Utilization and Duration of Systemic Corticosteroid Exposure in Atopic Dermatitis Patients After the Introduction of Advanced Therapies: A Population-Based Study From the United States

Abstract

Introduction: Clinical guidelines discourage routine use of systemic corticosteroids (SCS) for the management of atopic dermatitis (AD). However, adherence to these guidelines remain unclear. This is particularly relevant given the availability of advanced systemic treatments, including biologics and JAK inhibitors, for AD. We investigated the utilization and duration of SCS exposure among AD patients after the introduction of advanced therapies.

Methods: Using the U.S. Optum CDM database from 03/2017 to 03/2024, we defined a cohort of AD patients ≥ 12 years old who initiated oral or intramuscular SCS. To increase the likelihood that the SCS treatment was related to AD, we limited the cohort to recently diagnosed AD patients (within the preceding 6 months) without recent diagnoses of immuno-mediated diseases, asthma, osteoarthritis, dorsalgia, gout, bursitis, tendonitis, carpal tunnel, or a history of malignancies, organ transplant or HIV/AIDS. Continuous health insurance enrollment was required for at least 1 year before and after initiating SCS. We followed patients until the end of available data, health insurance discontinuation, or death to determine exposure duration. Exposure time was categorized as short-term (<30 days), medium-term (30-90 days), or long-term (>90 days) based on data observation and clinical experience. Categorical and continuous variables were presented as numbers and percentages or mean and standard deviation values, respectively.

Results: During the study period, 29,994 patients aged 12 years or older with a recent AD diagnosis initiated SCS treatment, representing 20% of eligible AD patients. Most SCS initiators were prescribed oral SCS (80%). Of all users, 67.7% (20,293) received SCS for a short-term period, while 8.5% (2,535) for a medium-term duration, and 23.9% (7,166) for a long-term period. Overall, the average age was 50 (±22) years old. Short-term SCS users had a higher percentage of patients under 30 years old (27%) compared to medium-term (19.7%) and long-term users (16.1%). Patients in all three groups were mostly female (58-60%). At baseline, long-term users received slightly higher prescriptions of biologics (3.3% vs 3.1% and 2.5%) and immunosuppressants (2.6% vs 1.9% and 1.2%) compared to medium-term and short-term users and had higher usage of non-steroidal anti-inflammatory drugs (19.2% vs 15.2% and 13.5%). Dermatologist visits were similar among the three groups, with medium-term users having the highest proportion of encounters (33.9%).

Conclusion: Despite clinical guidelines advising against the use of SCS for AD, they remain widely prescribed, and a relevant proportion of patients are exposed to SCS for extended durations (over 90 days).