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Use of Systemic Immuno-Modulatory Medications in Children with Atopic Dermatitis

Schneeweiss MC, Solomon DH and Merola JF

Objective: Immuno-modulatory agents are increasingly discussed for the treatment of atopic dermatitis (AD) in children. We sought to understand patterns of systemic immuno-modulatory medication uses in children.
Methods: We used longitudinal patient data from an insurance claims database, IBM Market Scan, covering 185 million patients in the US between 2003 and 2016 to identify children with a diagnosis of AD (ICD-9 691.x or ICD-10 L20.9) associated with an outpatient or inpatient encounter. We computed the proportion of patients using systemic medications for the treatment of AD during the 6 months following the first office visit with a diagnosis of AD. Medications of interest include systemic non-biologic immuno-modulatory drugs and biologic immunomodulatory drugs. We trended the use of systemic immuno-modulatory agents for the treatment of pediatric AD over a 10-year period, from 2005-2015, including for each agent separately.
Results: We identified 1.6 million children with AD and no other auto-immune or inflammatory conditions that would otherwise require immune-modulatory treatment. Across all age groups the use of biologic agents increased from 0.1 to 0.3 per 1,000 over the 10-year period from 2005-2015 and the use of non-biologic systemic immunomodulatory drugs increased from 0.2 to 0.7 per 1,000. Among the non-biologic systemic agents’ methotrexate was the one increasing fastest (0.1 to 0.3).
Conclusion: In children and adolescents diagnosed with atopic dermatitis and without other disease indication for their use, the new use of systemic immuno-modulatory agents was infrequent but steadily increasing over the past 10 years.