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Greater improvement seen in disease severity by 12 weeks with ciclosporin, but MTX was superior by 60 weeks

For children and young people with severe atopic dermatitis (AD), ciclosporin (CyA) and methotrexate (MTX) are both effective over 36 weeks, according to a study published online Sept. 19 in the British Journal of Dermatology.

Carsten Flohr, Ph.D., from Guy’s and St. Thomas’ NHS Foundation Trust and King’s College London, and colleagues compared the safety and efficacy of CyA versus MTX in children and young people with severe AD. Eligible participants were aged 2 to 16 years and were unresponsive to potent topical treatment. One hundred three participants were randomly assigned to oral CyA (4 mg/kg/day) or MTX (0.4 mg/kg/week) for 36 weeks (52 and 51 patients, respectively).

The researchers observed greater improvement in disease severity by 12 weeks with CyA (mean difference Objective Severity Scoring of Atopic Dermatitis [o-SCORAD], −5.69). A 50 percent decrease in o-SCORAD (o-SCORAD-50) was reached by more participants in the CyA than MTX arm at 12 weeks (odds ratio, 2.60). MTX was superior by 60 weeks (odds ratio, 0.33); a trend was also seen for o-SCORAD-75, 50 percent reduction from baseline in the Eczema Area and Severity Index (EASI-50), and EASI-75. The CyA arm had higher participant-reported flares posttreatment (odds ratio, 3.22). Improvement in quality of life was seen with both treatments and was sustained after cessation of treatment. Both treatments had comparable frequency of adverse events.

“The TREAT trial demonstrated that both CyA and MTX are effective well-tolerated treatments for children and young people with severe AD,” the authors write. “CyA acts more quickly, while MTX induces better disease control after treatment discontinuation.”

Several authors disclosed ties to the pharmaceutical industry.

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