While new systemic therapies for AD are being introduced, researchers want to establish a gold standard for treatment with the conventional systemic therapies.

Methotrexate bested cyclosporine in children with severe atopic dermatitis, a new study shows.

While new systemic therapies for AD are being introduced, researchers want to establish a gold standard for treatment with the conventional systemic therapies like methotrexate and cyclosporine is needed.

The trial assessed 103 children with severe atopic dermatitis aged 2 to 16 years across 13 center in the UK and Ireland. The patients were given oral doses of methotrexate or cyclosporine and assessed over nine months of treatment and six months after the therapy ended.

The study found that cyclosporine works faster and reduces disease severity more at 12 weeks but was more expensive, whereas methotrexate was significantly cheaper and led to better objective disease control after 12 weeks and off therapy, with fewer participant-reported flares of atopic dermatitis after treatment had stopped. 

There were also no concerning safety signals.

Based on the TREAT trial findings, methotrexate is a useful and safe treatment in pediatric patients with severe atopic dermatitis and a good alternative to cyclosporine, especially in settings where health care resources are limited.

“This is the largest pediatric trial using conventional immuno-modulatory treatments in severe atopic dermatitis and was conducted across 13 centres in the UK and Ireland and is likely to change our treatment paradigm around this condition, not just for patients in the UK but also internationally,” says Professor Carsten Flohr, Chair in Dermatology and Population Health Sciences at King’s College London, and consultant dermatologist at St John’s institute of dermatology, Guy’s and St Thomas’ NHS Foundation Trust, in a news release.

The study appears in the British Journal of Dermatology.