Vito DI Lernia1, Iria Neri2, Piergiacomo Calzavara Pinton3, Sergio DI Nuzzo4, Luca Stingeni5, Claudio Guarneri6, Anna Belloni Fortina7, Domenico Bonamonte8, Stefano Cambiaghi9, Claudia Lasagni10, Michele Panzone11, Monica Corazza12, Annamaria Offidani13, Paolo Gisondi14. 1. Dermatology Unit, Department of Internal Medicine, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy - vito.dilernia@asmn.re.it. 2. Dermatology Unit, Department of Specialist, Diagnostic and Experimental Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. 3. Section of Dermatology, Department of Medicine, University of Brescia, Brescia, Italy. 4. Section of Dermatology, Department of Clinical and Experimental Medicine, Parma University Hospital, Parma, Italy. 5. Section of Clinical Dermatology, Allergology and Venereology, Department of Medicine, University of Perugia, Perugia, Italy. 6. Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy. 7. Pediatric Dermatology Unit, Department of Medicine, University of Padua, Padua, Italy. 8. Section of Dermatology, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy. 9. Pediatric Dermatology Unit, Department of Pathophysiology and Transplantation, Maggiore Hospital, Polyclinic Hospital of Milan, Milan, Italy. 10. Dermatology Unit, Department of Head and Neck Surgery, University of Modena, Modena, Italy. 11. Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy. 12. Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy. 13. Dermatology Unit, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy. 14. Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy.
Abstract
BACKGROUND: The majority of available systemic therapies have never been systematically investigated in moderate to severe childhood plaque psoriasis. For this reason, treatment preferences for moderate to severe psoriasis in childhood are still unknown. The aim of this study was to investigate the systemic treatment patterns of moderate to severe psoriasis in children and adolescents aged 18 or older in Italy. Additional secondary outcomes were duration of treatment and reasons for discontinuation. METHODS: In order to define differences in treatment patterns, we performed a chart review of all consecutive patients treated with systemic drugs during an index period of 5 years. Consecutive sampling of all patients with psoriasis aged ≤18 years, who had been treated with at least one systemic drug over a 5-year period, was made. RESULTS: The records of 58 consecutive patients, 27 males, 31 females. with moderate to severe psoriasis treated with at least one systemic therapy were reviewed. The median age (standard deviation) at the start of the first systemic treatment was 11.7±3.7 years. The most preferred first-line systemic treatment was cyclosporine, which was administered as first systemic treatment in 53.4% of patients, followed by acitretin in 22.4% of patients, etanercept and PUVA respectively in 8.6%, methotrexate in 6.8%. 48.2% of patients received a second systemic treatment due to inefficacy or side effects of the first-line therapy during the index period. Because of the small sample, and voluntary contribution, selection bias may have occurred. CONCLUSIONS: A considerable variation in the management of the first-line systemic therapy in children with moderate to severe psoriasis was observed. Cyclosporine was most commonly preferred as a first-line treatment. The availability of new therapeutic agents could change the scenario of treatment patterns in childhood psoriasis.
BACKGROUND: The majority of available systemic therapies have never been systematically investigated in moderate to severe childhood plaque psoriasis. For this reason, treatment preferences for moderate to severe psoriasis in childhood are still unknown. The aim of this study was to investigate the systemic treatment patterns of moderate to severe psoriasis in children and adolescents aged 18 or older in Italy. Additional secondary outcomes were duration of treatment and reasons for discontinuation. METHODS: In order to define differences in treatment patterns, we performed a chart review of all consecutive patients treated with systemic drugs during an index period of 5 years. Consecutive sampling of all patients with psoriasis aged ≤18 years, who had been treated with at least one systemic drug over a 5-year period, was made. RESULTS: The records of 58 consecutive patients, 27 males, 31 females. with moderate to severe psoriasis treated with at least one systemic therapy were reviewed. The median age (standard deviation) at the start of the first systemic treatment was 11.7±3.7 years. The most preferred first-line systemic treatment was cyclosporine, which was administered as first systemic treatment in 53.4% of patients, followed by acitretin in 22.4% of patients, etanercept and PUVA respectively in 8.6%, methotrexate in 6.8%. 48.2% of patients received a second systemic treatment due to inefficacy or side effects of the first-line therapy during the index period. Because of the small sample, and voluntary contribution, selection bias may have occurred. CONCLUSIONS: A considerable variation in the management of the first-line systemic therapy in children with moderate to severe psoriasis was observed. Cyclosporine was most commonly preferred as a first-line treatment. The availability of new therapeutic agents could change the scenario of treatment patterns in childhood psoriasis.