Study Details Historical Changes in Medication Prescription Patterns for Atopic Dermatitis

Prescription patterns of topical medications for atopic dermatitis changed between 2002 and 2015, according to the results of a new study. Patterns differed depending on the type of institution they were prescribed in and the specialty of prescribing physicians.

Results of the investigative review were published in Annals of Dermatology.

Topical corticosteroids (TCSs) are considered the main anti-inflammatory treatment for acute atopic dermatitis flares. However, thanks to the introduction of new topical calcineurin inhibitors (TCIs), prescription patterns of topical agents have shifted, authors explained.

“It is important to understand these patterns of changes to increase patient compliance and to provide structured long-term treatment. However, to date, most studies have focused on the individual efficacy of topical agents and there has been no comprehensive study on the overall prescribing patterns of topical medications for [atopic dermatitis] in Korea,” they wrote.

To better characterize this change, the researchers analyzed medications prescribed to Korean patients with atopic dermatitis based on data from the National Health Insurance Sharing System. They also compared the potency of any prescribed TCSs for patients with atopic dermatitis vs psoriasis.

A total of 94,165 patients were included in the study, with the annual number of patients receiving treatment ranging from 5743 to 9340 between 2002 and 2015.

TCSs were the most prescribed topical medications among patients, the authors said. These were followed by topical antibiotics and TCIs. Over the period studied, “estimates indicated a slight decrease in prescription rates of TCSs from 95.4% to 92.0%, but there was no significant difference.”

Additional findings included the following:

• In terms of steroid class, prescription of moderate- to low-potency TCSs increased and the use of high-potency TCSs decreased
• Tertiary hospitals had a higher prescription rate for TCIs than secondary or primary hospitals: 16.2% vs 3.1% vs 1.9%, respectively)
• Dermatologists prescribed TCIs more frequently than pediatricians and internists: 4.3% vs 1.2% vs 0.6%, respectively
• Among TCSs, Class 5 was prescribed the most, at 40.6%, followed by Classes 7, 6, 4, 3, 1, and 2
• When investigators compared the potency of TCSs prescribed for atopic dermatitis with those for psoriasis, moderate- to low-potency TCSs were more commonly prescribed in atopic dermatitis

The prevalence of atopic dermatitis in Korea is around 9.5% in children under age 10 and just over 1% in those older than age 10. The overall prevalence is 1.9% among the entire Korean population.

Although TCSs have several advantages over other treatments, such as their availability in varying potencies and formulations, over the long term the medications can lead to local adverse effects (AEs) like rosacea, acne, and skin atrophy.

“Severe systemic AEs, including the suppression of the hypothalamic-pituitary adrenal axis, hyperglycemia, diabetes, and glaucoma, can occur,” the authors added.

Because TCIs have targeted anti-inflammatory effects without local or systemic AEs, they can serve as an appropriate alternative treatment for patients with atopic dermatitis.

The study researchers hypothesize a higher proportion of TCI and topical antibiotic prescriptions were made at tertiary hospitals because there is a higher proportion of patients using TCIs as maintenance therapy in tertiary hospitals. “These institutions treat more chronic patients with severe conditions that are difficult to manage in primary and secondary hospitals,” they noted.

However, as new topical agents like phosophodiesterase-4 and Janus kinase inhibitors emerge, prescription patterns will likely continue to change and become more diverse in the future.

“Therefore, to provide effective and safe treatment options for [atopic dermatitis] patients, more constructed topical treatment prescription algorithms are needed,” researchers concluded.

Reference

Lee J, Kim T, Cheon S, et al. Prescription patters of topical medications in patients with atopic dermatitis: an investigative review using big data from the national health insurance corporation. Ann Dermatol. Published online March 9, 2023. doi:10.5021/ad.22.114