title: Efficacy, safety and drug survival of conventional agents in pediatric psoriasis: A multicenter, cohort study.
abstract: The data on long-term efficacy, safety and drug survival rates of conventional systemic therapeutics in pediatric psoriasis is lacking. The primary aim of this study is to investigate acitretin, methotrexate, cyclosporin efficacy, safety and drug survival rates in pediatric patients as well as predictors of drug survival. This is a multicenter study including 289 pediatric cases being treated with acitretin, methotrexate and cyclosporin in four academic referral centers. Efficacy, adverse events, reasons for discontinuation, 1, 2- and 3-year drug survival rates, and determinants of drug survival were analyzed. A 75% reduction of Psoriasis Area and Severity Index score or better response rate was obtained in 47.5%, 34.1% and 40% of the patients who were treated with acitretin, methotrexate and cyclosporin, respectively. One-year drug survival rates for acitretin, methotrexate and cyclosporin were 36.3%, 21.1% and 15.1%, respectively. The most significant determinant of drug survival, which diminished over time, was treatment response whereas arthritis, body mass index and sex had no influence. Although all three medications are effective and relatively safe in children, drug survival rates are low due to safety concerns at this age group. Effective disease control through their rational use can be expected to improve survival rates.
authors.affiliation: Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey.
authors.forename: Tulin
authors.initials: T
authors.lastname: Ergun
authors.affiliation: Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey.
authors.forename: Dilek
authors.initials: D
authors.lastname: Seckin Gencosmanoglu
authors.affiliation: Department of Dermatology, Akdeniz University School of Medicine, Antalya, Turkey.
authors.forename: Erkan
authors.initials: E
authors.lastname: Alpsoy
authors.affiliation: Department of Dermatology, Uludag University School of Medicine, Bursa, Turkey.
authors.forename: Emel
authors.initials: E
authors.lastname: Bulbul-Baskan
authors.affiliation: Department of Dermatology, Oltu State Hospital, Erzurum, Turkey.
authors.forename: Merve Hatun
authors.initials: MH
authors.lastname: Saricam
authors.affiliation: Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey.
authors.forename: Andac
authors.initials: A
authors.lastname: Salman
authors.affiliation: Department of Dermatology, Bezm-i Alem University School of Medicine , Istanbul, Turkey.
authors.forename: Nahide
authors.initials: N
authors.lastname: Onsun
authors.affiliation: Department of Public Health, Marmara University School of Medicine, Istanbul, Turkey.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Sarioz
mesh_terms: D017255:Acitretin / Q000008:administration & dosage* / Q000009:adverse effects; D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D016572:Cyclosporine / Q000008:administration & dosage* / Q000009:adverse effects; D003879:Dermatologic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects; D011565:Psoriasis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D003879:Dermatologic Agents; D016572:Cyclosporine; D017255:Acitretin; D008727:Methotrexate
keywords: drug survival; efficacy; pediatric; psoriasis; systemic treatment