Pediatric psoriasis: biologics best methotrexate for easing severity

  • Bronckers IMGJ & al.
  • JAMA Dermatol
  • 5 Feb 2020

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • For pediatric psoriasis, biologics best methotrexate for easing symptom severity at 6 months and for drug survival rates up to 5 years.

Why this matters

  • Head-to-head comparisons of these 2 most common systemic therapies for pediatric psoriasis are rare.
  • A better performance for biologics could weigh on the choice between the two.

Key results

  • 163 children received methotrexate, 47 biologics, and 24 both (initiated with methotrexate or biologics).
  • At 6 months (unadjusted rates), 75% or greater disease severity score improvements seen in:
    • 40.0% on methotrexate and
    • 71.4% on biologics.
  • Achieved Physician Global Assessment score 0/1 seen in:
    • 35.6% on methotrexate vs
    • 48.6% on biologics.
  • With adjustment for confounders, biologics were associated at 6 months with greater odds (ORs; 95% CIs) of:
    • 75%+ decrease in severity scores: 4.56 (2.02-10.27).
    • Achieving Physician Global Assessment score 0/1: 2.00 (0.98-4.00; P=.06).
  • After adjustment for confounders, biologics were linked to better drug survival vs methotrexate:
    • HR, 2.23 (95% CI, 1.21-4.10).
  • Discontinuation rates were 35.3% with methotrexate vs 22.5% with biologics, largely for ineffectiveness or adverse events.

Study design

  • Retrospective chart review, 20 European and North American centers, covering 284 children.
  • Funding: International Psoriasis Council; individual funding from NIH.

Limitations

  • No standardized clinical approach to treatment, follow-up visits.