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. 2022 Jul 1;158(7):796-800.
doi: 10.1001/jamadermatol.2022.1706.

Agreement and Correlation Between Different Topical Corticosteroid Potency Classification Systems

Alexa C Bowie  1 , Mina Tadrous  1   2   3 , Alexander Egeberg  4 , Jane Harvey  5 , Stephanie J Lax  5 , Jacob P Thyssen  4 , Aaron M Drucker  1   3   6   7
Affiliations

Agreement and Correlation Between Different Topical Corticosteroid Potency Classification Systems

Alexa C Bowie et al. JAMA Dermatol. .

Abstract

Importance: Topical corticosteroids (TCSs) are available in multiple potencies that alter their effectiveness and safety. Pharmacoepidemiologic studies on TCSs are hampered by the absence of a universal potency classification system, limiting comparisons across studies, robust exposure classification, and clinical interpretation.

Objective: To classify TCSs into 3 commonly used potency classification systems and evaluate the agreement and correlation between the 3 systems.

Design, setting, and participants: In this classification study, a comprehensive list of TCS formulations was compiled using sources identified in the literature, the Ontario Drug Benefit Formulary, a recent Cochrane review on the use of TCSs in people with eczema, and the Anatomical Therapeutic Classification (ATC) of the World Health Organization from August 11, 2021, to January 6, 2022. Topical corticosteroid potency classifications were assigned and compared using the 7-category US classification system, a 4-category classification from a recent Cochrane review largely based on the UK formulary, and the 4-category ATC classification. To facilitate comparisons across systems, the 7-category US system was consolidated into 4 categories.

Main outcomes and measures: Cohen weighted κ (κw) and Spearman rank correlation coefficients (r) were computed to examine agreement and correlation between the classification systems.

Results: A total of 232 unique TCS formulations (ATC, n = 231; US classification, n = 232; Cochrane review, n = 89) were included. Overall, there was low-to-moderate agreement but strong correlation between the classification systems. The US classification had weak agreement with the ATC system (κw, 0.53; 95% CI, 0.45-0.60) and moderate agreement with the Cochrane review classification (κw, 0.60; 95% CI, 0.48-0.73); there was weak agreement between the ATC and Cochrane review classifications (κw, 0.58; 95% CI, 0.46-0.71). The US classification strongly correlated with the ATC system (r, 0.77; 95% CI, 0.71-0.82) and Cochrane review classification (r, 0.74; 95% CI, 0.62-0.82). There was also a strong correlation between the Cochrane review and ATC classifications (r, 0.71; 95% CI, 0.58-0.80).

Conclusions and relevance: This classification study used multiple resources to classify 232 TCS formulations into 3 potency classifications. Because these systems are often incongruent, they may yield different results in pharmacoepidemiologic studies; investigators need to be transparent in their classification approach and consider alternative potency definitions in sensitivity analyses.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Egeberg reported receiving research funding from Pfizer, Eli Lilly & Co, Novartis, Bristol Myers Squibb, AbbVie, Janssen Pharmaceuticals, the Danish National Psoriasis Foundation, the Simon Spies Foundation, and the Kgl Hofbundtmager Aage Bang Foundation; and receiving honoraria as a consultant or speaker from AbbVie, Almirall, Leo Pharma, Zuellig Pharma Ltd, Galápagos NV, Sun Pharmaceuticals, Samsung Bioepis, Pfizer, Eli Lilly & Co, Novartis, Union Therapeutics, Galderma, Dermavant, UCB, Mylan, Bristol Myers Squibb, and Janssen Pharmaceuticals. Dr Harvey reported receiving grants from the National Institute for Health Research Programme Grants for Applied Research UK during the conduct of the study and being an author of the cited Cochrane review article used in this study. Dr Lax reported receiving grants from the National Institute for Health Research Programme Grant for Applied Research and the National Institute for Health Research Research for Patient Benefit Grant outside the submitted work and being an author of the Cochrane review article used in this study. Prof Thyssen reported receiving grants from Pfizer, Regeneron, and Sanofi; receiving personal fees from Regeneron, Leo Pharma, Lilly, AbbVie, Almirall, Sanofi, Pfizer, Asana, Arena Pharmaceuticals, and OM Pharma outside the submitted work; serving as an advisor for AbbVie, Almirall, Arena Pharmaceuticals, Coloplast, OM Pharma, Aslan Pharmaceuticals, Union Therapeutics, Eli Lilly & Co, Leo Pharma, Pfizer, Regeneron, and Sanofi; and serving as a speaker for AbbVie, Almirall, Eli Lilly & Co, Leo Pharma, Pfizer, Regeneron, and Sanofi. Dr Drucker reported receiving compensation from the British Journal of Dermatology, American Academy of Dermatology, and National Eczema Association. No other disclosures were reported.

Figures

Figure.
Figure.. Mean Difference in Potency for Topical Corticosteroids With the Same Primary Ingredient
The unit of measure for average difference is potency classification units. ATC indicates Anatomical Therapeutic Classification. aNot classified in the ATC.
See this image and copyright information in PMC

Comment in

  • The Power of Topical Steroids.
    Albrecht J. Albrecht J. JAMA Dermatol. 2022 Jul 1;158(7):727-729. doi: 10.1001/jamadermatol.2022.0816. JAMA Dermatol. 2022. PMID: 35612867 No abstract available.

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