDay registry was sponsored by Sanofi, Regeneron Pharmaceuticals, Pfizer, and LEO Pharma. The TREAT Netherlands registry was sponsored by LEO Pharma, Sanofi, Novartis, Pfizer, Galderma, and AbbVie.