¿Psoriasis pediatrica: cuales tratamientos son mejores?

Superior Drug Survival Identified Among Systemic Therapies

for Pediatric PsO

Lisa Kuhns, PhD |

December 5, 2025

Acitretin and methotrexate show comparable 2-year drug survival, and both

outperform cyclosporine in pediatric patients with severe psoriasis, according to

results of a study published in the Journal of the European Academy of

Dermatology & Venereology.

Researchers conducted an international retrospective study at 30 centers located in

France, Italy, the United Kingdom, Canada, and Portugal. Patients eligible for

inclusion were under 18 years old at initiation of systemic treatment for the first

time; received acitretin, methotrexate, or cyclosporine as a single-agent therapy; had

taken the medication for at least 1 day; and attended at least 1 follow-up consultation

following the initial prescription.

Of the 506 pediatric patients with severe psoriasis included, 683 systemic treatment

courses were analyzed: 316 with acitretin, 245 with methotrexate, and 122 with

cyclosporine. The mean age at treatment initiation was 10.3 years. Plaque psoriasis

was the most common subtype (61.6%), followed by palmoplantar (14.1%) and guttate

(13.1%). Nail involvement (28.3%) and psoriatic arthritis (3.6%) were relatively

uncommon. The choice of initial systemic therapy varied significantly by country,

age, sex, and phenotype. Acitretin was favored in younger patients, those with

palmoplantar disease (odds ratio [OR], 3.88, P =.003), and those without psoriatic

arthritis (OR, 0.15; P =.005). Methotrexate was used more frequently in women, and

cyclosporine use was concentrated in Italian centers (OR, 5.50, P <.0001).

https://www.dermatologyadvisor.com/news/superior-drug-survi03a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 18/12/25, 3:41 AM

Page 1 of 3Median drug survival was significantly longer for acitretin (10.79 months) and

methotrexate (10.92 months) compared with cyclosporine (3.95 months; P <.0001).

Acitretin had higher persistence when used as a first-line therapy vs as a

subsequent therapy (11.3 vs 5.5 months; P <.0001), but this association was not

observed for methotrexate or cyclosporine. Effectiveness at 3 months was

comparable across drugs for both Physician's Global Assessment scores of 0/1 (41.4%

to 47.3%; P =.77) and Psoriasis Area and Severity Index score of 75 (30.7% to 34.8%; P

=.89).

"

These findings may aid in developing algorithms to

formulate recommendations for systemic treatments in

"

managing severe psoriasis in pediatric patients.

Discontinuations were mainly due to inefficacy with cyclosporine (43.0%) and loss of

effectiveness with methotrexate (31.8%) and acitretin (27.2%). Adverse events led to

discontinuation in 13.8% to 23.1% of patients. The most common adverse events were

cheilitis and xerosis/pruritus with acitretin; gastrointestinal symptoms, fatigue, and

transaminase elevations with methotrexate; and hypertrichosis with cyclosporine.

Only 1 serious adverse event, transaminase elevation with methotrexate, was

reported.

The study limitations include participation by only 1 center each in Canada and

Portugal as well as missing data on some efficacy measures.

The researchers concluded, "These findings may aid in developing algorithms to

formulate recommendations for systemic treatments in managing severe psoriasis

in pediatric patients."

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical,

and/or device companies. Please see the original reference for a full list of authors'

disclosures.

References:

https://www.dermatologyadvisor.com/news/superior-drug-survi03a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 18/12/25, 3:41 AM

Page 2 of 3Miao Y, Beauchet A, Piram M, et al. Drug survival of systemic treatments for severe

paediatric psoriasis: an international retrospective study. J Eur Acad Dermatol

Venereol . Published online October 17, 2025. doi:10.1111/jdv.70108

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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