How providers navigate systemic therapies in pediatric atopic dermatitis: Qualitative insights and the need for standardized guidelines

Summary: Abstract Body: Despite increasing use of biologics and oral JAK inhibitors for atopic dermatitis (AD), guidance on long-term use in pediatric populations is limited. We explored pediatric dermatology providers’ approaches to systemic therapies for moderate-to-severe pediatric AD to better understand their perspectives on long-term use. Providers were recruited via email to the Pediatric Dermatology Research Alliance. Semi-structured interviews (n =11) and free-listing techniques were used to identify themes in providers’ decision-making. Two researchers independently analyzed interviews using an emergent thematic framework, and a saliency index was applied to free-listing data. Our findings revealed concordance regarding initiation criteria and preferred treatments. Factors contributing to initiating systemics, in descending order of importance, were quality of life, refractoriness to other treatments, and disease severity. Dupilumab was the preferred first-line systemic (saliency index: 0.93). However, variability emerged in preferences for de-escalating therapies after achieving symptom control. Providers emphasized the need for standardized guidelines, as many decisions were perceived to be reliant on individual comfort. Concerns about long-term side effects, parental preferences, and loss of access were factors influencing decisions to discontinue therapy after achieving disease control. Reasons for continuing therapy after adequate control included maintaining therapeutic benefits, preserving quality of life, and preventing relapse. Barriers to systemics included concerns about safety, monitoring requirements, and the mode of administration (e.g., injections). While prior research has examined general approaches to treating AD in children, this study provides a focused lens on systemic therapies, which are increasingly used for moderate-to-severe AD. Our findings highlight the need for standardized, evidence-based guidelines for long-term management of systemic therapies for pediatric AD. Connie Cai¹, Delaney D. Ding², Karin Kartawira¹, Joy Wan¹ 1. Johns Hopkins Medicine, Baltimore, MD, United States. 2. University of Florida College of Medicine, Gainesville, FL, United States. Clinical Research: Epidemiology and Observational Research