Systemic treatments in childhood psoriasis: a French multicentre study on 154 children

Charbit, L.; Mahé, E.; Phan, Alice; Chiavérini, C.; Boralévi, F.; Bourrat, E.; Lasek, A.; Maruani, Annabel; Aubin, F.; Droitcourt, Catherine; Barbarot, S.; Mallet, S.; Mazereeuw‐Hautier, J.; Bégon, É.; Abasq, C.; Plantin, P.; Souillet, A.‐L.; Hadj‐Rabia, S.; Bursztejn, A.‐C.

doi:10.1111/bjd.14326

Cited by 43 publications

(35 citation statements)

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“…5,6 However, data are sparse on the efficacy and toxicity of systemic agents in the paediatric population. [6][7][8] Standardised guidelines are lacking, and few clinical trials have been conducted in children. 5,[9][10][11] Targeted therapies, including tumour necrosis factor alpha blockers (anti-TNFa agents) and ustekinumab, have recently been shown to be effective and safe as therapies for childhood psoriasis in controlled trials.…”

Section: Introductionmentioning

confidence: 99%

Biological treatments for paediatric psoriasis : a retrospective observational study on biological drug survival in daily practice in childhood psoriasis

Phan

Beauchet

Burztejn

et al. 2019

Acad Dermatol Venereol

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JEADV AbstractBackground Three biotherapiesetanercept, adalimumab and ustekinumabare licensed in childhood psoriasis. The few data available on their efficacy and tolerance are mainly derived from industry trials. However, biological drug survival impacts long-term performance in real-life settings.Objective The objective of this study was to evaluate the survival rates of biological therapies in children with psoriasis in real-life conditions. Secondary objectives were to evaluate the factors associated with the choice of the biological therapy and to report severe adverse events. Materials and methodsThis study was an observational retrospective study. Data were extracted from the clinical records of 134 children. Kaplan-Meier estimates were used to analyse drug survival overall and in subgroups of plaque psoriasis, bio-na€ ıve and non-na€ ıve patients. ResultsWe analysed 184 treatment courses: 70 with etanercept, 68 with adalimumab and 46 with ustekinumab.Factors associated with the choice of first-line biological agent were age at initiation (younger for adalimumab, P < 0.0001), age at onset of psoriasis (younger for adalimumab and etanercept, P = 0.03) and baseline Psoriasis Assessment Severity Index and Physician global assessment (both higher for adalimumab, P < 0.001). Drug survival rates were higher for ustekinumab than for adalimumab and etanercept (P < 0.0001) for all treatment and all psoriasis types, plaque-type psoriasis (P = 0.0003), patients na€ ıve for biological agents (P = 0.0007) and non-na€ ıve patients (P = 0.007). We reported eight serious adverse events (SAEs): severe infections (n = 3), significant weight gain (n = 2), psoriasis flare (n = 1) and malaise (n = 1). Biological therapy was discontinued in three children (one with psoriasis flare and two with weight gain). Only the two cases of weight gain resulted in an unfavourable outcome.Conclusions Our real-life comparative study found that ustekinumab had the best drug survival outcome. The profile of SAEs in children was comparable to that in adults. These results will assist dermatologists in the decision-making process when choosing treatment options for children with psoriasis in daily practice.

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Section: Introductionmentioning

confidence: 99%

Biological treatments for paediatric psoriasis : a retrospective observational study on biological drug survival in daily practice in childhood psoriasis

Phan

Beauchet

Burztejn

et al. 2019

Acad Dermatol Venereol

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“…Prospective large studies have been published for etanercept (Paller et al, ), ustekinumab (Landells et al, ), adalumimab (Papp et al, ), and methotrexate (Di Lernia et al, ; Papp et al, ). Other information come from case series, retrospective studies, or systematic review of the literature (Bronckers et al, in press; Bulbul Baskan, Yazici, Tunali, and Saricaoglu, ; Charbit et al, ; De Jager, de Jong, van de Kerkhof, and Seyger, ; Di Lernia et al, ; Kaur, Dogra, De, and Kanwar, ; Van Geel, Mul, et al, ; Van Geel, Oostveen, et al, ). Because few drugs have been evaluated in prospective studies, we have very little information on true efficiency and tolerance of them.…”

Section: Introductionmentioning

confidence: 99%

Management of childhood psoriasis in France. A national survey among general practitioners, pediatricians, and dermatologists

Mahé

Bursztejn

Phan

et al. 2017

Dermatologic Therapy

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Psoriasis affects 0.5-2% of children. Severe forms required use of systemic treatments. Few studies are published on efficiency and tolerance of systemic treatments in children. We conducted a survey in France to better understand management of children with psoriasis. A survey on childhood psoriasis management was sent by e-mail to GPs, pediatricians, and dermatologists. The survey included 384 physicians. Respectively 53.1%, 49.8%, and 83.3% of GPs, pediatricians, and dermatologists declare to have seen at least one child with psoriasis during the 3 previous months. Less than 5% of GPs and pediatricians used severity score versus 23.7% of dermatologists. If most of physicians declare to use local treatments, less than 5% of GPs and pediatricians used systemic treatments. 32.4% of dermatologists declared to use at least one systemic treatment, but only 2.9% to use the 4 systemic treatments available in France. This survey shows that only half of GPs and pediatricians see children with psoriasis, but most of dermatologists. However, the management of severe forms seems limited by the underuse of severity scores and systemic treatments. These results should stimulate dermatology societies to promote prospective studies and guidelines in young populations with psoriasis.

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“…Cyclosporine (2.5–5 mg/kg/week) can be used specially for erythrodermic and palmoplantar psoriasis. However, it is not recommended as a first choice since the reports are ambiguous about efficacy and side effects (Charbit et al, ; de Jager et al, ). Biologics approved for psoriasis treatment in pediatric population include adalimumab (≥4 years old), etanercept (≥4 years old), ustikenumab (≥12 years old) (Boyd & Menter, ; Leavitt, ).…”

Section: Treatment Strategies In Special Populationsmentioning

confidence: 99%

“…PUVA is to be avoided since there is an increased risk of skin cancer along with the associated photosensitization with oral PUVA requiring specific care for the child. Methotrexate (0.2-0.4 mg/kg/week) is considered as the first-line therapy for severe psoriasis in children in most European countries (Charbit et al, 2016;de Jager, de Jong, van de Kerkhof, & Seyger, 2010;Gisondi et al, 2017;Kogan et al, 2019). Acitretin (0.5-1 mg/kg/day) is also effective and tolerated for plaque, palmoplantar and pustular psoriasis.…”

Section: Childrenmentioning

confidence: 99%

See 1 more Smart Citation

Practical compendium for psoriasis management

Ibrahim

Amer

Nofal

et al. 2020

Dermatologic Therapy

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Psoriasis management is complex and challenging. It should be tailored for each patient. Treatment strategy differs according to patient's age, sex, disease type, disease severity, burden on patient's quality of life, comorbidities, involvement of specific sites, and pregnancy. The choice of the appropriate therapeutic must take into consideration the availability, the price, and the patient's preferences. It is very important that the chosen treatment is not more unpleasant, intolerable, or dangerous than the disease itself. According to the disease type, severity, and effect on patient's quality of life, dermatologist chooses whether to start with topical therapy, phototherapy or systemic therapy, or a combination of two or more of them. Under each category, there are different types of therapies that can be the first line therapeutics, second line, or even contraindicated. In this compendium, we provide dermatologists with different treatment plans considering all the mentioned variables so that a dermatologist can choose the optimum plan for the patient.

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Systemic treatments in childhood psoriasis: a French multicentre study on 154 children

Cited by 43 publications

References 12 publications

Biological treatments for paediatric psoriasis : a retrospective observational study on biological drug survival in daily practice in childhood psoriasis

Biological treatments for paediatric psoriasis : a retrospective observational study on biological drug survival in daily practice in childhood psoriasis

Management of childhood psoriasis in France. A national survey among general practitioners, pediatricians, and dermatologists

Practical compendium for psoriasis management

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