Systemic Corticosteroid Exposure in Patients with Atopic Dermatitis: A US Population-Based Study.
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INTRODUCTION: Clinical guidelines recommend against routine use of systemic corticosteroids in atopic dermatitis (AD) due to associated adverse effects. Real-world adherence to these guidelines is unclear. METHODS: This retrospective cohort study evaluated US healthcare claims using Optum's Clinformatics Data Mart Database. We included two cohorts: exposure and diagnosis-based cohorts. Index was defined as the date of first systemic corticosteroid use post-AD diagnosis in the exposure cohort (AD diagnosis must have occurred within 6 months preceding index) or as the date of the first AD diagnosis in the diagnosis-based cohort. Follow-up began on index and continued until end of available data, health insurance discontinuation, death, or systemic corticosteroid discontinuation (exposure cohort) or initiation (diagnosis-based cohort). Patients were aged ≥ 12 years with diagnosed AD between 2017 and 2024 and had continuous health insurance enrollment ≥ 1 year before and after index. Patients were excluded if they had other immune-mediated inflammatory diseases within the 6 months preceding index or had history of malignancy, organ transplant, or HIV/AIDS. Systemic corticosteroid exposure duration was categorized as short term (≥ 1 day to < 30 days), medium term (> 1 month to ≤ 3 months), or long term (continuous/intermittent use for > 3 months). Categorization was informed by expert recommendations and observed prescription patterns. Exposure duration and treatment patterns were assessed in the exposure cohort. Prevalence of systemic corticosteroid use within 6 months post-AD diagnosis was evaluated in the diagnosis-based cohort. RESULTS: The exposure cohort included 29,994 patients; 67.7% had short-term use, 8.5% had medium-term use, and 23.9% had long-term use. Intramuscular systemic corticosteroids accounted for 20.0% of prescriptions; 80.0% received oral systemic corticosteroids. The diagnosis-based cohort included 80,647 patients; the prevalence of systemic corticosteroid use in AD was 20.0%. CONCLUSIONS: In the USA, systemic corticosteroids remain widely prescribed. These findings highlight the critical need for broader adoption of effective corticosteroid-sparing therapies in patients with AD.