Can Systemic Treatment for Childhood Psoriasis Be Stopped in Cases of Remission? Data From the ACMe Cohort

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BACKGROUND: In childhood, moderate-to-severe psoriasis often requires systemic treatments such as acitretin, methotrexate, or cyclosporine. This study aimed to explore the feasibility of discontinuing systemic therapy in pediatric patients who achieve remission when receiving these treatments and to identify predictors of sustained remission. METHODS: The ACMe cohort study was a retrospective, multicenter, international, real-world study involving children and adolescents with moderate-to-severe psoriasis treated with acitretin, methotrexate, or cyclosporine. Patients who achieved remission and stopped their systemic treatment were monitored for up to 6 months to evaluate the need for further systemic treatment. RESULTS: Of the 433 patients analyzed, 79 (18.2%) discontinued systemic treatment due to remission. Of these, 70 (88.6%) remained off systemic treatment for at least 6 months. Factors predictive of discontinuation due to remission included younger age (9.0 ± 3.5 vs. 10.5 ± 4.1 years, p < 0.001); lower baseline psoriasis severity (PGA: 3.0 ± 0.7 vs. 3.3 ± 0.8; and PASI: 9.3 ± 4.8 vs. 11.1 ± 6.8, p < 0.04); and the presence of non-palmoplantar forms of psoriasis (palmoplantar psoriasis: 5 (6.3%) vs. 58 (16.4%), p = 0.02). No factors were identified that predicted sustained remission at 6 months. CONCLUSIONS: These promising results suggest that systemic treatment discontinuation during clinical remission is feasible for pediatric patients with moderate-to-severe psoriasis and is associated with a low risk of early relapse. Prospective studies with long-term follow-up are needed to confirm the durability of remission and to better define criteria for selecting candidates for treatment discontinuation.

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