Prescribing practices for systemic agents in the treatment of severe pediatric atopic dermatitis in the US and Canada: The PeDRA TREAT survey - 18/04/17
, Kirsty Logan, PhD c, Laura Proudfoot, MD, PhD c, Jochen Schmitt, MD, MPH d, Irene Lara-Corrales, MD, MSc e, Jeffrey Sugarman, MD, PhD f, Wynnis Tom, MD b, Elaine Siegfried, MD g, Kelly Cordoro, MD h, Amy S. Paller, MD, MS i, Carsten Flohr, MD, PhD cAbstract |
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.
Le texte complet de cet article est disponible en PDF.Key words : atopic dermatitis, azathioprine, cyclosporine, methotrexate, mycophenolate mofetil, oral antimicrobials, oral steroids
Abbreviations used : AD, AZA, CSA, MTX, MMF, PeDRA, RCT, SCORAD, TREAT
Plan
| This study was partially supported by the National Institutes of Health, Grant TL1RR031979. It was partially funded by the Rady Children's Hospital/University of California, San Diego, Eczema and Inflammatory Skin Disease Center and the Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' National Health Service Foundation Trust. CF holds a UK National Institute for Health Research (NIHR) Career Development Fellowship (CDF-2014-07-037). The views expressed in this publication are those of the authors and not necessarily those of the UK National Health Service, the NIHR, or the UK Department of Health. |
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| Drs Totri and Eichenfield contributed equally to this work. |
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| Conflicts of interest: None. |
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| Reprints not available from the authors. |
Vol 76 - N° 2
P. 281-285 - février 2017 Retour au numéro
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