- For pediatric psoriasis, biologics best methotrexate for easing symptom severity at 6 months and for drug survival rates up to 5 years.
Why this matters
- Head-to-head comparisons of these 2 most common systemic therapies for pediatric psoriasis are rare.
- A better performance for biologics could weigh on the choice between the two.
- 163 children received methotrexate, 47 biologics, and 24 both (initiated with methotrexate or biologics).
- At 6 months (unadjusted rates), 75% or greater disease severity score improvements seen in:
- 40.0% on methotrexate and
- 71.4% on biologics.
- Achieved Physician Global Assessment score 0/1 seen in:
- 35.6% on methotrexate vs
- 48.6% on biologics.
- With adjustment for confounders, biologics were associated at 6 months with greater odds (ORs; 95% CIs) of:
- 75%+ decrease in severity scores: 4.56 (2.02-10.27).
- Achieving Physician Global Assessment score 0/1: 2.00 (0.98-4.00; P=.06).
- After adjustment for confounders, biologics were linked to better drug survival vs methotrexate:
- HR, 2.23 (95% CI, 1.21-4.10).
- Discontinuation rates were 35.3% with methotrexate vs 22.5% with biologics, largely for ineffectiveness or adverse events.
- Retrospective chart review, 20 European and North American centers, covering 284 children.
- Funding: International Psoriasis Council; individual funding from NIH.
- No standardized clinical approach to treatment, follow-up visits.