Immunosuppressants for Atopic Dermatitis: Safe, Effective in Long-Term

Patients of one treatment center who received long-term treatment of their atopic dermatitis (AD) with one of three systemic immunosuppressive agents or a novel combination generally tolerated and benefited from the treatments, according to a new retrospective study.

Julien Seneschal, MD, PhD, and colleagues at the Department of Dermatology, National Reference Center for Rare Skin Disorders, Saint-André Hospital, Bordeaux, France, reported on therapeutic response and adverse events from the long-term immunosuppressive treatment of AD in 54 adult patients in the September issue of Acta Dermato-Venereologica.

"A large proportion of patients respond(ing) to systemic agents were able to discontinue their therapies without flare-up of their disease under topical therapies," Seneschal and colleagues relate, "suggesting that a long course of systemic agents could lead to partial remission of the disease."

The patients were treated at the center between January 2000 and December 2014 with either cyclosporin A (Neoral, Myfortic, others) for a mean 13.2 months, azathioprine (Imuran, Promethius Laboratories, others) for mean 11.3 months, methotrexate (Neotrexate, Glaxo SmithKline, others) for mean 20.4 months, or the novel combination of methotrexate and azathioprine for mean 27.9 months.

Follow-up conducted after 3 to 6 months with administration of the Physician's Global Assessment (PGA) found 65.9 percent of the 27 patients receiving cyclorporin A (CsA) were responders, 37.5 percent (6 patients) responded to azathioprine (AZA), and 55.6 percent (15 patients) responded to methotrexate. The combination of MTX with AZA was effective in 4 of 7 patients, despite each previously failing monotherapy.

Mild lymphocytopenia and common infections were among the most common adverse events, but did not require discontinuation of treatment. Treatment with CsA was discontinued in 2 patients for hypertension and in 1 for renal function impairment. MTX was discontinued in 2 patients and AZA in 1 patient for elevated transaminases. The combination treatment was discontinued in one patient because of nausea and vomiting.

The investigators indicate that their experiences with long-term use of the 3 agents are generally consistent with those reported in the literature. They suggest that their findings with the novel combination of MTX/AZA for AD warrants further study.

"The (combination), lowering the dose of both drugs, can be effective for patients for whom these treatments have failed used as monotherapy," Seneschal and colleagues wrote.

http://www.ncbi.nlm.nih.gov/pubmed/26925822

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