Can Children Stop Psoriasis Treatment After Remission?

Discontinuation of systemic treatments during remission in children and adolescents with moderate-to-severe psoriasis appeared to be feasible in a study, which also found that younger age, lower baseline disease severity, and non-palmoplantar psoriasis forms predicted successful treatment discontinuation. Researchers conducted a retrospective, multicenter, international study involving 433 children and adolescents with moderate-to-severe psoriasis from France, Italy, the UK, Canada, and Portugal who discontinued first-line systemic treatment with acitretin (n = 243), methotrexate (n = 95), or cyclosporine (n = 95). The cohort included 221 girls (51%) and 212 boys (49%), with a mean baseline age of 10.2 years. Patients who achieved remission and discontinued systemic treatment were followed for up to 6 months to assess treatment reintroduction as a marker of relapse. Factors associated with treatment discontinuation after remission were also assessed. Overall, 79 patients (18.2%) discontinued systemic treatment because they achieved remission, and 354 discontinued treatment for other reasons. Among patients who discontinued treatment because of remission, 70 (88.6%) remained off systemic treatment for at least 6 months. Patients who discontinued treatment due to remission were younger than those who stopped for other reasons (mean age, 9 years vs 10.5 years; P < .001), had lower baseline Physician Global Assessment (PGA) scores (mean, 3.0 vs 3.3; P = .02), and had lower baseline Psoriasis Area and Severity Index (PASI) scores (mean, 9.3 vs 11.1; P = .04). The proportion of patients with palmoplantar psoriasis who discontinued treatment because of remission was lower than that among those who stopped for other reasons (6.3% vs 16.4%; P = .02). “These findings underscore the importance of individualized treatment plans and highlight the potential for reducing the treatment burden in well-controlled cases,” the authors of the study wrote. “Although more research is needed to understand the long-term durability of remission and to identify predictors of relapse,” they added, the study “provides a valuable foundation for future investigations and for improving clinical practice in pediatric psoriasis management.” The study was led by Ahmad Rached, MD, Department of Dermatology, Hôpital Victor Dupouy, Argenteuil, France, and was published online on July 6 in Pediatric Dermatology. The retrospective design limited assessment to relapses occurring within 6 months after treatment discontinuation. Missing PASI, PGA, and BMI data, and the small number of patients who discontinued therapy because of remission limited analyses of predictors of relapse, and mild relapses treated with topical therapy may have been missed. The authors did not report any funding source. Several authors reported receiving consulting, advisory, or speaker fees, and other funding from many drug companies, including Sanofi, Incyte, Novartis, Boehringer Ingelheim, Sun Pharmaceutical Industries, and CSL Behring Canada.