Treatment Patterns in Danish Patients with Atopic Dermatitis Before and After Hospital Referral

• Published in: Dermatology and therapy 2021-04, Vol.11 (2), p.499-512
• Main Authors: Egeberg, Alexander, Thyssen, Jacob P., Wu, Jashin J., Pierce, Evangeline, Terres, Jorge A. Ross
• Format: Article
• Language: English
• Subjects: Antibiotics; Atopic dermatitis; Corticosteroids; Dermatology; Dosage and administration; Drug therapy; Forecasts and trends; Internal Medicine; Medicine; Medicine & Public Health; Methods; Oral and Maxillofacial Surgery; Original Research; Plastic Surgery; Quality of Life Research
• ISSN: 2193-8210; 2190-9172
• DOI: 10.1007/s13555-021-00491-2

Introduction A number of treatments for atopic dermatitis (AD) are available; however, long-term treatment patterns and healthcare consumption in patients with AD are poorly described. Methods We conducted a registry-based longitudinal drug utilization study among Danish patients with AD that were referred to their first-ever visit at hospital-based dermatology clinics. Their first visit was in the period between 1 January 2005 and 31 December 2012, and patients were followed up to 5 years after their first visit. Results In total, 8213 people with a first-time hospital dermatologist contact for AD were included in the study (3514 aged 0–9 years, 1501 aged 10–19 years, 3198 aged 20 years or older). At first visit, a baseline history of moderately potent topical corticosteroid (TCS) use was seen among 46.6% of children (0–9 years), whereas potent or very potent TCS use was more frequently among older individuals (e.g., 51.1% and 25.6% of people aged 50 years or older had used potent and very potent TCS, respectively). The median (interquartile range) annual number of visits to general practitioners was 4 (2–7) for children and 5 (2–8) for adults, in the 12 months prior to referral. Three years after referral, these numbers had decreased to 2 (1–4) and 3 (1–6), respectively. In the first year after referral, 6% of patients were prescribed systemic corticosteroids, whereas other systemic therapies were used in 5% or less. Conclusions After referral, low proportions of patients received systemic treatment, or potent TCS. These findings highlight considerable differences in treatment patterns between general practitioners and private practice dermatologists, compared with hospital-based dermatologists, and emphasize the need for better adherence to evidence-based treatment guidelines.