OBJECTIVES : Children and adolescents with moderate-to-severe atopic dermatitis (AD) which cannot be managed despite optimal use of topical therapies often require intervention with systemic immunosuppressants (IMs), almost all of which are used off-label in the UK. These patients must be closely monitored due to the adverse effect profile of these broad-spectrum therapies. The objective of this study is to quantify the healthcare burden associated with clinical interactions and monitoring of children with moderate-to-severe AD receiving IM therapies.

METHODS : A retrospective cohort study was undertaken using linked Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) databases in England. Patients included were aged 6 to 17 years and identified in CPRD between April 2014 and January 2019, with diagnosis codes for AD and treatment with IMs (ciclosporin, methotrexate, azathioprine, mycophenolate).

RESULTS : 599 patients were identified: 51.9% were male with a mean age of 12.08 years and mean follow-up time of 4.65 years. 240 (40%) had CPRD data linked to secondary care HES data. Of these 240, a total of 5,860 dermatologist appointments were recorded corresponding to a mean of 24.42 per person (standard deviation [SD]: 34.79) during the observation period or 5.13 per patient-year (SD: 6.75). Overall, 594 patients (99.2%) were recorded with 26,683 general practitioner appointments, a mean of 44.92 per person (SD: 44.14) equivalent to 10.14 per patient-year (SD: 7.21). 510 patients (85.1%) were recorded with 82,052 tests, a mean of 160.9 per patient (SD: 262.2). The most common blood tests were liver function (n=5,911), renal function (n=5,271) and platelet count (n=2,981).

CONCLUSIONS : Paediatric patients with moderate-to-severe AD impose a large burden on primary and secondary healthcare services in England. The close monitoring required with IM therapies adds to the already high healthcare burden due to moderate-to-severe AD, which is often difficult-to-treat in this cohort.