New Range of Investigational Therapies For AD
Numerous miscellaneous agents across several additional treatment classes are being investigated for the treatment of atopic dermatitis (AD). The therapies include targeted topical, oral, systemic, and biologic agents, according to a recent study by Vakharia and Silverberg, published online in Journal of the American Academy of Dermatology.
Study Looks at 5-Year Evidence for Off-Label AD Systemic Treatment
Systemic treatment is indicated for moderate to severe atopic dermatitis (AD), refractory to topical treatment. Gerbens and colleagues investigated the long-term effectiveness, safety, and drug survival of off-label prescribed methotrexate (MTX) and azathioprine (AZA) in a recent study, published online in British Journal of Dermatology.
In the open-label follow-up phase of a clinical trial, patients were seen every 3 months for 5 years. MTX and AZA doses could be increased or decreased concurrent with daily clinical practice. Primary effectiveness outcomes were mean absolute and relative reduction in SCORing Atopic Dermatitis (SCORAD) index and Investigator’s Global Assessment after 5 years compared to baseline. For safety type, frequency, severity, and relatedness to treatment of adverse events were investigated. Drug survival was analyzed by Kaplan-Meier curves.
This study included 35 of the 43 original participants, of which 27 completed follow up. At year 5 mean relative reduction in SCORAD index was similar in the MTX and AZA group: 52.8% and 53.8% by descriptive analysis. Eleven serious adverse events occurred in 5 years, including 3 in which there was a possible causal relationship. Drug survival demonstrated a longer survival for MTX, but survival in both groups was low after 5 years (MTX n=5, AZA n=1).
Based on this relatively small pragmatic study, MTX and AZA seem to be effective and safe as maintenance treatments in moderate to severe AD up to 5 years, the researchers concluded. Few patients in both groups survive on their originally allocated drug although some discontinued due to controlled AD.
Gerbens LAA, Hamann SAS, Brouwer MWD, et al. Methotrexate and azathioprine in severe atopic dermatitis: a 5-year follow up study of a randomised controlled trial [published online December 13, 2017]. Br J Dermatol. doi:10.1111/bjd.16240
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