Drug survival of systemic treatments for severe paediatric psoriasis: An international retrospective study
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".