Cyclosporine and Methotrexate in Atopic Dermatitis: Bridging Therapies or Real-World Alternatives?

Abstract

Background:

Conventional systemic therapies, including cyclosporine and methotrexate, have traditionally been used for moderate-to-severe atopic dermatitis (AD). However, their real-world effectiveness and treatment persistence in the era of advanced therapies remain uncertain.

Objective:

To evaluate the effectiveness, safety, and treatment persistence of cyclosporine and methotrexate in routine clinical practice.

Methods:

We conducted a retrospective observational cohort study, including patients with moderate-to-severe AD who initiated cyclosporine or methotrexate as first-line systemic therapy. Disease severity and patient-reported outcomes were assessed at treatment initiation and discontinuation. Outcomes after escalation to advanced therapies were also analyzed.

Results:

A total of 113 patients were included (mean age 33.7 ± 13.4 years; 53.1% female). Conventional systemic therapy was associated with modest clinical improvement, with no significant change in Eczema Area and Severity Index [EASI] (−0.66; P = 0.439) but a reduction in pruritus (Numerical Rating Scale [NRS] itch −1.3; P = 0.001). Median treatment duration was 20.5 weeks, and 96% discontinued therapy, mainly due to lack of efficacy (68.8%). After discontinuation, 76.0% escalated to advanced therapies, which achieved significant improvements in EASI (−11.1; P <0.001) and NRS itch (−3.2; P <0.001).

Conclusions:

In real-world practice, cyclosporine and methotrexate show limited effectiveness and low persistence, whereas advanced therapies provide substantial clinical benefit.