Dermatology: Practical and Conceptual Research Letter | Dermatol Pract Concept. 2024;14(2):e2024108 1 Parental Preferences Regarding the Novel Systemic Treatment for Atopic Dermatitis in Children Alicja Mesjasz1, Monika Suszyńska2, Marta Jaskulak3, Magdalena Trzeciak4 1 Dermatological Students Scientific Association, Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland 2 Department of Radiology, Faculty of Medicine, Regional Specialized Children’s Hospital in Olsztyn, Olsztyn, Poland 3 Department of Immunobiology and Environmental Microbiology, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland 4 Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland Key words: atopic dermatitis, monoclonal antibodies, dupilumab, Janus kinase inhibitors Citation: Mesjasz A, Suszyńska M, Jaskulak M, Trzeciak M. Parental Preferences Regarding the Novel Systemic Treatment for Atopic Dermatitis in Children. Dermatol Pract Concept. 2024;14(2):e2024108. DOI: https://doi.org/10.5826/dpc.1402a108 Accepted: November 29, 2023; Published: April 2024 Copyright: ©2024 Mesjasz et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Prof. Magdalena Trzeciak M.D., PhD, Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland, tel: +48-501 188 586 Email: mtrzeciak@gumed.edu.pl Introduction Atopic dermatitis (AD) is a dermatosis that affects up to 20% of children and 3-7% of adults globally [1]. Over the past few years, several biologics and inhibitors of Janus kinases (JAKi) have been approved for the treat- ment of moderate to severe AD [2]. Very little study has been conducted on the tendencies of patients towards characteristics of novel therapies, with even fewer exploring the preferences of parents [2]. Case Presentation A total of 221 participants were included in the study. They have the option to select from the alternatives provided in Table 1.The majority of respondents (80.09%) were aged be- tween 21-40. The average age of the patient was 4.67 years. The average Patient-Oriented Scoring of Atopic Dermatitis (PO-SCORAD) was 45.48288 ±19.81465. Up to 73.76% of parents would choose medication taken every day in a tablet form over an every two weeks injection (26.24%). Parents who had used multiple AD treatments were more likely to accept an injection over a tablet, as were older parents (P = 0.04255), parents of older children (P = 0.0109), and parents of children with higher PO-SCORAD scores (P = 0.00598) (Figure 1. and Figure 2.). Parents placed a higher value on the safety (81.45%) of the medication compared to its efficacy (18.55%). A trend was observed, especially among parents of children who took multiple treatments (P = 0.111). Older parents more frequently prioritized efficacy over safety (P = 1.75E-04). The prioritization of the drug effectiveness was positively cor- related with the duration since the diagnosis (P = 3.20E-04). 2 Research Letter | Dermatol Pract Concept. 2024;14(2):e2024108 Table 1. Possible responses that patients could have selected regarding their preferences for the novel, systemic treatment for atopic dermatitis (AD). First option Second option Injection every 2 weeks or tablet everyday Treatment more effective or treatment safer Reduction of the dose on caregiver own or reduction of the dose by the caregiver Withdrawal of the drug on caregiver own or withdrawal of the drug by the physician Drug taken more frequently & effects lasting for shorter or drug taken less frequently and effects lasting for longer Treatment on demand or maintenance treatment Administration at home or administration in the medical facility First effect-alleviation of pruritus or first effect-improvement of skin lesions Lasting effect-alleviation of pruritus or lasting effect-improvement of skin lesions Figure 1. The presented graph depicts the variations in the likelihood of choosing generally preferred attributes (once-daily tablet, safety, less frequent administration, on-demand treatment, and administration at home) across parents of children from different age groups. Children were categorized into three distinct subgroups based on their age: those who were under the age of 5, those who were between the ages of 6 and 10, and those who were over the age of 11. Figure 2. The presented graph depicts the variations in the likelihood of choosing generally preferred attributes (once-daily tablet, safety, less frequent administration, on-demand treatment, and administration at home) across parents of children with different disease sever- ity. Children were divided into three subgroups depending on severity of atopic dermatitis (AD) assessed by Patient-Oriented SCORing Atopic Dermatitis (PO-SCORAD) (PO-SCORAD: less than 25- mild AD, between 25 and 50- moderate AD, more than 50-severe AD). Research Letter | Dermatol Pract Concept. 2024;14(2):e2024108 3 Individuals who had older children (P = 0.03822) and those who have attempted more treatment options in the past (P = 0.01755) were more likely to choose administra- tion in a medical facility, even though administration at home was more popular overall. The most important early effect of the medication was the alleviation of pruritus (73.3%), while the most desired long-term result was a decrease in the severity of the skin lesions (67.87%). Conclusions Previous research has indicated that adult patients generally prioritize efficacy, whereas parents tend to prioritize safety. It is in line with our study. Given the parents heightened con- cern for their children safety, it may be significant to engage in a dialogue, as failure to do so could result in poor compli- ance and adherence [3]. Parents are also unwilling to accept a medication in an injection form, as supported by our study [9]. It is a well- established fact that the experience of pain can be intensified by fear, therefore, prior to the implementation of an injection therapy, it may be beneficial to provide parents with the option of enrolling their children in a needle-based educational experi- ence [4]. Many parents of children may experience “decisional conflict”, which is characterized by confusion regarding the optimal treatment option among competing alternatives [5]. The study revealed that parents of children with AD have a tendency to favor particular characteristics of novel medications. Doctors should take parental concerns into ac- count, especially when considering a new medication that may raise many parental concerns. References 1. Williams H, Robertson C, Stewart A, et al. Worldwide variations in the prevalence of symptoms of atopic eczema in the Interna- tional Study of Asthma and Allergies in Childhood. J Allergy Clin Immunol. 1999;103(1 Pt 1):125-138. DOI: 10.1016/s0091 -6749(99)70536-1. 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