Objectives: Topical therapies are commonly used as first-line treatments for patients with atopic dermatitis (AD). However, many patients do not achieve adequate disease control and are escalated to systemic agents, such as oral corticosteroids (OCS) and biologics. Here we describe treatment patterns in US patients with AD during the first 12 months of topical treatment use.

Methods: Data from 2017–2019 were extracted from the IBM MarketScan database. Eligible patients (≥12 years old; ≥1 medical claim for AD; 12 months of continuous enrollment in a healthcare plan before and after the first topical prescription claim for AD [index event]) were included. Patients with a history of topical AD prescriptions in the 12 months pre-index event were excluded. Treatment patterns were summarized based on prescription claim refills during the 12 months post-index event.

Results: Overall, 47,572 patients were included in the analysis; mean (SD) age was 38 (18.8) years; 63.7% were female. The most common comorbid conditions included allergic rhinitis (27.2%) and asthma (15.7%). Medium-potency topical corticosteroids (TCS) were the most frequent initial topical treatment (43.8%), followed by high-potency TCS (22.4%), low-potency TCS (20.6%), topical calcineurin inhibitors (6.5%), and crisaborole (5.7%). Across initial topical treatments, 26.4% of patients needed a systemic treatment (23%–29% escalated to OCS; 3%–7% escalated to dupilumab); mean time for adding OCS or dupilumab was 16–20 and 19–25 weeks, respectively. Some patients (13.4%) were on ≥2 topical treatments during the study period.

Conclusions: A considerable proportion of US patients with AD in this study needed >1 topical treatment in their first year after treatment initiation. Many patients needed a systemic treatment to manage their AD. These treatment patterns, and the use of dupilumab in particular, after initiating topical therapy may reflect the real-world effectiveness and treatment success of topical regimens during the analysis period.