Practice Gaps in Pediatric Atopic Dermatitis Reveal Need for Uniform, Effective Care

Systemic corticosteroids (SCS), among other ineffective therapies for atopic dermatitis (AD), are frequently prescribed in pediatric patients with AD. In addition, few pediatric patients with AD undergo initial treatment by a specialist. This is according to a retrospective study published in the Journal of the American Academy of Dermatology.

Deidentified patient data from the administrative medical and pharmacy claims of the IBM® MarketScan® Commercial Database and Multi-State Medicaid Database between 2011 and 2016 were retrospectively analyzed. Inclusion criteria were ≥1 claim with an AD diagnosis and an age of <18 years on the index date (n=607,258). The researchers examined the data to determine the prescribing frequency of corticosteroids (TCS), calcineurin inhibitors, topical and oral antihistamines, montelukast sodium, SCS, systemic immunosuppressants, intravenous immunoglobulin, and phototherapy.

During a median observation period of 30.3 months, 78.6% of patients were prescribed ≥1 AD medication. The majority of patients were prescribed TCS (86.7%), whereas the minority of patients were prescribed a calcineurin inhibitor (5.4%). Approximately 24.4% of patients were prescribed SCS, with more than half of these patients having no asthma/allergic comorbidities. Additionally, 62.0% and 41.3% of patients who were prescribed either an antihistamine (46.6%) or montelukast (16.2%), respectively, had no asthma/allergic comorbidities.

The prescribing rate of systemic immunosuppressants in this cohort was <0.5%. Increased use of SCS was observed with increasing age (infants: 12.3% vs adolescents: 40.7%). The researchers observed a positive association between TCS potency and age (low-/high-potency TCS, infants: 50.9%/10.1% vs adolescents: 22.6%/24.3%). Only 13.5% of patients saw a dermatologist or allergist/immunologist after pediatrician referral. High-potency TCS use was greater for patients who initially visited a dermatologist (28.1% vs 11.5%-14.5% for other providers). The same was found for use of calcineurin inhibitors (13.3% vs 3.9%-7.8%). Oral antihistamine use was lower in patients who initially saw a dermatologist (29.3% vs 37.7%-58.4%).

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Limitations of the study included its retrospective nature as well as the lack of data on over-the-counter product use.

In the United States, there is no consensus on a uniform approach to disease management of AD in pediatric populations, the investigators acknowledged. This is reflected in the study data, which found proven therapies such as systemic immunosuppressants were not commonly prescribed, although drugs without demonstrated efficacy such as oral antihistamines, or SCS with known risks, were. The researchers concluded that their findings “emphasize the need for effective therapies that are well tolerated by pediatric patients for long-term control of the disease.”

Disclosure: Several of the study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Paller AS, Siegfried EC, Vekeman F, et al. Treatment patterns of pediatric patients with atopic dermatitis: a claims data analysis [published online August 7, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.07.105