Subject(s)
Dermatologic Agents/therapeutic use , Eczema/drug therapy , Hand , Methotrexate/therapeutic use , Adult , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
BACKGROUND: Hand eczema is a common condition; it is often chronic and can be difficult to treat. Cyclosporine is used off-label to treat severe hand eczema; however, the evidence for this treatment is scarce. OBJECTIVE: To examine the drug survival of cyclosporine in a daily practice cohort of patients with chronic hand eczema. METHODS: This retrospective daily use study included hand eczema patients who were treated with cyclosporine between 01-06-1999 and 01-06-2014 in two Dutch university hospitals. Patient and treatment characteristics were retrospectively collected from medical charts. First treatment episodes were analysed by means of Kaplan-Meier drug survival curves. Possible determinants of drug survival were analysed by Cox regression models. Treatment effectiveness was analysed with a retrospective physician's global assessment. RESULTS: A total of 102 patients were treated with cyclosporine. The median drug survival rate was 0.86 years (10.3 months). The overall drug survival rate after 6 months, 1, 2 and 3 years were 61.7%, 45.2%, 18.6% and 13.9% respectively. Main reasons for discontinuation were adverse events, especially early in treatment, and ineffectiveness. After 3 months, a good response to treatment was recorded in 62.9% of the patients. CONCLUSION: Cyclosporine had a median drug survival of 10.3 months. Especially patients with recurrent vesicular hand eczema showed a good treatment response.
Subject(s)
Cyclosporine/therapeutic use , Eczema/drug therapy , Hand Dermatoses/drug therapy , Female , Humans , Male , Middle Aged , Netherlands , Off-Label Use , Patch Tests , Retrospective Studies , Treatment OutcomeSubject(s)
Dermatitis, Atopic/drug therapy , Dermatologic Agents/administration & dosage , Methotrexate/administration & dosage , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: Long-term data of ciclosporin A (CsA) treatment in daily practice in patients with severe atopic dermatitis (AD) are lacking. OBJECTIVES: To perform a detailed analysis of drug survival, which is the length of time a patient continues to take a drug, for CsA in a long-term daily practice cohort of patients with AD. The secondary objective was to identify determinants of drug survival. METHODS: Data were extracted from a retrospective cohort of patients treated with CsA for AD. Drug survival was analysed using Kaplan-Meier survival curves. Determinants of drug survival were analysed using uni- and multivariate Cox regression analyses with backward selection. RESULTS: In total, 356 adult patients were analysed (386 patient-years). The overall drug survival rates were 34%, 18%, 12% and 4% after 1, 2, 3 and 6 years, respectively. Reasons for discontinuation were controlled AD (26·4%), side-effects (22·2%), ineffectiveness (16·3%), side-effects plus ineffectiveness (6·2%) or other reasons (11·0%). Older age was associated with a decreased drug survival related to controlled AD [hazard ratio (HR) 0·91]. Older age was also associated with a decreased drug survival related to side-effects (HR 1·14). An intermediate-to-high starting dose (> 3·5-5·0 mg kg(-1) daily) was associated with an increased drug survival related to ineffectiveness (HR 0·63). CONCLUSIONS: This is the first study on drug survival for CsA treatment in AD. Older age was associated with decreased drug survival related to controlled AD and side-effects. An intermediate-to-high starting dose was associated with an increased drug survival related to ineffectiveness.
