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Treatment patterns of pediatric patients with atopic dermatitis: A claims data analysis - 11/02/20

Doi : 10.1016/j.jaad.2019.07.105 
Amy S. Paller, MD a, b, Elaine C. Siegfried, MD c, d, Francis Vekeman, MA e, Abhijit Gadkari, PhD f, Mandeep Kaur, MD, MS g, Usha G. Mallya, PhD g, Julie Héroux, MSc e, Raymond Miao, MSc h, Paola Mina-Osorio, MD, PhD f,
a Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 
b Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois 
c Department of Pediatrics, Division of Dermatology, Saint Louis University, St. Louis, Missouri 
d Cardinal Glennon Children's Hospital, St. Louis, Missouri 
e StatLog Inc, Montreal, Canada 
f Regeneron, Tarrytown, New York 
g Sanofi, Cambridge, Massachusetts 
h Sanofi, Bridgewater, New Jersey 

Reprint requests: Paola Mina-Osorio, MD, PhD, Regeneron Pharmaceuticals Inc, 777 Old Saw Mill River Rd, Tarrytown, NY 10591.Regeneron Pharmaceuticals Inc777 Old Saw Mill River RdTarrytownNY10591

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.

Le texte complet de cet article est disponible en PDF.

Key words : adolescents, atopic dermatitis, children, eczema, infants, systemic treatment, topical calcineurin inhibitors, topical corticosteroids, topical treatment

Abbreviations used : AD, FDA, SCS, TCI, TCS


Plan


 Dr Paller and Dr Siegfried contributed equally to the data analysis, interpretation, drafting, and revising of this article.
 Funding sources: Supported by Regeneron Pharmaceuticals Inc and Sanofi.
 Conflicts of interest: Dr Paller has been a consultant for and received honorarium from Regeneron Pharmaceuticals and Sanofi and has served as an investigator for Regeneron Pharmaceuticals. Dr Siegfried has been a consultant for, received honorarium from, and served as an investigator for Regeneron Pharmaceuticals and Sanofi. Mr Vekeman and Ms Héroux are employees of StatLog Inc, which received research funding for the current study. Dr Gadkari and Dr Mina-Osorio, are employees of and stockholders in Regeneron Pharmaceuticals Inc. Dr Kaur, Dr Mallya, and Mr Miao are employees of and stockholders in Sanofi.


© 2019  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 82 - N° 3

P. 651-660 - mars 2020 Retour au numéro
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