Drug survival for ciclosporin A in a long-term daily practice cohort of adult patients with atopic dermatitis

• Published in: British journal of dermatology (1951) Vol. 172; no. 6; pp. 1621 - 1627
• Main Authors: van der Schaft, J., Politiek, K., van den Reek, J.M.P.A., Christoffers, W.A., Kievit, W., de Jong, E.M.G.J., Bruijnzeel-Koomen, C.A.F.M., Schuttelaar, M.L.A., de Bruin-Weller, M.S.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.06.2015; Oxford University Press
• Subjects: Adult; Age Factors; Atopic dermatitis; Cyclosporine - administration & dosage; Cyclosporine - adverse effects; Dermatitis; Dermatitis, Atopic - drug therapy; Dermatologic Agents - administration & dosage; Dermatologic Agents - adverse effects; Drug Administration Schedule; Drug dosages; Drug Substitution; Eczema; Female; Humans; Long-Term Care; Male; Patients; Retrospective Studies; Survival; Treatment Outcome
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1111/bjd.13730

Summary 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. What's already known about this topic? Earlier studies demonstrate that ciclosporin A (CsA) is a safe and potent drug in the treatment of adult patients with severe atopic dermatitis (AD). What does this study add? Drug survival is a reflection of daily practice. This is the first detailed analysis on drug survival for CsA treatment in adult patients with AD.