Journal
JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY
Volume 76, Issue 2, Pages 281-285Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.jaad.2016.09.021
Keywords
atopic dermatitis; azathioprine; cyclosporine; methotrexate; mycophenolate mofetil; oral antimicrobials; oral steroids
Categories
Funding
- National Institutes of Health [TL1RR031979]
- Rady Children's Hospital/University of California
- San Diego
- Eczema and Inflammatory Skin Disease Center
- Unit for Population-Based Dermatology Research
- St John's Institute of Dermatology
- Guy's & St Thomas' National Health Service Foundation Trust
- UK National Institute for Health Research (NIHR) Career Development Fellowship [CDF-2014-07-037]
- National Institutes of Health Research (NIHR) [CDF-2014-07-037] Funding Source: National Institutes of Health Research (NIHR)
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Background: There is a paucity of literature to direct physicians in the prescribing of immunomodulators for patients with severe atopic dermatitis (AD). Objective: To survey systemic agent prescribing practices for severe childhood AD among clinicians in the United States and Canada. Methods: The TREatment of severe Atopic dermatitis in children Taskforce (TREAT), US&CANADA, a project of the Pediatric Dermatology Research Alliance (PeDRA), developed an online multiple-response survey to assess clinical practice, gather demographic information and details of systemic agent selection, and identify barriers to their use in patients with recalcitrant pediatric AD. Results: In total, 133 of 290 members (45.9%) of the Society for Pediatric Dermatology completed the survey, and 115 of 133 (86.5%) used systemic treatment for severe pediatric AD. First-line drugs of choice were cyclosporine (45.2%), methotrexate (29.6%), and mycophenolate mofetil (13.0%). The most commonly used second-line agents were methotrexate (31.3%) and mycophenolate mofetil (30.4%); azathioprine was the most commonly cited third-line agent. The main factors that discouraged use of systemic agents were side-effect profiles (82.6%) and perceived risks of long- term toxicity (81.7%). Limitations: Investigation of the sequence of systemic medications or combination systemic therapy was limited. Recall bias may have affected the results. Conclusion: Great variation exists in prescribing practices among American and Canadian physicians using systemic agents for treatment of pediatric AD.
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