Systemic treatments in paediatric psoriasis: a systematic evidence‐based update

Geel, M.J. van; Mul, Karlien; Jager, M.E.A. de; Kerkhof, P.C.M. van de; Jong, E.M.G.J. de; Seyger, M.M.B.

doi:10.1111/jdv.12749

Cited by 44 publications

(56 citation statements)

References 87 publications

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“…16 Although we cannot compare our data with the published work, our response rate is lower than the reported cyclosporin efficacy in adults. Published work on outcomes of pediatric psoriasis cases using cyclosporin is limited to nine patients, mostly with generalized pustular psoriasis (n = 5).…”

Section: Discussioncontrasting

confidence: 68%

Efficacy, safety and drug survival of conventional agents in pediatric psoriasis: A multicenter, cohort study

Ergun

Gençosmanoğlu

Alpsoy

et al. 2016

The Journal of Dermatology

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The data on long-term efficacy, safety and drug survival rates of conventional systemic therapeutics in pediatric psoriasis is lacking. The primary aim of this study is to investigate acitretin, methotrexate, cyclosporin efficacy, safety and drug survival rates in pediatric patients as well as predictors of drug survival. This is a multicenter study including 289 pediatric cases being treated with acitretin, methotrexate and cyclosporin in four academic referral centers. Efficacy, adverse events, reasons for discontinuation, 1, 2- and 3-year drug survival rates, and determinants of drug survival were analyzed. A 75% reduction of Psoriasis Area and Severity Index score or better response rate was obtained in 47.5%, 34.1% and 40% of the patients who were treated with acitretin, methotrexate and cyclosporin, respectively. One-year drug survival rates for acitretin, methotrexate and cyclosporin were 36.3%, 21.1% and 15.1%, respectively. The most significant determinant of drug survival, which diminished over time, was treatment response whereas arthritis, body mass index and sex had no influence. Although all three medications are effective and relatively safe in children, drug survival rates are low due to safety concerns at this age group. Effective disease control through their rational use can be expected to improve survival rates.

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Section: Discussioncontrasting

confidence: 68%

Efficacy, safety and drug survival of conventional agents in pediatric psoriasis: A multicenter, cohort study

Ergun

Gençosmanoğlu

Alpsoy

et al. 2016

The Journal of Dermatology

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“…However, there are no randomized controlled pediatric trials. Individual case reports and small case studies, particularly in children with pustular and erythrodermic psoriasis, include publications on acitretin monotherapy [9] as well as on its combination with systemic corticosteroids, NB-UVB or PUVA therapy [10][11][12][13][14]. Even though clinical improvement has generally been reported after 2-3 months of treatment, recurrences seem to be quite common and frequently require intermittent treatment.…”

Section: Acitretinmentioning

confidence: 99%

“…In children, it is primarily used for induction therapy of severe, recalcitrant plaque psoriasis as well as for treatment of erythrodermic and pustular disease variants. As regards cyclosporine treatment in children, there are -again -only individual case reports and small-scale case studies, which showed varying degrees of therapeutic success [10,18,19]. Cyclosporine is not approved for treatment of childhood psoriasis, and there are no controlled studies.…”

Section: Cyclosporinementioning

confidence: 99%

S2k guidelines for the treatment of psoriasis in children and adolescents – Short version part 2

Eisert

Augustin

Bach

et al. 2019

J Deutsche Derma Gesell

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Summary The present guidelines are aimed at residents and board‐certified physicians in the fields of dermatology, pediatrics, pediatric dermatology and pediatric rheumatology as well as policymakers and insurance funds. They were developed by dermatologists and pediatric dermatologists in collaboration with pediatric rheumatologists using a formal consensus process (S2k). The guidelines highlight topics such as disease severity, quality of life, treatment goals as well as problems associated with off‐label drug therapy in children. Trigger factors and diagnostic aspects are discussed. The primary focus is on the various topical, systemic and UV‐based treatment options available and includes recommendations for use and treatment algorithms. Other aspects addressed herein include vaccinations in children and adolescents with psoriasis as well as various disease subtypes such as guttate psoriasis, diaper psoriasis, pustular psoriasis and psoriatic arthritis. Finally, we also provide recommendations for imaging studies and the diagnostic workup to rule out tuberculosis prior to initiating systemic treatment. Note: This article constitutes part 2 of the Sk2 guidelines for the treatment of psoriasis in children and adolescents. Part 1 was published in last month's issue. It contained introductory remarks and addressed aspects of diagnosis and topical treatment.

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“…[21][22][23]29 Methotrexate is approved for adult plaque psoriasis only, but up to now has been the first-line systemic agent recommended for paediatric psoriasis. 14 Biologics have significantly changed psoriasis treatment over the decades and have greatly improved patients' health-related quality of life and patient-relevant outcomes. [30][31][32][33] ADA has been used to treat adults with moderate-to-severe plaque psoriasis for over a decade, and has shown superior efficacy to systemic treatments, such as MTX.…”

Section: Discussionmentioning

confidence: 99%

“…Conventional treatment options include topical therapy for mildto-moderate disease, 12 and for severe or refractory disease, ultraviolet (UV)B phototherapy, narrowband UVB therapy if accessible and systemic treatments, including methotrexate (MTX), ciclosporin, acitretin (retinoids) and biologics. [13][14][15] Approved biologic therapies for plaque psoriasis in children include the tumour necrosis factor (TNF)-a inhibitors etanercept [16][17][18][19] and adalimumab (ADA), 20 and the p40 inhibitor ustekinumab. 18,19 Etanercept is approved by the European Medicines Agency (EMA) for children aged ≥ 6 years with severe disease, and by the U.S. Food and Drug Administration (FDA) for children aged ≥ 4 years; ADA is approved by the EMA for children aged ≥ 4 years with severe chronic disease; and ustekinumab is approved by the EMA and FDA for children aged ≥ 12 years with moderate-to-severe disease.…”

Section: What Does This Study Add?mentioning

confidence: 99%

Sustained long‐term efficacy and safety of adalimumab in paediatric patients with severe chronic plaque psoriasis from a randomized, double‐blind, phase III study

et al. 2019

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SummaryBackgroundAdalimumab (ADA) (Humira®, AbbVie Inc., U.S.A.) is approved by the European Medicines Agency for children aged ≥ 4 years with severe plaque psoriasis.ObjectivesTo evaluate the long‐term efficacy and safety of ADA in children with severe plaque psoriasis.MethodsResults are presented from the 52‐week long‐term extension (LTE) of the randomized, double‐blind, double‐dummy, phase III trial, in children with severe plaque psoriasis (results from prior periods have been published). Patients aged ≥ 4 and < 18 years were randomized 1 : 1 : 1 to ADA 0·8 mg kg−1 (40 mg maximum) or 0·4 mg kg−1 (20 mg maximum) every other week or to methotrexate (MTX) 0·1–0·4 mg kg−1 (25 mg maximum) weekly. The 16‐week initial treatment (IT) period was followed by a 36‐week withdrawal period and a 16‐week retreatment period. Patients could enter the LTE at prespecified time points to receive ADA 0·8 mg kg−1 (blinded or open label) or ADA 0·4 mg kg−1 (blinded), or to remain off treatment. Efficacy is reported for patient groups according to doses received in the IT and LTE periods.ResultsOf the 114 patients randomized in the IT period, 108 entered the LTE (n = 36 in each group); 93 received ADA 0·8 mg kg−1. Efficacy (≥ 75% improvement from baseline in Psoriasis Area and Severity Index) was maintained or improved from entry to the end of the LTE: MTX(IT)/ADA 0·8(LTE) 31–86% of patients; ADA 0·4(IT)/0·4 or 0·8(LTE) 28–47%; ADA 0·8(IT)/0·8(LTE) 50–72%. No serious infections occurred in the LTE.ConclusionsAfter 52 weeks of long‐term ADA treatment in children aged 4–18 years with severe plaque psoriasis, disease severity was reduced and maintained or further improved, as demonstrated by efficacy outcomes. No new safety risks were identified. What's already known about this topic? The results from the first three periods of this phase III trial in children aged 4–18 years with severe plaque psoriasis suggest that adalimumab is a safe and efficacious treatment option in this population. What does this study add? This is the first study to evaluate long‐term treatment of adalimumab in children with severe psoriasis, and the first to evaluate switching from methotrexate to adalimumab in this population.

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Systemic treatments in paediatric psoriasis: a systematic evidence‐based update

Cited by 44 publications

References 87 publications

Efficacy, safety and drug survival of conventional agents in pediatric psoriasis: A multicenter, cohort study

Efficacy, safety and drug survival of conventional agents in pediatric psoriasis: A multicenter, cohort study

S2k guidelines for the treatment of psoriasis in children and adolescents – Short version part 2

Sustained long‐term efficacy and safety of adalimumab in paediatric patients with severe chronic plaque psoriasis from a randomized, double‐blind, phase III study

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