Off-label treatment of atopic dermatitis and psoriasis

OBJECTIVES: Off-label prescribing is a common and often necessary practice in dermatology, as approved treatment options frequently fail to meet the diverse needs of patients. This is particularly relevant in the management of two prevalent inflammatory dermatoses - atopic dermatitis and psoriasis. Despite the widespread use of off-label therapies, their application often lacks formal guidance, highlighting the need for updated clinical recommendations and consideration of expanded drug indications. METHODS: This retrospective study analyzed medical records of 5072 patients with atopic dermatitis and/or psoriasis who were treated in Northern Poland between 2014 and 2024. RESULTS: It was found that 62.5% of patients with atopic dermatitis and 25.7% of patients with psoriasis received some form of off-label treatment. The frequency of off-label therapy demonstrated an inverse correlation with patient age. On average, individuals managed with a combination of on-label and off-label therapies achieved greater reductions in EASI, PASI, and DLQI scores compared to those treated exclusively according to SmPC guidelines, with the statistically significant difference for PASI reductions. CONCLUSIONS: Off-label treatment is widely used in the management of both atopic dermatitis and psoriasis. Real-world evidence plays a crucial role in guiding clinical practice and should be leveraged to support the more evidence-based implementation of off-label therapies.