title: Drug survival for ciclosporin A in a long-term daily practice cohort of adult patients with atopic dermatitis.
abstract: BACKGROUND
  Long-term data of ciclosporin A (CsA) treatment in daily practice in patients with severe atopic dermatitis (AD) are lacking.
  
  
  OBJECTIVE
  To perform a detailed analysis of drug survival, which is the length of time a patient continues to take a drug, for CsA in a long-term daily practice cohort of patients with AD. The secondary objective was to identify determinants of drug survival.
  
  
  METHODS
  Data were extracted from a retrospective cohort of patients treated with CsA for AD. Drug survival was analysed using Kaplan-Meier survival curves. Determinants of drug survival were analysed using uni- and multivariate Cox regression analyses with backward selection.
  
  
  RESULTS
  In total, 356 adult patients were analysed (386 patient-years). The overall drug survival rates were 34%, 18%, 12% and 4% after 1, 2, 3 and 6 years, respectively. Reasons for discontinuation were controlled AD (26·4%), side-effects (22·2%), ineffectiveness (16·3%), side-effects plus ineffectiveness (6·2%) or other reasons (11·0%). Older age was associated with a decreased drug survival related to controlled AD [hazard ratio (HR) 0·91]. Older age was also associated with a decreased drug survival related to side-effects (HR 1·14). An intermediate-to-high starting dose (> 3·5-5·0 mg kg(-1) daily) was associated with an increased drug survival related to ineffectiveness (HR 0·63).
  
  
  CONCLUSIONS
  This is the first study on drug survival for CsA treatment in AD. Older age was associated with decreased drug survival related to controlled AD and side-effects. An intermediate-to-high starting dose was associated with an increased drug survival related to ineffectiveness.
authors: Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors: J
authors: J
authors: van der Schaft
authors: Department of Dermatology, University Medical Center Groningen, Groningen, the Netherlands.
authors: K
authors: K
authors: Politiek
authors: Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors: J M P A
authors: JMPA
authors: van den Reek
authors: Department of Dermatology, University Medical Center Groningen, Groningen, the Netherlands.
authors: W A
authors: WA
authors: Christoffers
authors: Department of Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors: W
authors: W
authors: Kievit
authors: Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors: E M G J
authors: EMGJ
authors: de Jong
authors: Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors: C A F M
authors: CAFM
authors: Bruijnzeel-Koomen
authors: Department of Dermatology, University Medical Center Groningen, Groningen, the Netherlands.
authors: M L A
authors: MLA
authors: Schuttelaar
authors: Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors: M S
authors: MS
authors: de Bruin-Weller
mesh_terms: D000328:Adult; D000367:Age Factors; D016572:Cyclosporine / Q000008:administration & dosage* / Q000009:adverse effects; D003876:Dermatitis, Atopic / Q000188:drug therapy*; D003879:Dermatologic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D057915:Drug Substitution; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D003879:Dermatologic Agents; D016572:Cyclosporine