2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:Tbf9,Lupus nephritis (LN) is a severe manifestation of systemic lupus erythematosus (SLE), affecting up to one-third of pediatric SLE patients. Timely induction therapy is critical in proliferative LN to prevent progression to kidney failure or death. Intravenous cyclophosphamide (IVCP) has long been a standard induction agent, but its toxicity profile has prompted interest in mycophenolate mofetil (MMF) as a potentially safer alternative. However, data comparing the efficacy and safety of MMF versus IVCP in children are limited and inconclusive. To systematically review and synthesise existing evidence comparing the efficacy and safety of MMF versus IVCP for induction therapy in pediatric patients with proliferative LN. A comprehensive search was conducted in six electronic databases (PubMed, EMBASE, Web of Science, SCOPUS, CINAHL, and CENTRAL) on June 2, 2025. Reference lists of included articles were also manually screened. We included randomised controlled trials and observational studies published in English that directly compared MMF and IVCP as induction therapies in pediatric patients with biopsy-proven proliferative LN. Studies were required to report at least one of the following outcomes: kidney remission (complete or partial), adverse events, kidney failure, or death. Eligible participants were children aged ≤ 17 years with a diagnosis of proliferative LN based on the American College of Rheumatology (ACR) criteria. Interventions involved MMF plus corticosteroids versus IVCP plus corticosteroids, with comparable adjunctive therapies. Authors independently screened articles, extracted data, and assessed study quality using the RoB2 tool for RCTs and the ROBINS-I tool for observational studies. A random-effects meta-analysis was conducted to estimate pooled risk ratios (RRs) for complete remission. Sensitivity analyses and funnel plots were used to assess robustness and publication bias. Out of 1,633 screened records, seven studies met the inclusion criteria, six observational studies (n = 282) and one RCT (n = 24). Meta-analysis of the observational studies revealed no significant difference in complete remission between the MMF and IVCP groups (pooled RR: 1.01; 95% CI: 0.78-1.29; I The analysis was limited by the predominance of observational studies and only one small pediatric RCT with a high risk of bias. Variability in outcome definitions, inconsistent reporting of baseline disease severity, and lack of subgroup analysis limited further interpretation. Small study numbers precluded a formal assessment of publication bias. The efficacy of MMF appears to be similar to IVCP for induction therapy in pediatric proliferative LN, with a potentially more favourable safety profile. These findings support MMF as a viable alternative to IVCP; however, robust, multicenter pediatric RCTs are urgently needed to establish definitive treatment recommendations and guide clinical practice. PROSPERO: CRD42024533313 available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024533313.31:T43a,A total of 506 patients received 683 treatments: acitretin (n = 316), methotrexate (n = 245) and cyclosporine (n = 122). Median drug survival at 2 years was similar for acitretin (10.8 months) and methotrexate (10.9 months), but lower for cyclosporine (3.9 months; p < 0.0001). The most common reasons for discontinuation were inefficacy for cyclosporine (43.0%), and loss of effectiveness for acitretin (27.2%) and methotrexate (31.8%). No demographic, clinical or therapeutic characteristics were associated with higher rates of treatment maintenance at 6 months. Drug survival was higher for acitretin when used as a first-line therapy (median drug survival: 11.3 months for first-line vs. 5.5 months for second- or subsequent-line therapy; p < 0.001), but there were no differences for methotrexate and cyclosporine. Adverse events (AEs) were the reason for stopping treatment in 13.8% of patients on acitretin, 23.1% on methotrexate and 14.0% on cyclosporine (p = 0.02). Only one serious AE was reported: hepatitis in the methotrexate group.32:Tdc4,Three conventional systemic treatments, acitretin, methotrexate and cyclosporine, are used for severe childhood psoriasis. In many countries, they are the only treatments available. There are limited data and no comparative evaluations of these treatments. The international, multicentre, retrospective, real-world ACMe cohort was developed to assess the comparative 2-year drug survival of acitretin, methotrexate and cyclosporine in paediatric psoriasis. Thirty dermatology centres in France, Italy, Portugal, Canada and the United Kingdom participated in the study. Demographic and clinical data were collected using a standardized form for patients receiving treatment from 2014 to 2024. A total of 506 patients received 683 treatments: acitretin (n = 316), methotrexate (n = 245) and cyclosporine (n = 122). Median drug survival at 2 years was similar for acitretin (10.8 months) and methotrexate (10.9 months), but lower for cyclosporine (3.9 months; p < 0.0001). The most common reasons for discontinuation were inefficacy for cyclosporine (43.0%), and loss of effectiveness for acitretin (27.2%) and methotrexate (31.8%). No demographic, clinical or therapeutic characteristics were associated with higher rates of treatment maintenance at 6 months. Drug survival was higher for acitretin when used as a first-line therapy (median drug survival: 11.3 months for first-line vs. 5.5 months for second- or subsequent-line therapy; p < 0.001), but there were no differences for methotrexate and cyclosporine. Adverse events (AEs) were the reason for stopping treatment in 13.8% of patients on acitretin, 23.1% on methotrexate and 14.0% on cyclosporine (p = 0.02). Only one serious AE was reported: hepatitis in the methotrexate group. This cohort study showed that acitretin and methotrexate had comparable 2-year drug survival rates, which were superior to cyclosporine. We did not find any predictive factors for increased treatment maintenance except for first-line use of acitretin. AEs were a frequent reason for discontinuing treatments. These results may help develop treatment algorithms for systemic therapy in paediatric psoriasis. Severe forms of psoriasis may require the use of general treatments. Three usual treatments (acitretin, methotrexate and cyclosporine) are used for severe childhood psoriasis. In many countries, they are the only treatments available. In this international, multicentre, retrospective study, we compared the 2‐year drug survival (duration before stopping treatment) of these treatments in paediatric psoriasis. Thirty dermatology centres from five countries included 506 patients who received 683 treatments: acitretin (n = 316), methotrexate (n = 245) and cyclosporine (n = 122). Median drug survival at 2 years was similar for acitretin and methotrexate, but lower for cyclosporine. The most common reasons for discontinuation were inefficacy for cyclosporine and loss of effectiveness for acitretin and methotrexate. We did not identify demographic, clinical or therapeutic characteristics associated with higher rates of treatment maintenance at 6 months. Adverse events were the reason for stopping treatment in 13.8% of patients on acitretin, 23.1% on methotrexate and 14.0% on cyclosporine. This study showed that acitretin and methotrexate had comparable 2‐year drug survival rates, which were superior to cyclosporine. These results may help develop treatment algorithms for systemic therapy in pediatric psoriasis.33:Tb7c,AbstractBackgroundThree conventional systemic treatments, acitretin, methotrexate and cyclosporine, are used for severe childhood psoriasis. In many countries, they are the only treatments available. There are limited data and no comparative evaluations of these treatments.ObjectivesThe international, multicentre, retrospective, real‐world ACMe cohort was developed to assess the comparative 2‐year drug survival of acitretin, methotrexate and cyclosporine in paediatric psoriasis.MethodsThirty dermatology centres in France, Italy, Portugal, Canada and the United Kingdom participated in the study. Demographic and clinical data were collected using a standardized form for patients receiving treatment from 2014 to 2024.ResultsA total of 506 patients received 683 treatments: acitretin (n = 316), methotrexate (n = 245) and cyclosporine (n = 122). Median drug survival at 2 years was similar for acitretin (10.8 months) and methotrexate (10.9 months), but lower for cyclosporine (3.9 months; p < 0.0001). The most common reasons for discontinuation were inefficacy for cyclosporine (43.0%), and loss of effectiveness for acitretin (27.2%) and methotrexate (31.8%). No demographic, clinical or therapeutic characteristics were associated with higher rates of treatment maintenance at 6 months. Drug survival was higher for acitretin when used as a first‐line therapy (median drug survival: 11.3 months for first‐line vs. 5.5 months for second‐ or subsequent‐line therapy; p < 0.001), but there were no differences for methotrexate and cyclosporine. Adverse events (AEs) were the reason for stopping treatment in 13.8% of patients on acitretin, 23.1% on methotrexate and 14.0% on cyclosporine (p = 0.02). Only one serious AE was reported: hepatitis in the methotrexate group.ConclusionsThis cohort study showed that acitretin and methotrexate had comparable 2‐year drug survival rates, which were superior to cyclosporine. We did not find any predictive factors for increased treatment maintenance except for first‐line use of acitretin. AEs were a frequent reason for discontinuing treatments. These results may help develop treatment algorithms for systemic therapy in paediatric psoriasis.34:T50c,There are limited data on the impact of the route of administration of methotrexate (MTX) on drug survival in psoriasis. To evaluate the impact of the initial route of administration of MTX (monotherapy) on drug survival in patients with moderate to severe skin psoriasis. A prospective cohort study based on the Psobioteq registry, included from July 2012 to January 2023, patients with plaque, erythrodermic or guttate psoriasis, naive to MTX, biologics and apremilast, who initiated MTX monotherapy. Factors associated with drug survival were identified using Kaplan-Meier curves and Cox regression analyses. In total, 406 patients were included, 58.1% received MTX per os (MTX-PO) and 41.9% subcutaneously (MTX-SC). At MTX initiation, the median PASI score was 11, and 67.3% had DLQI ≥6. Adjusted drug survival did not statistically differ according to the route of administration (p = 0.15). Limited number of patients leading to a potential lack of power. Residual confounding cannot be waived due to the observational nature of the data. Overall MTX survival did not significantly differ according to the route of administration. However, with MTX-SC, the hazard of discontinuation for ineffectiveness was lower and of discontinuation for intolerance was higher than with MTX-PO.35:T70b,AbstractBackgroundThere are limited data on the impact of the route of administration of methotrexate (MTX) on drug survival in psoriasis.ObjectiveTo evaluate the impact of the initial route of administration of MTX (monotherapy) on drug survival in patients with moderate to severe skin psoriasis.Materials and MethodsA prospective cohort study based on the Psobioteq registry, included from July 2012 to January 2023, patients with plaque, erythrodermic or guttate psoriasis, naive to MTX, biologics and apremilast, who initiated MTX monotherapy. Factors associated with drug survival were identified using Kaplan–Meier curves and Cox regression analyses.ResultsIn total, 406 patients were included, 58.1% received MTX per os (MTX‐PO) and 41.9% subcutaneously (MTX‐SC). At MTX initiation, the median PASI score was 11, and 67.3% had DLQI ≥6. Adjusted drug survival did not statistically differ according to the route of administration (p = 0.15).LimitationsLimited number of patients leading to a potential lack of power. Residual confounding cannot be waived due to the observational nature of the data.ConclusionOverall MTX survival did not significantly differ according to the route of administration. However, with MTX‐SC, the hazard of discontinuation for ineffectiveness was lower and of discontinuation for intolerance was higher than with MTX‐PO.36:Te28,Atopic dermatitis (AD), a chronic systemic disease, can cause intense skin itching and negatively impact sleep, mood, and quality of life (QoL) for patients and families. PEDISTAD is an ongoing, 10-year, observational registry describing disease characteristics, atopic comorbidities, and treatment patterns in pediatric patients (aged <12 years at enrollment) with moderate-to-severe AD. This 3-year interim analysis evaluates clinician-reported and caregiver-reported/patient-reported outcomes (Eczema Area and Severity Index [EASI], percent body surface area affected, worst itching/scratching, Children's Dermatology Life Quality Index, and Dermatitis Family Impact) in children treated with dupilumab, methotrexate, and/or cyclosporine. Outcomes were assessed as change from therapy start to last observation (either data cutoff date or treatment discontinuation). Mean (±SE) EASI scores at the time of the last 3-year interim observation were consistent with mild disease in the dupilumab cohort and moderate disease in the methotrexate and cyclosporine cohorts. Improvements in pruritus were numerically greater in the dupilumab cohort relative to the methotrexate and cyclosporine cohorts, while improvements in QoL were similar in the dupilumab and methotrexate cohorts, with no significant change in the cyclosporine cohort. Rates of AD exacerbation were numerically lower with dupilumab treatment relative to methotrexate treatment which were numerically lower than cyclosporine treatment. Dupilumab discontinuation rates were numerically lower relative to methotrexate which were numerically lower than cyclosporine. This PEDISTAD 3-year interim analysis of dupilumab, methotrexate, and cyclosporine treatment in children with AD demonstrates numerically greater improvements in AD signs, symptoms and QoL with dupilumab treatment relative to methotrexate and cyclosporine [Video abstract and graphical abstract available]. NCT03687359. Supplementary file1 (MP4 58163 KB). Atopic dermatitis (AD) is a chronic inflammatory skin disease, often diagnosed before 5 years of age. AD causes intense itching and negatively impacts the sleep, mood, and quality of life of affected children and their families. Children may be treated with skin creams and ointments, which are often not enough to treat all AD signs (extent and severity of disease assessed by a clinician) and symptoms (burden of disease reported by a patient and/or caregiver). The drug dupilumab is approved for use in children as young as 6 months with moderate-to-severe AD and has shown improvements in signs and symptoms in clinical trials (sponsored by Regeneron Pharmaceuticals Inc., and Sanofi). We compared the use of dupilumab, methotrexate, and cyclosporine in routine clinical practice in children under the age of 12 years with moderate-to-severe AD using 3-year data from the PEDISTAD study. Compared with children treated with methotrexate and cyclosporine, children treated with dupilumab had greater improvements in the extent and severity of their AD, as assessed by their doctor. Children treated with dupilumab also showed greater improvements in how they described the severity of their symptoms, such as daytime/nighttime itching, and their quality of life. Fewer children using dupilumab stopped treatment and fewer reported side effects compared with those using methotrexate and cyclosporine. In summary, dupilumab-treated children had greater improvements in AD signs, AD symptoms, and quality of life, were more likely to continue treatment, and had fewer reported side effects than those given cyclosporine and methotrexate.37:T112f,Amy S. Paller is an investigator for AbbVie, Applied Pharma Research, Dermavant, Eli Lilly, Incyte, Janssen, Krystal Biotech, Regeneron Pharmaceuticals Inc., and UCB; a consultant for Aegerion Pharmaceuticals, Azitra, BioCryst, Boehringer Ingelheim, BMS, Eli Lilly, Janssen, Johnson & Johnson, Krystal Biotech, LEO Pharma, Novartis, Primus Pharmaceuticals, Regeneron Pharmaceuticals Inc., Sanofi, Seanergy, TWi Biotechnology, and UCB; and participates on data safety monitoring boards for AbbVie, Abeona Therapeutics, Catawba Research, Galderma, and InMed Pharmaceuticals. Amy S. Paller is an Editorial Board member of the American Journal of Clinical Dermatology. Amy Paller was not involved in the selection of peer reviewers for the manuscript nor any of the subsequent editorial decisions. Danielle Marcoux is an advisory board member for Arcutis Biotherapeutics, Johnson & Johnson, Pierre Fabre, and Sanofi; is a consultant for AbbVie, Novartis, and Sanofi; an investigator for AbbVie, Amgen, Celgene, Eli Lilly, Incyte, LEO Pharma, Pfizer, Regeneron Pharmaceuticals Inc., Sanofi, and UCB; and a speaker for LEO Pharma, Pfizer, and Sanofi. Michele Ramien is a consultant for AbbVie, Eli Lilly, LEO Pharma, Pfizer, and Sanofi; and participates in a registry study for Sanofi. Eulalia Baselga is a speaker for Almirall; an investigator for AbbVie, Eli Lilly, and Pfizer; an investigator and consultant for Pierre Fabre Dermatologie; a consultant for Regeneron Pharmaceuticals Inc. and Sanofi; and a co-founder and consultant for Venthera. Vania Oliveira de Carvalho is a speaker for Expanscience, Galderma, Johnson & Johnson Consumer Health, Mantecorp Skincare, Megalabs, and Royal Canin; and an investigator for Sanofi. Ledit R.F. Ardusso is a consultant and/or advisory board member, and/or speaker for AstraZeneca, GSK, Novartis, and Sanofi. Marlies De Graaf is an investigator for AbbVie, Eli Lilly, LEO Pharma, Pfizer, Regeneron Pharmaceuticals Inc., and Sanofi; a consultant for AbbVie, Almirall, Eli Lilly, LEO Pharma, Regeneron Pharmaceuticals Inc., and Sanofi; and a speaker for AbbVie, Eli Lilly, LEO Pharma, Novartis, Pfizer, Regeneron Pharmaceuticals Inc., and Sanofi. Suzanne Pasmans is an advisor, consultant, speaker, and/or investigator for Boehringer Ingelheim, LEO Pharma, Novartis, Pierre Fabre, Regeneron Pharmaceuticals Inc., and Sanofi; and has received grants from BAP Medical, Boehringer Ingelheim, D&M, DeclaCare (part of BENU Netherlands), Micreos, Ministry of Health Welfare and Sport, Novartis, Pierre Fabre, and Zon MW. Mirna Toledo-Bahena is a speaker for AbbVie, Expanscience, Janssen, LEO Pharma, and Pierre Fabre; and an investigator for Pfizer and Sanofi. Cory Rubin is a speaker for AbbVie, Amgen, Bayer, BMS, Castle Creek Biosciences, Celgene, Cutanea, Dermavant, DermTech, Galderma, Genentech, Helsinn, Incyte, LEO Pharma, Novartis, Ortho Dermatologics, Pfizer, Promius Pharma, Regeneron Pharmaceuticals Inc., Sanofi, Sun Pharma, and UCB; a consultant for AbbVie, Allergan, Amgen, Biofrontera, Castle Creek Biosciences, Celgene, Dermavant, DermTech, Incyte, LEO Pharma, Novartis, Ortho Dermatologics, Pfizer, Promius Pharma, Regeneron Pharmaceuticals Inc., Sanofi, and UCB; and an investigator for BMS, Cara Therapeutics, Castle Creek Biosciences, DermTech, Janssen, LEO Pharma, and Sanofi. Joel C. Joyce has received consultant fees from Pfizer and Sanofi; speaker fees from Sanofi; and is a study investigator for AbbVie, Aclaris Therapeutics, Amgen, AstraZeneca, Bayer, BMS, Eli Lilly, Galderma, Incyte, Janssen, NFlection Therapeutics, Novartis, Pfizer, Sanofi, and UCB. Lara Wine Lee is an advisory board member for Castle Creek Biosciences, Eli Lilly, Pfizer, and Regeneron Pharmaceuticals Inc; is a consultant for AbbVie, Amryt Pharma, Kimberly-Clark, Krystal Biotech, Novartis, and Pyramid Biosciences; an investigator with AbbVie, Amgen, Amryt Pharma, Arcutis Biotherapeutics, Castle Creek Biosciences, Celgene, Eli Lilly, Galderma, Incyte, Mayne Pharma, Novartis, Pfizer, Regeneron Pharmaceuticals Inc., Sanofi, Target Pharma, Trevi Therapeutics, and UCB; and a speaker for Amryt Pharma and Krystal Biotech. Rajan Gupta has served as a consultant for Sanofi. Bryan Adams and Annie Zhang are employees of Sanofi and may hold stock and/or stock options in the company. Marius Ardeleanu is an employee and shareholder of Regeneron Pharmaceuticals Inc.38:T43f,A total of 122 308 patients with CISDs (median [IQR] age, 49 [38-58] years; 63 663 [52.1%] male) starting systemic immunomodulatory treatment in the US were included. Treatment for patients with CISDs comprised methotrexate (28 684), tumor necrosis factor α inhibitors (40 965), ustekinumab (12 841), IL-23i (6116), IL-17Ai (9799), dupilumab (7787), or apremilast (16 116). Complete blood cell count was the most common test, performed in 41% (3161/7787) to 69% (19 659/28 684) of individuals before initiation across treatments. Between 11% (889/7787) and 59% (3613/6116) of patients had tuberculosis screening within 6 months before treatment, and 3% (149/4577) to 26% (1559/6097) had updated tests 1 year later. Between 13% (1006/7787) and 41% (16 728/40 965) had hepatitis panels before treatment. Low pretreatment testing levels before apremilast (15% [2331/16 116] to 45% [7253/16 116]) persisted a year into treatment (9% [816/8496] to 36% [2999/8496]) and were similar to dupilumab (11% [850/7787] to 41% [3161/7787] vs 3% [149/4577] to 25% [1160/4577]).39:T98b,Laboratory testing for the presence of tuberculosis, hepatitis, and other conditions before starting most systemic immunomodulatory agents is recommended in patients with chronic inflammatory skin diseases (CISD) but current testing patterns in the US are unclear. To determine the prevalence of pretreatment testing that is recommended for patients with CISD (psoriasis, hidradenitis suppurativa, or atopic dermatitis). This descriptive analysis of US commercial insurance claims databases from December 31, 2002, to December 31, 2020, included adult patients with CISD (psoriasis, hidradenitis suppurativa, or atopic dermatitis) who started an immunomodulatory agent, including methotrexate, tumor necrosis factor α inhibitors, interleukin (IL)-17Ai, ustekinumab, IL-23i, dupilumab, or apremilast. The proportion of patients who underwent the screening tests as suggested by professional societies-including for tuberculosis, hepatitis, and liver function; complete blood cell counts; and lipid panels-were determined within 6 months before and during 2 years after treatment start. A total of 122 308 patients with CISDs (median [IQR] age, 49 [38-58] years; 63 663 [52.1%] male) starting systemic immunomodulatory treatment in the US were included. Treatment for patients with CISDs comprised methotrexate (28 684), tumor necrosis factor α inhibitors (40 965), ustekinumab (12 841), IL-23i (6116), IL-17Ai (9799), dupilumab (7787), or apremilast (16 116). Complete blood cell count was the most common test, performed in 41% (3161/7787) to 69% (19 659/28 684) of individuals before initiation across treatments. Between 11% (889/7787) and 59% (3613/6116) of patients had tuberculosis screening within 6 months before treatment, and 3% (149/4577) to 26% (1559/6097) had updated tests 1 year later. Between 13% (1006/7787) and 41% (16 728/40 965) had hepatitis panels before treatment. Low pretreatment testing levels before apremilast (15% [2331/16 116] to 45% [7253/16 116]) persisted a year into treatment (9% [816/8496] to 36% [2999/8496]) and were similar to dupilumab (11% [850/7787] to 41% [3161/7787] vs 3% [149/4577] to 25% [1160/4577]). In this descriptive analysis of patients with CISDs starting systemic immunomodulatory treatment in the US, less than 60% received the recommended pretreatment testing. Additional research is required to understand whether variations in testing affect patient outcomes.3a:Tbec,ImportanceLaboratory testing for the presence of tuberculosis, hepatitis, and other conditions before starting most systemic immunomodulatory agents is recommended in patients with chronic inflammatory skin diseases (CISD) but current testing patterns in the US are unclear.ObjectiveTo determine the prevalence of pretreatment testing that is recommended for patients with CISD (psoriasis, hidradenitis suppurativa, or atopic dermatitis).Design, Setting, and ParticipantsThis descriptive analysis of US commercial insurance claims databases from December 31, 2002, to December 31, 2020, included adult patients with CISD (psoriasis, hidradenitis suppurativa, or atopic dermatitis) who started an immunomodulatory agent, including methotrexate, tumor necrosis factor α inhibitors, interleukin (IL)–17Ai, ustekinumab, IL-23i, dupilumab, or apremilast.Main Outcomes and MeasuresThe proportion of patients who underwent the screening tests as suggested by professional societies—including for tuberculosis, hepatitis, and liver function; complete blood cell counts; and lipid panels—were determined within 6 months before and during 2 years after treatment start.ResultsA total of 122 308 patients with CISDs (median [IQR] age, 49 [38-58] years; 63 663 [52.1%] male) starting systemic immunomodulatory treatment in the US were included. Treatment for patients with CISDs comprised methotrexate (28 684), tumor necrosis factor α inhibitors (40 965), ustekinumab (12 841), IL-23i (6116), IL-17Ai (9799), dupilumab (7787), or apremilast (16 116). Complete blood cell count was the most common test, performed in 41% (3161/7787) to 69% (19 659/28 684) of individuals before initiation across treatments. Between 11% (889/7787) and 59% (3613/6116) of patients had tuberculosis screening within 6 months before treatment, and 3% (149/4577) to 26% (1559/6097) had updated tests 1 year later. Between 13% (1006/7787) and 41% (16 728/40 965) had hepatitis panels before treatment. Low pretreatment testing levels before apremilast (15% [2331/16 116] to 45% [7253/16 116]) persisted a year into treatment (9% [816/8496] to 36% [2999/8496]) and were similar to dupilumab (11% [850/7787] to 41% [3161/7787] vs 3% [149/4577] to 25% [1160/4577]).Conclusions and RelevanceIn this descriptive analysis of patients with CISDs starting systemic immunomodulatory treatment in the US, less than 60% received the recommended pretreatment testing. Additional research is required to understand whether variations in testing affect patient outcomes.25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Antimetabolite: modality Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Antimetabolite (modality). Clinician-written summaries and actionable practice insights. Updated daily.\",\"url\":\"https://www.reachrx.ai/hub/tag/modality/Antimetabolite\",\"breadcrumb\":{\"@type\":\"BreadcrumbList\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https://www.reachrx.ai\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Research Hub\",\"item\":\"https://www.reachrx.ai/hub\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Modalities\",\"item\":\"https://www.reachrx.ai/hub/tag/modality\"},{\"@type\":\"ListItem\",\"position\":4,\"name\":\"Antimetabolite\",\"item\":\"https://www.reachrx.ai/hub/tag/modality/Antimetabolite\"}]}}"}}]],["$","$L2f",null,{"title":"Antimetabolite: Research & Clinical Takeaways","description":"Review evidence by treatment modality: Antimetabolite — concise summaries and practical next steps.","papers":[{"doi":"10.1002/art.70262","pmid":"42370484","title":"Expert Perspective: Treatment of Patients With Calcium Pyrophosphate Deposition Disease: Where Do We Begin and Where Are We Going?","journal_title":"Arthritis & Rheumatology","journal_issn":"2326-5191","published_at":"2026-07-14T00:00:00.000Z","url":"https://doi.org/10.1002/art.70262","source_score":15,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-04T18:17:42.083Z","updated_at":"2026-08-04T18:17:42.083Z","tags":[{"paper_doi":"10.1002/art.70262","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1002/art.70262","tag_type":"brand","value":"Kineret","value_numeric":null},{"paper_doi":"10.1002/art.70262","tag_type":"category","value":"Rheumatology","value_numeric":null},{"paper_doi":"10.1002/art.70262","tag_type":"condition","value":"Calcium Pyrophosphate Deposition Disease","value_numeric":null},{"paper_doi":"10.1002/art.70262","tag_type":"condition","value":"Crystal Arthritis","value_numeric":null},{"paper_doi":"10.1002/art.70262","tag_type":"generic","value":"anakinra","value_numeric":null},{"paper_doi":"10.1002/art.70262","tag_type":"generic","value":"baricitinib","value_numeric":null},{"paper_doi":"10.1002/art.70262","tag_type":"generic","value":"colchicine","value_numeric":null},{"paper_doi":"10.1002/art.70262","tag_type":"generic","value":"hydroxychloroquine","value_numeric":null},{"paper_doi":"10.1002/art.70262","tag_type":"generic","value":"methotrexate","value_numeric":null},{"paper_doi":"10.1002/art.70262","tag_type":"generic","value":"tocilizumab","value_numeric":null},{"paper_doi":"10.1002/art.70262","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1002/art.70262","tag_type":"level_of_evidence","value":"6","value_numeric":null},{"paper_doi":"10.1002/art.70262","tag_type":"modality","value":"Antimalarial","value_numeric":null},{"paper_doi":"10.1002/art.70262","tag_type":"modality","value":"Antimetabolite","value_numeric":null},{"paper_doi":"10.1002/art.70262","tag_type":"modality","value":"Corticosteroid","value_numeric":null},{"paper_doi":"10.1002/art.70262","tag_type":"modality","value":"IL-1 Inhibitor","value_numeric":null},{"paper_doi":"10.1002/art.70262","tag_type":"modality","value":"IL-6 Inhibitor","value_numeric":null},{"paper_doi":"10.1002/art.70262","tag_type":"modality","value":"JAK Inhibitor","value_numeric":null},{"paper_doi":"10.1002/art.70262","tag_type":"study_design","value":"Expert Review / Narrative Review","value_numeric":null},{"paper_doi":"10.1002/art.70262","tag_type":"warning","value":"Baricitinib is tagged as a JAK Inhibitor based on its drug class; its role in CPPD is investigational and not yet established.","value_numeric":null},{"paper_doi":"10.1002/art.70262","tag_type":"warning","value":"No sample size is applicable as this is a review article, not a primary study.","value_numeric":null},{"paper_doi":"10.1002/art.70262","tag_type":"warning","value":"Study design label 'Expert Review / Narrative Review' is used as the article does not fit a standard trial design category.","value_numeric":null},{"paper_doi":"10.1002/art.70262","tag_type":"warning","value":"This is an expert perspective/narrative review, not a systematic review or RCT; the level of evidence is inherently low and recommendations reflect author opinion synthesized from limited trial data.","value_numeric":null}],"summaries":{"what_studied":"This expert review proposes a practical treatment framework for calcium pyrophosphate deposition (CPPD) disease in older adults, covering acute and chronic manifestations, and summarizes evidence from randomized trials, open-label studies, and ongoing clinical trials.","key_result":"For acute CPP crystal arthritis, supported options include short-course systemic glucocorticoids, colchicine, intra-articular glucocorticoids, and anakinra. For chronic disease or recurrent flares, colchicine, hydroxychloroquine, methotrexate, IL-1 inhibition, and IL-6 inhibition are discussed. Ongoing trials are evaluating colchicine, tocilizumab, and baricitinib.","limitations":"No approved disease-modifying therapy exists for CPPD; the review is an expert perspective rather than a systematic review or meta-analysis, so recommendations reflect limited clinical trial evidence rather than high-quality RCT data.","practice_takeaway":"Before selecting therapy, confirm CPPD diagnosis and attribute current symptoms to CPPD specifically. Tailor treatment to disease manifestation—acute flare vs. chronic/recurrent disease—using available agents while awaiting results of ongoing trials and future disease-modifying strategies."}},{"doi":"10.1111/pde.70313","pmid":"42409581","title":"Can Systemic Treatment for Childhood Psoriasis Be Stopped in Cases of Remission? Data From the\n ACMe\n Cohort","journal_title":"Pediatric Dermatology","journal_issn":"0736-8046","published_at":"2026-07-06T00:00:00.000Z","url":"https://doi.org/10.1111/pde.70313","source_score":7,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-14T13:24:12.952Z","updated_at":"2026-07-14T13:24:12.952Z","tags":[{"paper_doi":"10.1111/pde.70313","tag_type":"age_group","value":"pediatric","value_numeric":null},{"paper_doi":"10.1111/pde.70313","tag_type":"category","value":"Dermatology","value_numeric":null},{"paper_doi":"10.1111/pde.70313","tag_type":"condition","value":"Psoriasis","value_numeric":null},{"paper_doi":"10.1111/pde.70313","tag_type":"generic","value":"acitretin","value_numeric":null},{"paper_doi":"10.1111/pde.70313","tag_type":"generic","value":"cyclosporine","value_numeric":null},{"paper_doi":"10.1111/pde.70313","tag_type":"generic","value":"methotrexate","value_numeric":null},{"paper_doi":"10.1111/pde.70313","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1111/pde.70313","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1111/pde.70313","tag_type":"modality","value":"Antimetabolite","value_numeric":null},{"paper_doi":"10.1111/pde.70313","tag_type":"modality","value":"Calcineurin Inhibitor","value_numeric":null},{"paper_doi":"10.1111/pde.70313","tag_type":"modality","value":"Retinoid","value_numeric":null},{"paper_doi":"10.1111/pde.70313","tag_type":"sample_size","value":"n=433","value_numeric":433},{"paper_doi":"10.1111/pde.70313","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1111/pde.70313","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1111/pde.70313","tag_type":"warning","value":"Follow-up was limited to 6 months; durability of remission beyond this window is unknown and authors explicitly call for longer-term prospective studies.","value_numeric":null},{"paper_doi":"10.1111/pde.70313","tag_type":"warning","value":"Sex distribution of the study population is not reported in the abstract; the 'mixed' sex tag is assumed.","value_numeric":null},{"paper_doi":"10.1111/pde.70313","tag_type":"warning","value":"The 'impact_flag' of practice_changing was applied cautiously — results are promising but come from a retrospective design without long-term data.","value_numeric":null}],"summaries":{"what_studied":"This retrospective, multicenter, international real-world cohort study (ACMe) evaluated whether systemic therapy (acitretin, methotrexate, or cyclosporine) could be safely stopped in pediatric patients with moderate-to-severe psoriasis who achieved remission, and sought predictors of sustained remission over 6 months.","key_result":"Of 433 patients analyzed, 79 (18.2%) stopped systemic treatment due to remission; 70 of those 79 (88.6%) remained off systemic therapy for at least 6 months. Predictors of achieving remission-driven discontinuation included younger age (9.0 vs. 10.5 years, p<0.001), lower baseline PASI (9.3 vs. 11.1, p<0.04), lower PGA (3.0 vs. 3.3, p<0.04), and non-palmoplantar psoriasis (6.3% vs. 16.4%, p=0.02). No predictors of sustained remission at 6 months were identified.","limitations":"- Retrospective design limits causal inference and may introduce selection bias.\n- Follow-up capped at 6 months — longer-term relapse rates are unknown.\n- No predictors of *sustained* remission were found, limiting patient selection guidance.","practice_takeaway":"In pediatric patients with moderate-to-severe psoriasis who reach remission on conventional systemics, stopping treatment appears feasible — nearly 9 in 10 stayed off systemic therapy for 6 months. Younger children and those with lower baseline severity or non-palmoplantar disease are most likely to achieve remission-driven discontinuation."}},{"doi":"10.1002/acr.80100","pmid":"42294821","title":"Real‐World Safety and Effectiveness of JAK Inhibitors in Systemic Sclerosis: A Propensity‐Matched Study from the EUSTAR Cohort","journal_title":"Arthritis Care & Research","journal_issn":"2151-464X","published_at":"2026-06-15T00:00:00.000Z","url":"https://doi.org/10.1002/acr.80100","source_score":4,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-22T13:23:58.733Z","updated_at":"2026-06-22T13:23:58.733Z","tags":[{"paper_doi":"10.1002/acr.80100","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1002/acr.80100","tag_type":"brand","value":"CellCept","value_numeric":null},{"paper_doi":"10.1002/acr.80100","tag_type":"brand","value":"Rituxan","value_numeric":null},{"paper_doi":"10.1002/acr.80100","tag_type":"category","value":"Rheumatology","value_numeric":null},{"paper_doi":"10.1002/acr.80100","tag_type":"condition","value":"Diffuse Cutaneous Systemic Sclerosis","value_numeric":null},{"paper_doi":"10.1002/acr.80100","tag_type":"condition","value":"Systemic Sclerosis","value_numeric":null},{"paper_doi":"10.1002/acr.80100","tag_type":"generic","value":"methotrexate","value_numeric":null},{"paper_doi":"10.1002/acr.80100","tag_type":"generic","value":"mycophenolate mofetil","value_numeric":null},{"paper_doi":"10.1002/acr.80100","tag_type":"generic","value":"rituximab","value_numeric":null},{"paper_doi":"10.1002/acr.80100","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1002/acr.80100","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1002/acr.80100","tag_type":"modality","value":"Anti-CD20 Monoclonal Antibody","value_numeric":null},{"paper_doi":"10.1002/acr.80100","tag_type":"modality","value":"Antimetabolite","value_numeric":null},{"paper_doi":"10.1002/acr.80100","tag_type":"modality","value":"JAK Inhibitor","value_numeric":null},{"paper_doi":"10.1002/acr.80100","tag_type":"sample_size","value":"n=36","value_numeric":36},{"paper_doi":"10.1002/acr.80100","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1002/acr.80100","tag_type":"study_design","value":"Propensity-Matched Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1002/acr.80100","tag_type":"warning","value":"Level of evidence assigned as 3 (retrospective cohort with matching); no randomization was performed.","value_numeric":null},{"paper_doi":"10.1002/acr.80100","tag_type":"warning","value":"Specific JAKi agents used (e.g., tofacitinib, baricitinib, ruxolitinib) are not named in the abstract — drug-level safety or efficacy differences cannot be assessed.","value_numeric":null},{"paper_doi":"10.1002/acr.80100","tag_type":"warning","value":"The sample size of the JAKi arm (n=36) is very small; propensity matching may not fully account for confounding at this scale.","value_numeric":null},{"paper_doi":"10.1002/acr.80100","tag_type":"warning","value":"Three malignancies in 36 patients is a notable signal, but the study lacks a matched malignancy rate comparison with sufficient detail to draw firm conclusions.","value_numeric":null}],"summaries":{"what_studied":"This retrospective propensity-matched study from the EUSTAR cohort compared JAK inhibitors (JAKi) to standard immunosuppressants — mycophenolate mofetil (MMF), rituximab (RTX), and methotrexate (MTX) — in systemic sclerosis (SSc) patients, evaluating safety, drug survival, and effectiveness over a median drug exposure of 37 months.","key_result":"Only 36 JAKi-treated patients were identified from 19,601 in the cohort. Over 98.7 patient-years, 23 adverse events occurred (12 infections, 7 lab abnormalities, 3 malignancies); 39% permanently discontinued treatment. At 12 months, FVC was stable (+1.7%, p=0.530) and mRSS showed a numerical improvement (−1.8) in diffuse SSc — outcomes comparable to MMF, RTX, and MTX matched arms.","limitations":"- Very small JAKi group (n=36) limits statistical power and generalizability.\n- Retrospective observational design with inherent selection bias, despite propensity matching.\n- Short follow-up window for effectiveness outcomes (12 months) relative to SSc disease course.","practice_takeaway":"JAKi appear to have comparable effectiveness to standard immunosuppressants in SSc, but the high discontinuation rate (39%) and safety signals — including 3 malignancies in a small cohort — warrant caution. Until larger trials report, JAKi use in SSc should be reserved for carefully selected patients with close monitoring."}},{"doi":"10.1200/jco-26-00947","pmid":"42274647","title":"High-Dose Methotrexate as CNS Prophylaxis in Ultra High-Risk Large B-Cell Lymphoma: An International Multicenter Analysis","journal_title":"Journal of Clinical Oncology","journal_issn":"0732-183X","published_at":"2026-06-11T00:00:00.000Z","url":"https://doi.org/10.1200/jco-26-00947","source_score":55,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-24T06:18:26.196Z","updated_at":"2026-08-24T06:18:26.196Z","tags":[{"paper_doi":"10.1200/jco-26-00947","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1200/jco-26-00947","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1200/jco-26-00947","tag_type":"category","value":"Oncology","value_numeric":null},{"paper_doi":"10.1200/jco-26-00947","tag_type":"condition","value":"Large B-Cell Lymphoma","value_numeric":null},{"paper_doi":"10.1200/jco-26-00947","tag_type":"condition","value":"Secondary CNS Lymphoma","value_numeric":null},{"paper_doi":"10.1200/jco-26-00947","tag_type":"generic","value":"methotrexate","value_numeric":null},{"paper_doi":"10.1200/jco-26-00947","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1200/jco-26-00947","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1200/jco-26-00947","tag_type":"modality","value":"Antimetabolite","value_numeric":null},{"paper_doi":"10.1200/jco-26-00947","tag_type":"modality","value":"CNS Prophylaxis","value_numeric":null},{"paper_doi":"10.1200/jco-26-00947","tag_type":"sample_size","value":"n=1923","value_numeric":1923},{"paper_doi":"10.1200/jco-26-00947","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1200/jco-26-00947","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1200/jco-26-00947","tag_type":"warning","value":"Brand name tags are not applicable here as methotrexate is a generic drug used off-label in this context.","value_numeric":null},{"paper_doi":"10.1200/jco-26-00947","tag_type":"warning","value":"DHL/THL was not included as a formal UHR subgroup due to inconsistent reporting; CNS relapse pattern in this group may differ and warrants separate consideration.","value_numeric":null},{"paper_doi":"10.1200/jco-26-00947","tag_type":"warning","value":"The impact_flag 'practice_changing' is applied based on the JCO editor's explicit commentary that these data 'should definitively end the practice of CNS prophylaxis with methotrexate in LBCL,' but the study is retrospective and not a randomized trial.","value_numeric":null},{"paper_doi":"10.1200/jco-26-00947","tag_type":"warning","value":"The no HD-MTX group had a notably earlier median diagnosis date (Nov 2012 vs. Dec 2016) and longer follow-up (76 vs. 41 months), which may introduce era-related confounding despite sensitivity analyses.","value_numeric":null}],"summaries":{"what_studied":"This international multicenter retrospective analysis examined whether high-dose methotrexate (HD-MTX) CNS prophylaxis reduces CNS relapse in 1,923 ultra high-risk (UHR) large B-cell lymphoma (LBCL) patients (CNS-IPI 5–6, testicular/renal/adrenal/breast involvement, or ≥3 extranodal sites), treated with (n=872) or without (n=1,051) HD-MTX after R-CHOP/R-CHOP-like therapy, with a landmark analysis at 6 months (n=1,555).","key_result":"No significant difference in 3-year CNS relapse was seen between no HD-MTX vs. HD-MTX groups overall (9.3% vs. 8.1%; adjusted HR 1.13, 95% CI 0.82–1.57), for isolated CNS relapse (5.9% vs. 5.7%; adjusted HR 1.03, 95% CI 0.69–1.53), or in the landmark cohort (6.7% vs. 6.6%; adjusted HR 0.95, 95% CI 0.62–1.44); no individual UHR subgroup showed benefit. Median post-CNS relapse OS was only 3.8 months regardless of HD-MTX receipt.","limitations":"- Retrospective design with inherent selection bias: HD-MTX patients were younger, fitter, and had more extranodal site involvement, despite multivariable and propensity-score adjustments.\n- Variable HD-MTX dosing, timing, infusion schedules, and cycle numbers across 47+ centers, with no standardized protocol.\n- Baseline CNS screening was performed in only ~37–50% of patients and was not mandated, risking inclusion of occult CNS disease.","practice_takeaway":"These data strongly support abandoning routine HD-MTX CNS prophylaxis even in the highest-risk LBCL patients, as no meaningful reduction in CNS relapse was found in any UHR subgroup. Clinicians should prioritize sensitive baseline CNS screening and watch for emerging data on bispecific antibodies and CAR-T cells as potential alternatives."}},{"doi":"10.1080/09273948.2026.2681732","pmid":"42205079","title":"Efficacy of Adalimumab Therapy for Non-Infectious Uveitis in Japanese Patients: Methotrexate Concomitance Across Different Uveitis Etiologies and the Effect of Dose Spacing","journal_title":"Ocular Immunology and Inflammation","journal_issn":"0927-3948","published_at":"2026-05-28T00:00:00.000Z","url":"https://doi.org/10.1080/09273948.2026.2681732","source_score":2,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-06T13:22:51.987Z","updated_at":"2026-06-06T13:22:51.987Z","tags":[{"paper_doi":"10.1080/09273948.2026.2681732","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1080/09273948.2026.2681732","tag_type":"brand","value":"Humira","value_numeric":null},{"paper_doi":"10.1080/09273948.2026.2681732","tag_type":"category","value":"Ophthalmology","value_numeric":null},{"paper_doi":"10.1080/09273948.2026.2681732","tag_type":"condition","value":"Behçet's Disease","value_numeric":null},{"paper_doi":"10.1080/09273948.2026.2681732","tag_type":"condition","value":"Non-Infectious Uveitis","value_numeric":null},{"paper_doi":"10.1080/09273948.2026.2681732","tag_type":"condition","value":"Sclerouveitis","value_numeric":null},{"paper_doi":"10.1080/09273948.2026.2681732","tag_type":"condition","value":"Sympathetic Ophthalmia","value_numeric":null},{"paper_doi":"10.1080/09273948.2026.2681732","tag_type":"condition","value":"Vogt-Koyanagi-Harada Disease","value_numeric":null},{"paper_doi":"10.1080/09273948.2026.2681732","tag_type":"generic","value":"adalimumab","value_numeric":null},{"paper_doi":"10.1080/09273948.2026.2681732","tag_type":"generic","value":"methotrexate","value_numeric":null},{"paper_doi":"10.1080/09273948.2026.2681732","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1080/09273948.2026.2681732","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1080/09273948.2026.2681732","tag_type":"modality","value":"Antimetabolite","value_numeric":null},{"paper_doi":"10.1080/09273948.2026.2681732","tag_type":"modality","value":"TNF Inhibitor","value_numeric":null},{"paper_doi":"10.1080/09273948.2026.2681732","tag_type":"sample_size","value":"n=83","value_numeric":83},{"paper_doi":"10.1080/09273948.2026.2681732","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1080/09273948.2026.2681732","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1080/09273948.2026.2681732","tag_type":"warning","value":"All patients were Japanese, which may limit generalizability to other ethnic populations due to differences in uveitis etiology distribution.","value_numeric":null},{"paper_doi":"10.1080/09273948.2026.2681732","tag_type":"warning","value":"The dose spacing cohort was small (n=24), so relapse rate and survival estimates carry wide uncertainty.","value_numeric":null},{"paper_doi":"10.1080/09273948.2026.2681732","tag_type":"warning","value":"The etiology-dependent difference in MTX requirements (VKH/sympathetic ophthalmia vs. Behçet's) was described as a trend and was not statistically confirmed; interpret with caution.","value_numeric":null}],"summaries":{"what_studied":"This retrospective study evaluated long-term adalimumab (ADA) efficacy in 83 Japanese patients (160 eyes) with chronic non-infectious uveitis (NIU) or sclerouveitis over ≥6 months, focusing on steroid-sparing effects, etiology-dependent methotrexate (MTX) requirements, and the feasibility of ADA dose spacing.","key_result":"At 12 months, 61.5% (48/78) of patients achieved inactive uveitis; mean oral corticosteroid dose dropped from 13.7 mg/day to 0.9 mg/day (p < 0.0001). Of 24 patients who attempted dose spacing, 14 (58%) relapsed, with a median relapse-free survival of 20.8 months (95% CI 14.5–25.2); most regained disease control by shortening intervals. Late/chronic-stage Vogt-Koyanagi-Harada disease/sympathetic ophthalmia patients trended toward higher MTX requirements than Behçet's disease patients.","limitations":"Retrospective single-center design limits generalizability. The MTX concomitance difference between etiologies was a trend only, not statistically definitive. Dose spacing was attempted in only 24 patients, limiting power for that analysis.","practice_takeaway":"ADA provides meaningful steroid-sparing and inflammation control in NIU, but dose spacing carries a high relapse risk (~58%) and should only be attempted with close monitoring. Etiology—particularly VKH disease/sympathetic ophthalmia vs. Behçet's—may guide decisions about adding MTX."}},{"doi":"10.1007/s00467-025-07118-0","pmid":"41501260","title":"Efficacy of mycophenolate mofetil versus cyclophosphamide in the management of childhood-onset lupus nephritis: a systematic review and meta-analysis","journal_title":"Pediatric Nephrology","journal_issn":"0931-041X","published_at":"2026-01-08T00:00:00.000Z","url":"https://doi.org/10.1007/s00467-025-07118-0","source_score":8,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-01-13","doi":"10.1007/s00467-025-07118-0","days":"7","issn":"0931-041X","rank":"7","field":"Clinical Medicine","score":"8","category":"Urology & Nephrology","categories":["Urology & Nephrology"],"_categories":["Urology & Nephrology"]},"pubmed":{"doi":"10.1007/s00467-025-07118-0","title":"Efficacy of mycophenolate mofetil versus cyclophosphamide in the management of childhood-onset lupus nephritis: a systematic review and meta-analysis.","journal":"Pediatric nephrology (Berlin, Germany)","methods":"","results":"Out of 1,633 screened records, seven studies met the inclusion criteria, six observational studies (n = 282) and one RCT (n = 24). 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Seven studies were included (six observational, n=282; one RCT, n=24).","key_result":"Across six observational studies (n=282), complete remission rates were similar between MMF and IVCP (pooled RR 1.01; 95% CI 0.78–1.29).","limitations":"Evidence was dominated by observational studies with only one small pediatric RCT at high risk of bias. Outcome definitions and baseline disease severity varied, and small study numbers limited subgroup analyses and assessment of publication bias.","practice_takeaway":"MMF appears to achieve similar induction efficacy as IVCP in pediatric proliferative lupus nephritis and is a reasonable alternative when appropriate. 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Responders (n=25) and non‑responders (n=23) were compared by immunohistochemistry and quantitative virtual microscopy.","key_result":"Baseline macrophage populations did not differ, but after treatment M2 (CD163+) macrophages were higher in responders than non‑responders in the whole biopsy (228 vs 119 cells/mm²; P=0.0450) and the middle dermis (97 vs 37; P=0.0168); increases occurred almost exclusively in triamcinolone‑treated keloids, with TAC responders exceeding both 5‑FU groups across layers after treatment. Regulatory T cells were fewer in responders in the superficial dermis after treatment (P=0.0267), and M2s inversely correlated with myofibroblasts in the middle dermis (r = −0.51; P=0.0008).","practice_takeaway":"Baseline macrophage and T‑cell counts did not predict response to intralesional therapy. In keloids that respond—especially with triamcinolone—M2 macrophages accumulate and Tregs fall, so the therapeutic effect appears to track with an immune shift rather than pre‑treatment status."}},{"doi":"10.1111/jdv.70108","pmid":"41104794","title":"Drug survival of systemic treatments for severe paediatric psoriasis: An international retrospective study","journal_title":"Journal of the European Academy of Dermatology and Venereology","journal_issn":"0926-9959","published_at":"2025-10-17T00:00:00.000Z","url":"https://doi.org/10.1111/jdv.70108","source_score":15,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2025-10-22","doi":"10.1111/jdv.70108","days":"14","issn":"0926-9959","rank":"9","field":"Clinical Medicine","score":"15","category":"Dermatology","categories":["Dermatology"],"_categories":["Dermatology"]},"pubmed":{"doi":"10.1111/jdv.70108","title":"Drug survival of systemic treatments for severe paediatric psoriasis: An international retrospective 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Adverse events prompted discontinuation in 13.8% (acitretin), 23.1% (methotrexate), and 14.0% (cyclosporine), with one serious event (hepatitis) on methotrexate."}},{"doi":"10.1111/jdv.70044","pmid":"41024667","title":"Impact of methotrexate administration route on drug survival in psoriasis: Results from PSOBIOTEQ","journal_title":"Journal of the European Academy of Dermatology and Venereology","journal_issn":"0926-9959","published_at":"2025-09-30T00:00:00.000Z","url":"https://doi.org/10.1111/jdv.70044","source_score":15,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2025-10-05","doi":"10.1111/jdv.70044","days":"14","issn":"0926-9959","rank":"7","field":"Clinical Medicine","score":"15","category":"Dermatology","categories":["Dermatology"],"_categories":["Dermatology"]},"pubmed":{"doi":"10.1111/jdv.70044","title":"Impact of methotrexate administration route on drug survival in psoriasis: Results from PSOBIOTEQ.","journal":"Journal of the European Academy of Dermatology and Venereology : JEADV","methods":"","results":"In total, 406 patients were included, 58.1% received MTX per os (MTX-PO) and 41.9% subcutaneously (MTX-SC). 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Outcomes (EASI, %BSA, worst itch/scratch, CDLQI, DFI) were assessed as change from therapy start to last observation (data cutoff or discontinuation).","key_result":"At last observation, mean EASI indicated mild disease in the dupilumab cohort and moderate disease in the methotrexate and cyclosporine cohorts. Pruritus improved more with dupilumab; QoL gains were similar with dupilumab and methotrexate but showed no significant change with cyclosporine; AD exacerbations and discontinuation rates were lowest with dupilumab, intermediate with methotrexate, and highest with cyclosporine, with fewer reported side effects on dupilumab.","limitations":"Observational, non-randomized registry with a 3-year interim analysis. 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Cyclosporine showed no significant QoL improvement in this analysis."}},{"doi":"10.1001/jamadermatol.2023.5895","pmid":"38294794","title":"Prevalence of Pretreatment Testing Recommended for Patients With Chronic Inflammatory Skin Diseases","journal_title":"JAMA Dermatology","journal_issn":"2168-6068","published_at":"2024-01-31T00:00:00.000Z","url":"https://www.ncbi.nlm.nih.gov/pmc/articles/10831628","source_score":29,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2024-02-19","doi":"10.1001/jamadermatol.2023.5895","days":"30","issn":"2168-6068","rank":"5","field":"Clinical Medicine","score":"29","category":"Dermatology","categories":["Dermatology"],"_categories":["Dermatology"]},"pubmed":{"doi":"10.1001/jamadermatol.2023.5895","title":"Prevalence of Pretreatment Testing Recommended for Patients With Chronic Inflammatory Skin Diseases.","journal":"JAMA dermatology","methods":"","results":"$38","abstract":"$39","keywords":[],"pubmed_id":"38294794","conclusions":"","publication_date":"2024-01-31T00:00:00"},"crossref":{"DOI":"10.1001/jamadermatol.2023.5895","URL":"https://doi.org/10.1001/jamadermatol.2023.5895","ISSN":["2168-6068"],"link":[{"URL":"https://jamanetwork.com/journals/jamadermatology/articlepdf/2814379/jamadermatology_schneeweiss_2024_br_230025_1710184586.95516.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":"334","type":"journal-article","issue":"3","score":1,"title":["Prevalence of Pretreatment Testing Recommended for Patients With Chronic Inflammatory Skin Diseases"],"author":[{"given":"Maria C.","family":"Schneeweiss","sequence":"first","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts"},{"name":"Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"}]},{"given":"Denys","family":"Shay","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts"},{"name":"Department of Epidemiology, Harvard T.H. 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Screening was measured within 6 months before and up to 2 years after treatment start.","key_result":"Before initiation, CBC testing occurred in 41% (3161/7787) to 69% (19,659/28,684); TB screening in 11% (889/7787) to 59% (3613/6116), with 1‑year retesting in 3% (149/4577) to 26% (1559/6097); hepatitis panels in 13% (1006/7787) to 41% (16,728/40,965). Apremilast and dupilumab showed low pretreatment testing (apremilast 15% [2331/16,116] to 45% [7253/16,116]; dupilumab 11% [850/7787] to 41% [3161/7787]) that persisted at 1 year (apremilast 9% [816/8496] to 36% [2999/8496]; dupilumab 3% [149/4577] to 25% [1160/4577]).","practice_takeaway":"Fewer than 60% of patients starting systemic immunomodulators received recommended baseline tests. Clinicians should verify TB and hepatitis screening and needed labs by agent (notably TNF/IL inhibitors and methotrexate) and note that 1‑year TB retesting was uncommon (3%‑26%)."}}],"initialOffset":11,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"modality","value":"Antimetabolite"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Modalities","href":"/hub/tag/modality"},{"name":"Antimetabolite"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"modality","hub_tag_value":"Antimetabolite"}}}]]

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