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How Safe Are Various Systemic Therapies for Pediatric Psoriasis?

NEW YORK (Reuters Health) – For children with psoriasis, adverse events (AEs) occur less frequently with tumor necrosis factor (TNF) inhibitors than with methotrexate, but appropriate folic acid administration may mitigate the latter’s gastrointestinal effects, researchers suggest.

“Our understanding of the immune changes in skin that lead to psoriasis has been increasing, and has led to a number of more ‘targeted’ therapies for individuals affected by moderate-to-severe psoriasis,” Dr. Amy Paller of Northwestern University, in Chicago, told Reuters Health.

 “Most of these (targeted therapies) are currently available for adults, but not yet for children,” she said by email.

To investigate patterns of use and the relative risks of systemic agents for pediatric psoriasis, Dr. Paller and colleagues reviewed data from 20 centers in North America and Europe on children with moderate-to-severe disease who used systemic medications for at least three months from 1990 to 2014.

As reported in JAMA Dermatology, online September 13, the analysis included 203 girls and 187 boys with a mean age of 8.4 years at psoriasis diagnosis. The mean interval between diagnosis and starting systemic therapy was three years.

 Methotrexate was taken by about 69% of children, biologic agents (mainly etanercept) by 27%; acitretin by 15%; cyclosporine by 8%; and fumaric acid esters by 5%. About 19% of children used more than one medication.

Close to half (48.1%) of children reported one or more AEs associated with methotrexate, mainly gastrointestinal (24.8%). Taking folic acid six days per week (odds ratio, 0.16) or every day (OR, 0.21) protected against gastrointestinal AEs more than once-weekly folic acid, regardless of the total weekly dosage. Dr. Paller noted that this finding is changing practice in Europe, where clinicians commonly administered folic acid weekly.

Methotrexate-associated hepatic transaminase elevations were associated with obesity (in 13% of children), but folic acid was not.

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About Dr. J. Kim

Dr Kim developed (and is continuing to develop) dermatology research news as we way from dermatologists to stay on top of the latest advances in the field of dermatology.

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