Measuring and Improving Adherence to Crisaborole 2% Ointment in Patients With Atopic Dermatitis

October 2022 | Volume 21 | Issue 10 | 1043 | Copyright © October 2022


Published online September 30, 2022

Stephanie N. Snyder BAa, Alexandra Collins MDa, Abigail E. Cline MDa, Arjun M. Bashyam MDa, Emily L. Unrue BSa, Steven R. Feldman MD PhD,a,b,c,d, Lindsay C. Strowd MDa,b

aCenter for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC
bDepartment of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC
cDepartment of Pathology, Wake Forest School of Medicine, Winston-Salem, NC
dDepartment of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC

Abstract
Background: Atopic dermatitis (AD) is an inflammatory skin condition with dry, scaly, and intensely itchy skin. Treatment failure is the result of poor adherence.
Objective: In this study, we assessed the impact of an internet-based survey on adherence to topical crisaborole 2% ointment in patients with mild AD.
Methods: Participants were randomized to the intervention or control group. The intervention group received weekly email surveys regarding adherence for 6 weeks, then monthly for 12 months. All participants came in for 5 visits over the year.
Results: Twenty-eight subjects were recruited for the study (n=19 adults, n=9 pediatrics). Adherence for adults that remained in study (n=6) was 60%. Adherence of the adult control and intervention groups were 49% and 45%, respectively (P>0.05). Adherence for pediatric participants that remained in study (n=2) was 6%. The adherence of the pediatric control and intervention groups were 27% and 29%, respectively (P>0.05).
Discussion: Medication adherence was low. The survey intervention did not improve adherence. However, more participants in the intervention group completed the study than in the control group of adults. Regular communication from the provider may help patients feel supported and continue treatment.

ClinicalTrials.gov identifier: NCT03250663

J Drugs Dermatol. 2022;21(10):1043-1048. doi:10.36849/JDD.6280

INTRODUCTION

Atopic dermatitis (AD) is described as an inflammatory skin condition in which patients present with dry, scaly, and intensely itchy skin.1 A number of treatment methods are available to these patients, including corticosteroids, topical calcineurin inhibitors, and antimicrobial therapies.2 In December 2016, a non-steroidal topical, crisaborole 2% ointment was approved by the Food and Drug Administration (FDA) for mild to moderate atopic dermatitis in patients ages 2 years and older, with more recent approval extended to patients aged 3 months and older.3 Despite the use of topical agents as the primary treatment method, most patients with AD do not adequately respond to topical treatment.4 Topical treatment failure may be the result of poor adherence.5-7

In this study, we hypothesized that an internet-based survey intervention would improve adherence to crisaborole in children and adults with AD. This study yielded important information including the first detailed characterization of atopic dermatitis patients’ long-term adherence to topical treatment.

MATERIALS AND METHODS

Study Design
The purpose of this study was to evaluate the impact of an internet-based survey on adherence to topical therapy using data collected by using the Medication Electronic Monitoring System (MEMS) cap fitted to a 60-gram tube of crisaborole ointment. This was a double blinded open label study of the FDA-approved medication crisaborole 2% ointment (Eucrisa) used on-label for AD.

Subjects were randomized to 1 of 2 groups; a control group and an intervention group. All patients included in the study were provided crisaborole to use. The intervention group received weekly email surveys regarding adherence for 6 weeks, then monthly thereafter for 12 months (Figure 6). Participants in both
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