Prescribing practices for systemic agents in the treatment of severe pediatric atopic dermatitis in the US and Canada: The PeDRA TREAT survey

Totri, C. R.; Eichenfield, L. F.; Logan, K.; Proudfoot, L.; Schmitt, J.; Lara-Corrales, I.; Sugarman, J.; Tom, W.; Siegfried, E.; Cordoro, K.; Paller, A. S.; Flohr, C.

J Am Acad Dermatol. 2016 Nov 20; 76(2):281-285


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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