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Official Journal of the Italian Society of Dermatology and Sexually Transmitted Diseases
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Giornale Italiano di Dermatologia e Venereologia 2016 Jan 13

lingua: Inglese

Treatment patterns with systemic antipsoriatic agents in childhood psoriasis: an Italian database analysis.

Vito DI LERNIA 1, Iria NERI 2, Piergiacomo CALZAVARA PINTON 3, Sergio DI NUZZO 4, Luca STINGENI 5, Claudio GUARNERI 6, Anna BELLONI FORTINA 7, Domenico BONAMONTE 8, Stefano CAMBIAGHI 9, Claudia LASAGNI 10, Michele PANZONE 11, Monica CORAZZA 12, Annamaria OFFIDANI 13, Paolo GISONDI 14

1 Dermatology Unit, Deparment of Medicine and Medical Specialities, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy; 2 Dermatology Unit, Department of Specialistic, Diagnostic and Experimental Medicine, University of Bologna, S. Orsola­ Malpighi Hospital, Bologna, Italy; 3 Section of Dermatology, Department of Medicine, University of Brescia, Brescia, Italy; 4 Section of Dermatology, Department of Clinical and Experimental Medicine, Parma University Hospital, Parma, Italy; 5 Section of Clinical, Allergological and Venereological Dermatology, Department of Medicine, University of Perugia, Perugia, Italy; 6 Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy; 7 Pediatric Dermatology Unit, Department of Medicine, University of Padua, Padua, Italy; 8 Section of Dermatology, Department of Biomedical Science and Human Oncology University of Bari, Bari, Italy; 9 UOC Pediatric Dermatology, Department of Pathophysiology and Transplantation, Ospedale Maggiore, Policlinic of Milan, Milan, Italy; 10 Dermatology Unit, Department of Head and Neck Surgery, University of Modena, Modena, Italy; 11 Section of Dermatology, Department of Medical Sciences, University ofTurin, Turin, Italy; 12 Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy; 13 Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy; 14 Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy


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BACKGROUND: Most of systemic therapies have not been systematically investigated in moderate to severe childhood plaque psoriasis. Treatment preferences for moderate to
severe psoriasis in childhood are unknown.
OBJECTIVE: The objectives of this study were to investigate the systemic treatment patterns of moderate to severe psoriasis in children and adolescents aged ≤ 18 years in Italy. Additional secondary outcomes were duration of treatment and reasons for discontinuation.
METHODS: To define differences in treatment patterns, we performed a chart review of all consecutive patients treated with systemic drugs during an index period of five years. Consecutive sampling of all patients with psoriasis, aged ≤ 18 years, who had been treated with at least one systemic drug over a 5­year period, was made.
RESULTS: The records of 58 consecutive patients, 27 males, 31 females. with moderate to severe psoriasis treated with at least one systemic therapy were reviewed. The median age (standard deviation) at the start of the first systemic treatment was 11.7 years (± 3.7). The most preferred first line systemic treatment was cyclosporine, which was administered as first systemic treatment in 53.4% of patients, followed by acitretin in 22.4% of patients, etanercept and PUVA respectively in 8.6%, methotrexate in 6.8%. 48.2% of patients received a second systemic treatment due to inefficacy or side effects of the first line therapy during the index period. Because of the small sample, and voluntary contribution, selection bias may have occurred.
CONCLUSION: A considerable variation in the management of the first line systemic therapy in children with moderate to severe psoriasis was observed. Cyclosporine was most commonly preferred as a first­line treatment. The availability of new therapeutic agents could change the scenario of treatment patterns in childhood psoriasis.

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vito.dilernia@asmn.re.it