Methotexate and cyclosporine appear to have better safety profiles over a six-month period than other systemic treatments used to treat atopic dermatitis, according to the results of a study published in the Journal of the American Academy of Dermatology.1
Researchers at Brigham and Women’s Hospital in Boston analyzed insurance claims data to determine and compare rates of occurrence of serious bacterial and opportunistic infections among patients taking the drugs for atopic dermatitis in real-life practice.
They examined five non-biologic systemic drugs that are often used off-label: methotrexate, cyclosporine, azathioprine, prednisone and mycophenolate. They also examined phototherapy and dupilumab (Dupixent, Sanofi and Regeneron Pharmaceuticals), the only targeted biologic drug specifically approved for atopic dermatitis. Phototherapy is generally considered a safe treatment option for patients with recalcitrant atopic dermatitis, with most of its safety evidence coming from use in patients with psoriasis.2
Cyclosporine and methotrexate were associated with the lowest rates of serious infections, while prednisone, azathioprine and mycophenolate were associated with higher infection rates.1 The small amount of available data on dupilumab did not suggest any safety concerns, but the researchers pointed out that since dupilumab has been marketed in the United States since March 28, 2017, a more in-depth evaluation is needed.
The claims data covered 185 million patients in the United States between 2003 and 2017. Patients aged 18 or older with a diagnosis of atopic dermatitis who had not taken an immunomodulating agent in the six months prior to initiation of treatment were included. Patients were excluded if they had started a systemic immunomodulatory drug for reasons other than atopic dermatitis, such as rheumatoid arthritis, connective tissue disease, psoriasis, inflammatory bowel disease, cancer or HIV.
1. Schneeweiss MC, Perez-chada L, Merola JF. Comparative Safety of Systemic Immuno-modulatory Medications in Adults with Atopic Dermatitis. J Am Acad Dermatol. 2019;
2. Patrizi A, Raone B, Ravaioli GM. Management of atopic dermatitis: safety and efficacy of phototherapy. Clin Cosmet Investig Dermatol. 2015;8:511-20.