Fahad Ahmed, BA

Black and Hispanic patients were less likely to be prescribed nonsteroidal topical treatments for atopic dermatitis (AD), according to recent findings.¹

Topical corticosteroids are often the first type of pediatric AD treatment administered, but nonsteroidal topicals, phototherapy, and systemic immunomodulators are often brought in for recalcitrant disease cases.

This study’s investigators pointed out that while the prevalence of use for these 3 secondary treatments has been identified, there is less available information about the demographics of the patients given these medications.²

The research was authored by Fahad Ahmed, BA, from the Department of Dermatology at the Perelman School of Medicine, University of Pennsylvania.

“We sought to explore factors associated with receipt of prescriptions for nonsteroidal topical, phototherapy, and systemic treatments among children with AD,” wrote Ahmed and colleagues.

Study Background

The investigators conducted a cross-sectional study with AD patients being recruited who were aged <18 years and had ≥2 SNOMED diagnosis codes for either “atopic dermatitis” or “eczema.”

The patients’ codes would have been reported at the Children's Hospital of Philadelphia—known for being an extensive urban academic center—in the period between January of 2009 and September of 2017.

The data gathered by the team was accessed through the pediatric learning health system known as PEDSnet, and 39,289 patients in total were recruited.

The investigators’ analysis involved the collection of the following points of information, controlled for their multivariable analysis:

• Demographics
• Utilization of healthcare
• Atopic comorbidity data

The research team assessed prescriptions that had been made for nonsteroidal topicals such as tacrolimus, crisaborole, and pimecrolimus.

They also assessed prescriptions for systemic immunosuppressants, including mycophenolate, methotrexate, azathioprine, and cyclosporine, for phototherapy, and for systemic corticosteroids.

Study Results

The investigators concluded after their multivariable analysis, the prescription of nonsteroidal topicals was associated with several factors:

• Being of older age
• Having a younger age at the time of diagnosis
• Male sex
• Atopic comorbidities
• Dermatologist visits

The team concluded that Black and Hispanic patients were about 14 to 38% less likely to be prescribed a nonsteroidal topical treatment than White patients, although Asian patients were found to be 39% more likely to be given nonsteroidals.

Additionally, the investigators wrote that atopic comorbidities were common, and that nonsteroidal topicals were given to about 10.6% of the patients, with 6.6% given pimecrolimus, 5.2% given tacrolimus, and 0.8% given crisaborole.

They added that of the 0.6% of patients prescribed systemic immunosuppressants, 0.5% were given methotrexate, 0.09% were given cyclosporine, 0.08% were given mycophenolate, and 0.08% were given azathioprine.

The investigators found that 17,159 patients were given systemic corticosteroids and about 0.2% of patients were given phototherapy.

“The study period also predates dupilumab approval for pediatric AD in 2019,” they wrote. “Although prescription patterns have likely changed since our findings serve as a comparator to future treatment utilization studies and call for further examination of potential disparities in pediatric AD treatment.”

References:

1. Ahmed, F, Takeshita, J, Wan, J. Differences in prescriptions for systemic medications and nonsteroidal topicals among children with atopic dermatitis. Pediatr Dermatol. 2023; 1- 5. doi:10.1111/pde.15263
2. Paller AS, Siegfried EC, Vekeman F, et al. Treatment patterns of pediatric patients with atopic dermatitis: a claims data analysis. J Am Acad Dermatol. 2020; 82(3): 651- 660.