Study Highlights Strategies for Treatment Adherence in Pediatric Atopic Dermatitis

Adherence to pediatric atopic dermatitis therapies represents a multifactorial challenge for caregivers as well as patients, new findings suggest, and a new analysis provides both groups with an index of strategies designed to optimize adherence.¹

These results represent the conclusion of a new systematic review conducted to investigate this topic, led in part by Caitlyn B. Dagenet Dagenet is an MD candidate from the University of Arizona College of Medicine in Tucson, Arizona.

Dagenet et al. highlighted the fact that adherence is a commonly-observed issue among children with atopic dermatitis, necessitating collaboration between the clinician and guardians of the patients. They noted the example of adherence falling to 32% by the conclusion of an 8-week treatment regimen with topical triamcinolone.²

“There is a paucity of literature that examines adherence issues in childhood atopic dermatitis),” Dagenet and colleagues wrote. “This systematic review aims to shed light on the current barriers to pediatric (atopic dermatitis) treatments and proposes strategies to improve adherence.”¹

Background and Study Design

The investigators carried out their systematic review in March 2023, during which 2 independent authors conducted searches on the PubMed and EMBASE databases for articles written from 2000 - 2023. They also included an updated search with identical terms in December 2023 on PubMed.

In the research team’s list of search words, they included such terms as atopic dermatitis, eczema, treatment adherence, and compliance. The team manually screened the various articles based on their full text, titles, and abstracts, deciding to include them if they met several criteria. Specifically, if they contained original data that was non-review and non-commentary, were written in English, and addressed adherence and adherence-related factors in atopic dermatitis.

Given their criteria for study exclusion, the investigators would not look at non-relevant studies, non-human ones, commentaries, reviews, or meta-analyses. They sought to sort the research into pediatric versus adult study populations and this was based on volume.

The variables which the research team looked into included the demographic data among subjects, intervention data, and results of the studies assessed in their analysis. They implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram for the purposes of tracking the search schema.

Findings on Adherence to Treatment

There were 62 studies which the investigators found met their criteria for inclusion in the analysis. Thirty-six studies had inquired to both patients and caregivers (N = 10,268) about barriers to adherence to atopic dermatitis treatment. They noted that none of the research included were specific to systemic treatment options.

The research team reported that 5 studies exclusively evaluated levels of adherence using Morisky medication adherence scale, medication electronic monitoring systems, or self-reported levels of adherence to topical therapies.

Adherence barriers the team identified included inadequate disease-related education, unclear medication-related requirements, caregiver life quality issues, fear of topical corticosteroid (TCS) use, and dissatisfaction with doctor-patient interaction. There were 21 studies which the investigators found described interventions associated with text message or email reminders, nurse-led or web-based education programs, and education into TCS.

Notably, the team concluded that improvements in adherence to atopic dermatitis medication coincided with daily text-message reminders, caregiver education programs, disease action plans, the TCS potency “traffic light” color system, and follow-up meetings which had a high frequency.

“The implementation of these strategies and tools has a multitude of barrier's including funding, physical resources, and patient access to online tools,” they wrote. “We hope to continue to bring awareness to these tools to motivate all stakeholders to work toward implementation.”¹

References

1. ^{Dagenet, C.B., Gawey, L., Davoudi, S., Ma, E., Jeong, C., Atluri, S., Kincannon, J.M., Hsiao, J.L., Feldman, S.R. and Shi, V.Y. (2024), Treatment Adherence in Pediatric Atopic Dermatitis: A Systematic Review. Pediatric Dermatology. https://doi.org/10.1111/pde.15771.}
2. ^{J. Krejci-Manwaring, M. G. Tusa, C. Carroll, et al., “Stealth Monitoring of Adherence to Topical Medication: Adherence Is Very Poor in Children With Atopic Dermatitis,” Journal of the American Academy of Dermatology 56, no. 2 (2007): 211–216, https://doi.org/10.1016/j.jaad.2006.05.073.}