Drug survival for acitretin and cyclosporine in patients with chronic hand eczema.

Brandsma, A.E. (2014) Drug survival for acitretin and cyclosporine in patients with chronic hand eczema. thesis, Medicine.

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Abstract

Background Long-term data on the use of acitretin and cyclosporine in patients with chronic hand eczema in daily practice are lacking. Objectives The primary objective was to describe drug survival for acitretin and cyclosporine in a retrospective long-term multicenter daily practice cohort of patients with chronic hand eczema. The secondary objective was to identify determinants of drug survival for acitretin and cyclosporine in general and separately for discontinuation due to adverse events or ineffectiveness of treatment. Methods Data of all patients treated with systemic therapy for hand eczema between the 1st of January 1994 and the 1st of June 2014 were collected. All first treatment episodes of acitretin and cyclosporine were included. Drug survival was analyzed by Kaplan-Meier survival curves and split for two reasons for discontinuation: adverse events and ineffectiveness. Determinants of drug survival were analyzed using univariate Cox regression analysis and multivariate Cox regression analysis with backward selection. Results In total, data of 267 patients was collected and 120 patients with a first episode of acitretin and 102 patients with a first episode of cyclosporine were included. The overall drug survival of acitretin was 35.4%, 23.2% and 16.3% after 1, 2 and 4 years respectively, with a median drug survival of 0.5 years. The overall drug survival of cyclosporine was 48.2%, 26.3% and 13.1% after 1, 2 and 4 years respectively, with a median drug survival of 0.9 years. Reasons for discontinuation of acitretin were adverse events (37.5%), ineffectiveness (16.7%), both adverse events and ineffectiveness (5.0%) and other reasons (8.3%). The reasons for discontinuation of cyclosporine were adverse events (43.1%), ineffectiveness (17.6%) both adverse events and ineffectiveness (4.9%) and other reasons (2.9%). Patients with a good response at treatment after 3 months (PGA score 1) had a longer overall drug survival of acitretin and cyclosporine. Males also had a longer overall drug survival of cyclosporine and patients with prior immunosuppressive therapy had a shorter overall drug survival of cyclosporine. Conclusions This is the first daily practice study analyzing drug survival of acitretin and cyclosporine in the treatment of chronic hand eczema. Drug survival of cyclosporine in particular, was longer than expected based on previous studies (median 0.9 years). Because no serious adverse events or complications occurred during this longer treatment, maintenance therapy with cyclosporine for a longer period should be considered in future treatment of patients with chronic hand eczema. Most important determinant of longer overall drug survival of acitretin and cyclosporine was a good response at treatment after 3 months (PGA score 1).

Item Type:	Thesis (Thesis)
Supervisor name:	Schuttelaar, Dr. M.L.A.
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:02
Last Modified:	25 Jun 2020 11:02
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2254

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