Treatment patterns of pediatric patients with atopic dermatitis: A claims data analysis

Abstract

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.

Keywords: adolescents; atopic dermatitis; children; eczema; infants; systemic treatment; topical calcineurin inhibitors; topical corticosteroids; topical treatment.