Utilization of topical steroids and topical immunomodulators in the United States

Abstract

Atopic dermatitis (AD) is a common disease of the skin with worldwide prevalence, affecting over 20% of the population. Socioeconomic studies indicate that an estimated 0.9 to 3.8 billion dollars are spent in the United States annually, ranking this disease as the 6th most expensive to treat. Topical steroids have been the mainstay of therapy in AD. Concerns regarding usage of topical steroid medications include skin atrophy, telangiectasia, and steroid-induced rosacea. In January 2001, the first topical immunomodulator (TIM), tacrolimus ointment, was approved for the treatment of moderate to severe AD. Subsequently, pimecrolimus cream was introduced in January 2002 for the treatment of mild eczema. To determine the significance of these new agents, data from National Data Corporation, an independent data collection company that gathers information on prescribing trends from participating pharmacies, were analyzed quarterly from January 2001 to 2003. The numbers of prescriptions written for TIMs and topical steroids by dermatologists and primary care physicians (pediatricians, family practitioners, and internists) were evaluated. The number of prescriptions for topical steroids did not show any appreciable changes, averaging about 4.5 million prescriptions/quarter. In contrast, utilization of TIMs has been steadily increasing. About 950K prescriptions are written for TIMs per quarter with topical steroids to TIMs prescription ratio of 5:1. Utilization of TIMs by dermatologists began immediately after product release and has continued to increase, with a prescription ratio of topical steroids to TIMs of 3:1. In contrast, utilization of TIMs by primary care physicians lagged. Currently, the number of prescriptions written for TIMs and the ratio of steroids to TIMs prescribed is comparable between dermatologists and pediatricians. Use of TIMs by family physicians and internists are increasing but still lags when compared to dermatologists, with a steroid to TIMs prescription ratio of about 8:1. These data suggest that TIMs are increasingly used in the routine treatment of eczema and prescribed in combination with topical steroids.