Cyclosporine and Methotrexate in Atopic Dermatitis: Bridging Therapies or Real-World Alternatives?

Conventional systemic therapies, including cyclosporine and methotrexate, have traditionally been used for moderate-to-severe atopic dermatitis (AD). However, their real-world effectiveness and treatment persistence in the era of advanced therapies remain uncertain.

To evaluate the effectiveness, safety, and treatment persistence of cyclosporine and methotrexate in routine clinical practice.

We conducted a retrospective observational cohort study, including patients with moderate-to-severe AD who initiated cyclosporine or methotrexate as first-line systemic therapy. Disease severity and patient-reported outcomes were assessed at treatment initiation and discontinuation. Outcomes after escalation to advanced therapies were also analyzed.

A total of 113 patients were included (mean age 33.7 ± 13.4 years; 53.1% female). Conventional systemic therapy was associated with modest clinical improvement, with no significant change in Eczema Area and Severity Index [EASI] (-0.66; P = 0.439) but a reduction in pruritus (Numerical Rating Scale [NRS] itch -1.3; P = 0.001). Median treatment duration was 20.5 weeks, and 96% discontinued therapy, mainly due to lack of efficacy (68.8%). After discontinuation, 76.0% escalated to advanced therapies, which achieved significant improvements in EASI (-11.1; P <0.001) and NRS itch (-3.2; P <0.001).

In real-world practice, cyclosporine and methotrexate show limited effectiveness and low persistence, whereas advanced therapies provide substantial clinical benefit.