Biologics may be superior to methotrexate in pediatric psoriasis
Biologics were more likely to improve psoriasis than methotrexate in pediatric patients, as assessed by both the Psoriasis Area and Severity Index and Physician Global Assessment, according to a study.
A retrospective medical records review of pediatric patients treated for moderate to severe psoriasis at 20 European and North American centers compared PASI and/or PGA scores at baseline and after 6 months of treatment.
Of 234 patients who were treated with biologics or methotrexate, 163 received only methotrexate, while 47 received only biologics and 24 received the treatments sequentially. Biologics prescribed were etanercept (73.2%), adalimumab (19.7%), ustekinumab (5.6%) and infliximab (1.4%).
“Our international, retrospective cohort study appears to support a greater reduction in psoriasis severity from use of biologics compared with methotrexate in a real-world practice setting and showed a longer overall drug survival,” the study authors wrote. “To our knowledge, this is the first study to compare drug survival rates and the real-world utility profiles of methotrexate and biologics in pediatric psoriasis.”
Defined as the time patients received a specific drug, drug survival was delineated by three events: discontinuation in general, discontinuation due to ineffectiveness and discontinuation due to adverse events.
The overall drug survival for methotrexate was 77.5% after 1 year, 50.3% after 3 years and 35.9% after 5 years, while in the biologics group, the overall drug survival was 83.4% after 1 year, 64.3% after 3 years and 57.1% after 5 years.
In terms of psoriasis severity, PASI 75 was achieved in 40% of methotrexate-treated patients after 6 months compared with 71.4% of biologics-treated patients (P = .02). PGA 0/1 was higher in the biologics group (48.6%) compared with the methotrexate group (35.6%), but the difference was not statistically significant.
“In addition to their documented efficacy, biologics are convenient to use, require less monitoring and are associated with fewer treatment-related toxic effects than conventional agents in children, making them an attractive treatment option,” the authors wrote.
However, methotrexate is still a viable option due to its cost-effectiveness compared with biologics.- by Rebecca L. Forand
Disclosures: Bronkers reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.