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Comparing prescribing patterns for topical corticosteroids based on their FDA indication by age
Megan E Freeze1, Esther A Balogh1, Abigail Cline1
1Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Pediatric Dermatology
|November 10, 2020
Summary
Topical corticosteroids (TCS) are frequently prescribed off-label for pediatric atopic dermatitis (AD), indicating a gap between clinical practice and FDA guidelines. Further research is needed to ensure safe and effective use in younger patients.
Area of Science:
- Dermatology
- Pediatrics
- Pharmacology
Background:
- Atopic dermatitis (AD) affects up to 20% of children, with increasing prevalence.
- Topical corticosteroids (TCS) are a common first-line treatment for AD, used in 59% of visits.
- Concerns exist regarding the prescription of TCS outside of their FDA-approved age indications.
Purpose of the Study:
- To investigate the frequency of off-label topical corticosteroid prescribing for atopic dermatitis based on age.
- To identify specific TCS and age groups with higher rates of off-label use.
Main Methods:
- Prescribing data for AD were analyzed from the National Ambulatory Medical Care Survey (NAMCS).
- Off-label use was assessed by comparing prescriptions to FDA-approved age indications across four age groups (0-1, 2-7, 8-18, and 19+ years).
Main Results:
- While all identified TCS had indications for dermatoses, some were prescribed off-label.
- Off-label prescription rates varied significantly, with desoximetasone at 52% and halobetasol/alclometasone at 0% or undetectable rates.
Conclusions:
- Off-label use of TCS for pediatric AD is prevalent, highlighting a discrepancy with regulatory guidelines.
- Further pediatric studies are recommended to gather evidence for maintaining or expanding TCS label indications in younger populations.
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