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Wide variation exists in prescribing practices of systemic agents for pediatric atopic dermatitis

A survey of physicians in the United States and Canada found that there is great variation in prescribing practices of systemic agents to treat atopic dermatitis, according to results published in the Journal of the American Academy of Dermatology.

Reseearchers developed an online multiple response survey to collect information on demographics, clinical practice data, systemic agent selection and barriers to systemic medication use for patients with recalcitrant pediatric atopic dermatitis.

Invitation emails were sent to 391 members of the Society for Pediatric Dermatology, with the survey completed by 133 members (45.9%), including 115 in the United States (86.5%) and 18 in Canada (13.5%). There were 115 respondents (86.5%) who reported prescribing systemic treatment for severe pediatric atopic dermatitis.

Cyclosporine (45.2%), methotrexate (29.6%) and mycophenolate mofetil (13%) were first-line systemic agents of choice. Methotrexate (31.3%) and mycophenolate mofetil (30.4%) were most commonly used second-line argents; while azathioprine (33%) and mycophenolate mofetil (24.3%) were the most commonly used third-line agents.

Adverse-effect profiles (82.6%) and risks for long-term toxicity (81.7%) were main factors that discouraged use of agents. Of the survey respondents, 65.2% were discouraged from use of systemic agents based on concerns expressed by patents and their families, while 49.6% of respondents did not use atopic dermatitis guidelines or protocols to direct prescription of systemic treatments.

“Our study reveals great variation in prescribing practices among North American physicians prescribing systemic agents for pediatric [atopic dermatitis],” the researchers reported. “The results differ from those seen in the European TREAT study, which queried 343 individuals from eight different countries … While both our study and its European counterpart found [cyclosporine] to be the most commonly prescribed first-line agent, the use of [methotrexate] different greatly. [Methotrexate] was most often used as a third-line agent in Europe but commonly used as a first-line therapy in the United States and Canada.”

“There is a clinical need for development and testing of new systemic agents for pediatric [atopic dermatitis], the researchers concluded.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.