The European TREatment of ATopic eczema (TREAT) Registry Taskforce survey: prescribing practices in Europe for phototherapy and systemic therapy in adult patients with moderate‐to‐severe atopic eczema*

Abstract

Summary Background For many years dermatologists have had access to few therapies for patients with moderate‐to‐severe atopic eczema (AE). New promising therapies are entering the market but conventional phototherapies and systemic therapies have more well‐known safety profiles, lower costs and wider availability. Objectives To provide insight into current prescribing practices of conventional phototherapy and systemic immunomodulatory therapies for adults with chronic AE, and the factors influencing these prescribing practices, before biologics and other novel therapeutics become routine clinical practice. Methods In this exploratory study dermatologists were invited to participate in an online survey via a mailing list of the European Academy of Dermatology and Venereology and national societies. Data were collected on participant characteristics (including clinical practice data), the use of phototherapies and systemic therapies, and factors influencing their use. Results From 30 European countries, 238 out of 361 dermatologists willing to participate (65·9%) completed the survey, with 229 meeting the inclusion criteria. For phototherapy (prescribed by 84·7%), most preferred narrowband ultraviolet B as first line (80·9%) and psoralen plus ultraviolet A as second (21·6%). For systemic therapy (prescribed by 95·2%) ciclosporin (54·1%), oral corticosteroids (32·6%) and methotrexate (30·7%) were used first line. Dermatologists relied mostly on personal experience for prescribing phototherapy and systemic therapy. Azathioprine and mycophenolic acid were prescribed by only 135 (59·0%) and 85 (37·1%) participants in total, mostly due to a lack of personal experience. Conclusions This study provides insight into prescribing practices for conventional phototherapy and systemic therapy in Europe and shows that off‐label therapies are also preferred as first‐line choice of systemic therapy.

Dupilumab in Adults with Moderate-to-Severe Atopic Dermatitis and Prior Use of Systemic Non-Steroidal Immunosuppressants: Analysis of Four Phase 3 Trials

“…Oral corticosteroids (OCS) are unsuitable for chronic or relapsing AD because of high likelihood of disease rebound [9]. Systemic non-steroidal immunosuppressants (NSISS), including cyclosporin A (CsA), methotrexate (MTX), mycophenolate mofetil, and azathioprine, are frequently prescribed to treat severe AD refractory to topical therapy (EUROSTAD [10]; TREAT [11,12]); however, there is a lack of robust evidence from large, well-designed randomized clinical trials (RCT) to support their use, and their toxicity profile requires frequent laboratory monitoring, and long-term treatment is not recommended because of a poor benefit-risk profile [13][14][15][16][17][18]. Patients treated with these broad-spectrum NSISS can suffer relapses and substantial side effects, including nephrotoxicity, liver dysfunction, and an increased risk of infection and cancer, and they are contraindicated in many patients [13,[15][16][17][18][19][20][21][22].…”

Current Perspectives on the Systemic Management of Atopic Dermatitis

“…Conventional systemic therapy options offered in the survey were CsA, AZA, MTX, MMF and oral corticosteroids, while dupilumab was not included. 30 In 2014, prior to the approval of dupilumab, another survey completed by members of the Society for Pediatric Dermatology in the US and Canada showed that the most commonly chosen first-line agents were CsA and MTX, second-line agents were MTX and MMF, and third-line agents were AZA and MMF. 31 With the exception of dupilumab, systemic immunomodulating agents do not have formal dosing guidelines for AD and require laboratory monitoring ( Table 1 ).…”

On which evidence can we rely when prescribing off-label methotrexate in dermatological practice? – a systematic review with GRADE approach

“…Methotrexate (MTX) is regularly prescribed for off-label use in dermatology as it is only registered for psoriasis vulgaris and mycosis fungoides. A recent survey study showed that almost one-third of all participating dermatologists preferred MTX as their first choice of therapy for atopic dermatitis (AD) (7). The use of MTX has many advantages: it is widely available, the safety profile is well-known and it is a low-cost treatment (8,9).…”