Pharmacotherapy Trends for Atopic Dermatitis in the US

pharmacist filling prescription
pharmacist filling prescription
Although the atopic dermatitis treatment patterns found reflect existing clinical guidelines, second-generation antihistamines are not recommended in the management of atopic dermatitis, despite being the third most prescribed medication class.

Survey data published in the Journal of Drugs in Dermatology outline prescribing patterns for atopic dermatitis (AD) in the United States. The most commonly prescribed medications were topical corticosteroids, followed by antibiotics and second-generation antihistamines. Pediatricians were found to manage more AD visits than dermatologists overall, although dermatologists managed more AD visits per practitioner.

Investigators conducted a cross-sectional analysis of data from the National Ambulatory Medical Care Survey (NAMCS). NAMCS is a nationally representative survey of office-based ambulatory visits conducted in the United States, and captures data on patient demographics, diagnoses, and treatments. The present analysis used NAMCS data from 2006 through 2015. Patient visits with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for AD (691.8) were analyzed. Frequency tables were created for patient demographics, providers managing AD, and treatment methods.

Between 2006 and 2016, an estimated 10.4 million (95% CI, 9.2-11.5 million) office visits for AD were recorded through NAMCS. Per demographics analyses, 51% (95% CI, 44%-58%) of patients attending visits were men, 71% were white (95% CI, 65%-77%), 19% were black (95% CI, 14%-25%), and 10% were Asian (95% CI, 6%-14%). Pediatricians managed 31% (95% CI, 24%-37%) of total visits, whereas dermatologists managed 27% (95% CI, 22%-33%). However, dermatologists managed more AD visits per practitioner compared with pediatricians. The most commonly prescribed medication class was corticosteroids (59%; 95% CI, 52%-66%), followed by moisturizers (12%; 95% CI, 8%-17%), antibiotics (11%; 95% CI, 6%-16%), and second-generation antihistamines (6%; 95% CI, 3%-10%). Compared with pediatricians and family physicians, dermatologists prescribed more potent topical corticosteroids; 34% of dermatologists prescribed triamcinolone compared with 24% of pediatricians and 6% of family physicians. Overall, triamcinolone was the most commonly used topical corticosteroid, prescribed at 25% (95% CI, 18%-31%) of office visits. Among children aged <1 year and 8 to 18 years, however, hydrocortisone was the most commonly prescribed topical corticosteroid.

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As a study limitation, the authors noted that moisturizers are not considered a drug and may not have been formally prescribed. As such, NAMCS data may underrepresent the true use of moisturizer among patients with AD. In addition, patients could not be followed longitudinally for health outcomes, and disease severity could not be ascertained.

As the data demonstrated, AD treatment patterns in the United States were largely in line with existing clinical guidelines. Investigators noted, however, that second-generation antihistamines are not recommended in the management of AD, despite being the third most prescribed medication class. “Characterizing how AD patients are currently treated may build a reference for future clinical research,” the investigators wrote.

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

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Pona A, Cline A, Kolli SS, Feldman SR, Fleischer AB Jr. Prescribing patterns for atopic dermatitis in the United States. J Drugs Dermatol. 2019;18(10):987-990.