Journal
JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY
Volume 82, Issue 3, Pages 651-660Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.jaad.2019.07.105
Keywords
adolescents; atopic dermatitis; children; eczema; infants; systemic treatment; topical calcineurin inhibitors; topical corticosteroids; topical treatment
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Funding
- Regeneron Pharmaceuticals Inc
- Sanofi
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Background: Real-world evidence on treatment patterns of pediatric patients with atopic dermatitis (AD) is sparse. Objective: To assess current treatment patterns in pediatric AD patients. Methods: Retrospective observational analysis of commercial insurance and Medicaid administrative claims data (January 2011-December 2016) for pediatric AD patients, stratified by age and provider type. Results: The analytic sample comprised 607,258 pediatric AD patients. Median observation period was 30.3 months. Overall, 78.6% were prescribed >= 1 AD medication; 86.7% were prescribed topical corticosteroids, and 5.4% were prescribed a calcineurin inhibitor. Systemic corticosteroids (SCSs) were prescribed for 24.4% of patients, 51.8% of whom did not have asthma or allergic comorbidities. Of the 46.6% prescribed an antihistamine and 16.2% prescribed montelukast, 62.0% and 41.3%, respectively, did not have asthma or allergic comorbidities. Systemic immunosuppressants were rarely prescribed (<0.5%). Higher potency topical corticosteroid and SCS use increased with age. Treatment patterns varied by provider type; specialists were more likely to prescribe higher potency topicals and/or systemics, regardless of patient age. A minority of patients were treated by or referred to a specialist. Limitations: Identification of AD patients relied on billing diagnoses; the disease severity was proxied by the treatment prescribed. Conclusion: Results indicate that SCSs, despite known risks, and other medications with disproven efficacy in AD are frequently prescribed, suggesting a need for safer and more effective alternatives.
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