Format

Send to

Choose Destination
J Am Acad Dermatol. 2017 Feb;76(2):281-285. doi: 10.1016/j.jaad.2016.09.021. Epub 2016 Nov 14.

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

Author information

1
Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York.
2
Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital and University of California, San Diego, California. Electronic address: leichenfield@rchsd.org.
3
Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' Hospital NHS Foundation Trust and King's College London, London, UK.
4
Center for Evidence-based Healthcare, University Hospital Dresden and Institute for Occupational and Social Medicine, Technical University, Dresden, Germany.
5
Section of Dermatology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada.
6
Department of Dermatology, University of California at San Francisco, San Francisco, California.
7
Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital and University of California, San Diego, California.
8
Department of Pediatrics and Dermatology, Saint Louis University, Cardinal Glennon Children's Hospital, St Louis, Missouri.
9
Department of Pediatrics and Dermatology, University of California at San Francisco, San Francisco, California.
10
Department of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Abstract

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.

KEYWORDS:

atopic dermatitis; azathioprine; cyclosporine; methotrexate; mycophenolate mofetil; oral antimicrobials; oral steroids

PMID:
27855965
DOI:
10.1016/j.jaad.2016.09.021
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center