title: Prescribing practices for systemic agents in the treatment of severe pediatric atopic dermatitis in the US and Canada: The PeDRA TREAT survey.
abstract: BACKGROUND
  There is a paucity of literature to direct physicians in the prescribing of immunomodulators for patients with severe atopic dermatitis (AD).
  
  
  OBJECTIVE
  To survey systemic agent prescribing practices for severe childhood AD among clinicians in the United States and Canada.
  
  
  METHODS
  The TREatment of severe Atopic dermatitis in children Taskforce (TREAT), US&CANADA, a project of the Pediatric Dermatology Research Alliance (PeDRA), developed an online multiple-response survey to assess clinical practice, gather demographic information and details of systemic agent selection, and identify barriers to their use in patients with recalcitrant pediatric AD.
  
  
  RESULTS
  In total, 133 of 290 members (45.9%) of the Society for Pediatric Dermatology completed the survey, and 115 of 133 (86.5%) used systemic treatment for severe pediatric AD. First-line drugs of choice were cyclosporine (45.2%), methotrexate (29.6%), and mycophenolate mofetil (13.0%). The most commonly used second-line agents were methotrexate (31.3%) and mycophenolate mofetil (30.4%); azathioprine was the most commonly cited third-line agent. The main factors that discouraged use of systemic agents were side-effect profiles (82.6%) and perceived risks of long-term toxicity (81.7%).
  
  
  CONCLUSIONS
  Investigation of the sequence of systemic medications or combination systemic therapy was limited. Recall bias may have affected the results.
  
  
  CONCLUSIONS
  Great variation exists in prescribing practices among American and Canadian physicians using systemic agents for treatment of pediatric AD.
authors.affiliation: Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York.
authors.forename: Christine R
authors.initials: CR
authors.lastname: Totri
authors.affiliation: Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital and University of California, San Diego, California. Electronic address: leichenfield@rchsd.org.
authors.forename: Lawrence F
authors.initials: LF
authors.lastname: Eichenfield
authors.affiliation: Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' Hospital NHS Foundation Trust and King's College London, London, UK.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Logan
authors.affiliation: Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' Hospital NHS Foundation Trust and King's College London, London, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Proudfoot
authors.affiliation: Center for Evidence-based Healthcare, University Hospital Dresden and Institute for Occupational and Social Medicine, Technical University, Dresden, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Schmitt
authors.affiliation: Section of Dermatology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada.
authors.forename: Irene
authors.initials: I
authors.lastname: Lara-Corrales
authors.affiliation: Department of Dermatology, University of California at San Francisco, San Francisco, California.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Sugarman
authors.affiliation: Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital and University of California, San Diego, California.
authors.forename: Wynnis
authors.initials: W
authors.lastname: Tom
authors.affiliation: Department of Pediatrics and Dermatology, Saint Louis University, Cardinal Glennon Children's Hospital, St Louis, Missouri.
authors.forename: Elaine
authors.initials: E
authors.lastname: Siegfried
authors.affiliation: Department of Pediatrics and Dermatology, University of California at San Francisco, San Francisco, California.
authors.forename: Kelly
authors.initials: K
authors.lastname: Cordoro
authors.affiliation: Department of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Paller
authors.affiliation: Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' Hospital NHS Foundation Trust and King's College London, London, UK.
authors.forename: Carsten
authors.initials: C
authors.lastname: Flohr
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use*; D002170:Canada; D002648:Child; D016572:Cyclosporine / Q000627:therapeutic use*; D003876:Dermatitis, Atopic / Q000188:drug therapy*; D003880:Dermatology; D011307:Drug Prescriptions / Q000592:standards*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000627:therapeutic use*; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D012720:Severity of Illness Index; D014481:United States
chemical_list: D016572:Cyclosporine; D009173:Mycophenolic Acid; D001379:Azathioprine; D008727:Methotrexate
keywords: atopic dermatitis; azathioprine; cyclosporine; methotrexate; mycophenolate mofetil; oral antimicrobials; oral steroids