Related Experiment Video
Updated: Jan 14, 2026
The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis
Published on: July 11, 2013
Drug survival of systemic treatments for severe paediatric psoriasis: An international retrospective study
Yunyun Miao1, Alain Beauchet2, Maryam Piram3
1Department of Dermatology, Hôpital Victor Dupouy, Groupement Hospitalier de Territoire Sud Val d'Oise - Nord Hauts-de-Seine, Argenteuil, France.
Insights
Acitretin and methotrexate showed similar 2-year drug survival rates for severe childhood psoriasis, outperforming cyclosporine. First-line acitretin use improved survival, while adverse events frequently led to treatment discontinuation.
Area of Science:
- Dermatology
- Pharmacology
- Pediatrics
Background:
- Severe childhood psoriasis is treated with acitretin, methotrexate, and cyclosporine.
- Limited comparative data exists for these systemic treatments in pediatric patients.
Purpose of the Study:
- To compare the 2-year drug survival of acitretin, methotrexate, and cyclosporine in pediatric psoriasis.
- To identify factors influencing treatment maintenance and reasons for discontinuation.
Main Methods:
- Retrospective, real-world data from the ACMe cohort study.
- Involved 30 dermatology centers across five countries (France, Italy, Portugal, Canada, UK).
- Collected demographic and clinical data from 2014-2024 for 506 pediatric patients.
Main Results:
- Acitretin (10.8 months) and methotrexate (10.9 months) had comparable 2-year drug survival, superior to cyclosporine (3.9 months).
- In-efficacy and loss of effectiveness were primary reasons for discontinuation for all drugs.
- First-line acitretin use was associated with longer drug survival; adverse events led to discontinuation in 13.8-23.1% of patients.
Conclusions:
- Acitretin and methotrexate offer comparable and superior 2-year drug survival compared to cyclosporine for pediatric psoriasis.
- First-line use of acitretin is a positive predictor for treatment maintenance.
- Adverse events are a significant factor in treatment discontinuation, informing future treatment algorithms.
Background:
Three conventional systemic treatments, acitretin, methotrexate and cyclosporine, are used for severe childhood psoriasis. In many countries, they are the only treatments available. There are limited data and no comparative evaluations of these treatments.
Objectives:
The international, multicentre, retrospective, real-world ACMe cohort was developed to assess the comparative 2-year drug survival of acitretin, methotrexate and cyclosporine in paediatric psoriasis.
Methods:
Thirty dermatology centres in France, Italy, Portugal, Canada and the United Kingdom participated in the study. Demographic and clinical data were collected using a standardized form for patients receiving treatment from 2014 to 2024.
Results:
A total of 506 patients received 683 treatments: acitretin (n = 316), methotrexate (n = 245) and cyclosporine (n = 122). Median drug survival at 2 years was similar for acitretin (10.8 months) and methotrexate (10.9 months), but lower for cyclosporine (3.9 months; p < 0.0001). The most common reasons for discontinuation were inefficacy for cyclosporine (43.0%), and loss of effectiveness for acitretin (27.2%) and methotrexate (31.8%). No demographic, clinical or therapeutic characteristics were associated with higher rates of treatment maintenance at 6 months. Drug survival was higher for acitretin when used as a first-line therapy (median drug survival: 11.3 months for first-line vs. 5.5 months for second- or subsequent-line therapy; p < 0.001), but there were no differences for methotrexate and cyclosporine. Adverse events (AEs) were the reason for stopping treatment in 13.8% of patients on acitretin, 23.1% on methotrexate and 14.0% on cyclosporine (p = 0.02). Only one serious AE was reported: hepatitis in the methotrexate group.
Conclusions:
This cohort study showed that acitretin and methotrexate had comparable 2-year drug survival rates, which were superior to cyclosporine. We did not find any predictive factors for increased treatment maintenance except for first-line use of acitretin. AEs were a frequent reason for discontinuing treatments. These results may help develop treatment algorithms for systemic therapy in paediatric psoriasis.
Related Concept Videos
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
01:20Comparing the Survival Analysis of Two or More Groups