The Impact of Topical Prescription Drug Delivery Devices in the Adherence and Ease of Use of Corticosteroids in Pediatric Patients with Atopic Dermatitis

Overview

Atopic dermatitis (AD) is the most common pediatric inflammatory skin disease affecting 15-30% of children worldwide. Topical corticosteroids remain the mainstay of treatment in AD and when used as directed, are highly effective. However, upwards of 50% to 88% of children and adolescents are non-adherent with their prescribed regimen. Current studies exploring the barriers and interventions in adherence place the blame and responsibility on patients and clinicians to improve outcomes. Yet, no effort has been made to improve the application and delivery of topical medication to help promote adherence and alleviate the burden on patients. Since the patent of the collapsible metal tube in 1841, there have been very little changes, improvements, or alterations made to the packaging of topically prescribed treatments. In addition, the tube packaging of topical medications does not provide a mechanism for accurate dosing. Patients are required to apply arbitrary amounts like “pea-sized” or “palm of hand”, which often leads to underutilization and subpar therapeutic results. Thus, rather than placing the responsibility of adherence on pediatric patients and their caregivers, our efforts will be to optimize a drug delivery device that would encourage adherence, reduce dose discrepancies, and improve treatment outcomes.

To solve this problem, we will investigate topical prescription drug delivery devices and their impact on adherence and ease of use in the pediatric population suffering from AD. This process will include identifying the needs and barriers in the application process of topical medication and utilizing these findings to discover and design a drug delivery device that addresses these issues. We will also be focusing on using a topical drug delivery device that would deliver medication in a dose-dependent manner, reducing the responsibility on patients to guess the amount that is needed and improve adherence. The rationale of our proposed model is supported by the fact that several studies in the elderly population demonstrating changes in packaging design increases the adherence of medication, and thus improving treatment outcomes. Therefore, our central hypothesis is that redesigning the method of drug delivery of topically prescribed medication can improve adherence and reduce dose discrepancies for pediatric patients suffering from AD.

Aim 1: Determine the specific barriers in the tube packaging of topical medication in pediatric patients and their caregivers.

Aim 2: Investigate and compare alternative models of topical drug delivery devices that would increase ease of use and adherence in the pediatric population.

Aim 3: Evaluate the adherence and ease of use of a topical corticosteroid dose-dependent drug delivery device in an open label pilot study in pediatric patients with AD.

Status

This project was funded through a 2021 PeDRA Research Fellowship Grant.