University Rennes 1, Rennes, France.
Department of Dermatology, CHU Rennes, Rennes, France.
J Eur Acad Dermatol Venereol. 2018 Aug;32(8):1327-1335. doi: 10.1111/jdv.14880. Epub 2018 Mar 6.
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).
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.
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'.
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.
环孢素和甲氨蝶呤是特应性皮炎的两种首选一线免疫抑制治疗药物。本研究旨在通过两种生存分析，即“药物生存”（使用药物的时间）和“药物后生存”（两种药物之间的时间），比较甲氨蝶呤和环孢素作为特应性皮炎一线免疫抑制治疗的治疗方案。
这是一项回顾性研究，纳入了接受甲氨蝶呤或环孢素作为一线免疫抑制治疗的中重度特应性皮炎患者。收集了治疗中断的原因，包括：疾病得到控制、治疗失败、不良反应（妊娠）和不遵医嘱。使用 Kaplan-Meier 方法进行“药物生存”和“药物后生存”分析，并使用单变量和多变量 Cox 回归分析来分析预测因素。
纳入了 56 名患者，其中 25 名接受环孢素治疗，31 名接受甲氨蝶呤治疗（中位年龄：34±15 岁），研究时间为 2007 年至 2016 年。“疾病得到控制”和其他原因之间的停药原因无显著差异（P=0.11）。甲氨蝶呤的“药物生存”中位数明显长于环孢素（23 个月比 8 个月）（P<0.0001）。从基线开始 6 个月时，93%接受甲氨蝶呤治疗的患者仍在接受治疗，而接受环孢素治疗的患者为 63%。甲氨蝶呤的“药物后生存”中位数明显长于环孢素（12 个月比 2 个月）。只有 CYC 治疗是“药物生存”和“药物后生存”缩短的预测因素。
这是首次在日常实践中对甲氨蝶呤和环孢素作为中重度特应性皮炎一线免疫抑制治疗的直接比较。我们发现了两种不同的治疗方案：甲氨蝶呤的给药时间长于环孢素。“药物后生存”可能是评估特应性皮炎停药后药物疗效维持的新工具，更广泛地说是评估慢性皮肤病的工具。
