Eucrisa for Atopic Dermatitis

Overview

Patients with mild to moderate atopic dermatitis will be asked to participate in helping the study team determine how well the medication works for atopic dermatitis. Participants will not be told that adherence will be monitored. Patients will be dispensed topical crisaborole 2% ointment (Eucrisa®) in a medication tube fitted with a Medication Event Monitoring System (MEMS) cap if they agree to participate. This cap records dates and times the bottle is opened and this data can be downloaded and tabulated with the associated software. Investigators and subjects will be blinded to the adherence data until the final treatment (12 month) session. The study subjects will be randomized to two groups. After baseline visit, both groups will come for a follow-up visit at 1 month, 3 months, 6 months, and 12 months. The intervention group will also be asked to complete an online treatment response survey designed to improve adherence at weekly intervals for 6 weeks, then monthly thereafter. The study will consist of a 12-month Treatment Phase. Study subjects will be instructed to apply the medication twice daily (morning and evening) to all of their AD lesions. They will be instructed to apply the smallest amount of study medication possible that is sufficient to cover all lesions. These instructions are standard-of-care for patients with AD. Subjects will be asked to bring their medication tubes with them at each visit. At each visit, the study coordinator will weigh the medication tube and download the MEMS cap data. Disclosure of the adherence monitoring will occur at the 12 month visit (or end of treatment), at which time the results of the subject's adherence behavior will be used to supply individualized treatment options for each subject (feedback session). At each visit, drug tubes will be measured for weight to determine the amount of study medication used. This data will be correlated with the extent of BSA involved and the response of the disease. The MEMS caps will be downloaded at each visit.

Atopic Dermatitis (AD) affects between 10% and 30% of all children, making it one of the most common childhood diseases. Recent epidemiological studies report a trend toward the increasing prevalence of AD in children. Symptoms of AD include dry, scaly, and intensely itchy skin. A number of treatments are available for these patients. Topical corticosteroids are commonly prescribed. Topical immunomodulators without the potential for steroid atrophy are also used. A non-steroidal topical, Eucrisa (crisaborole) ointment, is specifically indicated for mild to moderate atopic dermatitis and was approved for marketing in the U.S. for the treatment atopic dermatitis in December 2016. The 2% ointment is approved for use in patients ages 2 and older. Unfortunately, many people with atopic dermatitis do not adequately respond to topical treatment. It is widely recognized that adherence to oral medications is poor. Adherence to medication in chronic disease is worse. Adherence to topical medication for chronic disease in children is horrible. In a previous study, the investigator found that the adherence of children to topical triamcinolone for atopic dermatitis was poor. Adherence dropped by roughly 60-70% over the first 3 days of treatment. While that study analyzed adherence over 8 weeks, the long-term adherence to topical treatment in patients with atopic dermatitis is not well characterized. Measures to improve adherence have the potential to improve treatment outcomes. Adherence to topical treatment tends to improve around the time of office visits (so called, "white coat compliance"), much as tooth flossing behavior improves around the time of dental visits. Standard-of-care treatment of atopic dermatitis generally involves having patients return in roughly 4 weeks to assess treatment efficacy. Clinical trials generally have more frequent visits. The investigator's recent studies have suggested that adherence may be improved with virtual medical visits, alleviating the need for more frequent in-person office visits that can be costly and negatively impact access to care.