A Systematic Scoping Literature Review of Publications Supporting Treatment Guidelines for Pediatric Atopic Dermatitis in Contrast to Clinical Practice Patterns

Abstract

IntroductionTreatment guidelines endorse a variety of strategies for atopic dermatitis (AD) which may vary from published data and clinical practice patterns. The objective of this review was to quantify the volume of available medical literature supporting pediatric AD treatments and compare these patterns to those recommended by published guidelines and/or clinical practice patterns.MethodsSearches of Embase (2005–2016) and abstracts from selected meetings (2014–2016) related to AD treatment in patients younger than 17 years of age yielded references that were assessed by study design, primary treatment, age groups, and AD severity.ResultsPublished literature partially supports clinical guidelines, with emollients and topical medications being the most investigated. There were disproportionately more publications for topical calcineurin inhibitors (TCI) compared with topical corticosteroids (TCS); however, the search interval may have biased the results toward treatments approved near the beginning of the time frame. In contrast, publications documenting clinical practice patterns reflect greater use of emollients and TCS (over TCI), as well as systemic corticosteroids. Data is relatively limited for long-term and combination treatment, treatment of severe AD, and patients younger than 2 years of age, and completely lacking for systemic corticosteroids.ConclusionThis scoping review demonstrates that available medical literature largely supports published guidelines for topical therapy; however, clinical practice patterns are less aligned. There is a lack of data for older, more frequently used generic treatments, including oral antihistamines, oral antibiotics, and systemic corticosteroids. Overall, literature is lacking for long-term treatment, treatment for patients younger than 2 years of age, and for systemic treatment for severe disease.FundingRegeneron Pharmaceuticals Inc.

Treatment patterns of pediatric patients with atopic dermatitis: A claims data analysis

“…As for TCSs, dermatologists might have more comfort with the risk-benefit profile of this class of treatments when used as prescribed. 10 There was widespread use of medications not recommended by published AD guidelines, consistent with a previously published observational study. 21 Oral antihistamines were the most commonly used agents after TCSs, despite concerns over adverse effects, such as undesired sedation, dry mouth, and blurred vision, which might be particularly detrimental for school-aged children.…”

“…Published literature is scant on current pediatricspecific practice patterns. 10 The objective of this study was to assess current treatment patterns in a large population of insured pediatric patients with AD to identify opportunities for improved management.…”

Treatment Patterns of Atopic Dermatitis Medication in 0–10-Year-Olds: A Nationwide Prescription-Based Study

“…There are notable discrepancies in the literature regarding paediatric patients treated with TCIs. In a review by Siegfried et al., TCI treatment ranged from 0% to 52% [ 6 ]. Accordingly, we found that only 5% of the patients received TCIs, consistent with Paller et al.…”

“…The heterogeneity of the clinical picture and disease course of patients with AD indicates a complex reality and uncertain disease trajectories. The literature on treatment patterns and disease severity, particularly in patients under 2 years of age, is sparse [5,6]. A review by Siegfried et al [6] revealed limited data on longterm and combination treatment, treatment of severe AD, and systemic corticosteroids in children [6].…”

“…The literature on treatment patterns and disease severity, particularly in patients under 2 years of age, is sparse [5,6]. A review by Siegfried et al [6] revealed limited data on longterm and combination treatment, treatment of severe AD, and systemic corticosteroids in children [6]. In addition, methodological divergence, assessments of AD signs, variations in participants, clinical settings and countries studied were evident.…”