Cyclosporine, methotrexate pose less risk for serious infections in atopic dermatitis

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In adults with atopic dermatitis, treatment with cyclosporine or methotrexate appears to have a lower rate of serious infections than mycophenolate, azathioprine and systemic prednisone, according to a study.

“These findings may help inform clinicians in their selection of medications for patients requiring systemic therapy for atopic dermatitis,” Maria C. Schneeweiss, MD, of the departments of dermatology and medicine in the division of pharmacoepidemiology and pharmacoeconomics at Brigham and Women’s Hospital, and colleagues wrote.

Researchers searched an insurance claims database for patients aged at least 18 years with a diagnosis of atopic dermatitis, an outpatient or inpatient visit and those who received treatment for the condition.

The serious infection rates were compared in patients treated with five popular systemic nonbiologic drugs: methotrexate, cyclosporine, azathioprine, prednisone and mycophenolate. Researchers also explored the use of phototherapy in this population.

The study endpoint was serious bacterial infections that led to a hospital admission within 180 days of follow-up.

Cohort 1 was made up of 232,611 new users of nonbiologic systemic immunomodulators (n =225,023) or phototherapy (n = 7,588).

Cohort 2 included 23,908 new users of dupilumab (Dupixent, Regeneron/Sanofi; n = 391) or nonbiologic systemic immunomodulators (n = 23,517).

Within the systemic nonbiologic agents, researchers found little differences in prior infection rates. The 6-month risk for serious infections in these treatments ranged from 6.9 per 1,000 to 37.2 per 1,000 patients.

The 6-month risk was 23% lower with cyclosporine vs. methotrexate (RR = 0.87; 95% CI, 0.59-1.29). Conversely, compared with methotrexate, the risk was doubled with azathioprine (RR = 1.78; 95% CI, 0.98-3.25) and prednisone (RR = 1.89; 95% CI, 1.05-3.42). In mycophenolate, the risk was triple that of methotrexate (RR = 3.31; 95% CI, 1.94-5.64), the researchers reported.

Among nonbiologic systemic immunomodulators, the incidence of serious infections was 7.53 per 1,000 patients, and in phototherapy initiators, the 6-month risk was 7.38 per 1,000 patients.

The researchers found an almost equal risk for serious infection with nonbiologic systemic immunomodulators and phototherapy treatment (RR = 1.12; 95% CI, 0.79-1.61).

One serious infection was identified among the dupilumab users, representing a risk of 2.6 per 1,000 patients, according to the researchers.

Preliminary data on dupilumab were favorable and showed no increase in risk for infections but need confirmation in larger populations with greater follow-up, the researchers concluded. – by Abigail Sutton

Disclosure s : Schneeweiss reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.



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