Treatment Patterns in Pediatric Patients with Atopic Dermatitis

OBJECTIVES: Limited studies characterize the use of atopic dermatitis (AD) treatments over time as well as patient factors associated with treatment discontinuation in the pediatric population. This study utilizes electronic health records (EHR) data to better understand real-world treatment patterns in pediatric patients with this debilitating disease.

METHODS: This is a retrospective study of pediatric patients with moderate to severe AD who received care at a large integrated delivery network health system in Texas, identified using ICD-10 codes L20, L20.9, and L20.8x between January 1, 2020 and December 31, 2022, and have been prescribed at least one medication indicated for AD between January 1, 2014 and April 24, 2023. The primary outcome of the study was time to treatment discontinuation in AD medications. Predictors (sex, age, race, income, insurance) were evaluated for association with treatment discontinuation. Survival curves were constructed using unadjusted Kaplan-Meier estimates. Cox proportional hazards regression models were constructed to determine the predictors of time to treatment discontinuation.

RESULTS: Of 285 pediatric patients with AD, 262 (91.9%) patients were prescribed triamcinolone, 146 (51.2%) dupilumab, 121 (42.5%) crisaborole, 114 (40.0%) tacrolimus, and 85 (29.8%) hydrocortisone. Out of the 728 prescription records prescribed to the 285 patients, there were 99 (13.6%) cases of treatment discontinuations. Median time to treatment discontinuation was 45.2 months for triamcinolone, 10.4 months for dupilumab, 37.5 months for hydrocortisone, 18.6 months for crisaborole, and 25.4 months for tacrolimus. Dupilumab had the lowest discontinuation rate at 4.8% while hydrocortisone had the highest rate at 18.9%. Higher income was significantly associated with a decreased hazard of treatment discontinuation.

CONCLUSIONS: This is among the few studies that assessed treatment discontinuation in pediatric patients with AD over a 10-year period. With increased use of biologics and expansion of indications for pediatrics, future studies are warranted to help us better manage AD in pediatric patients.