Burden, Control, and Treatment of Moderate to Severe Atopic Dermatitis in 2021: A United States Patient Survey Study

February 2023 | Volume 22 | Issue 2 | 119 | Copyright © February 2023


Published online January 31, 2023

Peter Lio MDa, deMauri S. Mackie PhDb, Dawn T. Bates MSc MBAb, Emily Mulvihill MBAv, Miraj Y. Patel PharmD MSc, Yestle Kim PharmDc, Vivian Y. Shi MDd

aNorthwestern University Feinberg School of Medicine, Department of Dermatology, Chicago, IL
bCerner Enviza, Kansas City, MO
cLEO Pharma Inc., Madison, NJ
dUniversity of Arkansas for Medical Sciences, Department of Dermatology, Little Rock, AR

Abstract
Background: Recent data on unmet needs in the treatment of moderate to severe atopic dermatitis (AD) in the US are not available.
Objective: To describe disease control, quality of life (QoL), and treatment satisfaction in a United States population with moderate-to-severe AD.
Methods: Cross-sectional 2021 survey conducted among US patients recruited to an online survey from Kantar e-profiles, their panel partners, and Global Perspectives. Adults with self-reported, physician-diagnosed AD completed the primary survey. Of those reporting moderate to severe AD, a subset, including patients who "strongly disagreed," "somewhat disagreed," or were "neutral" on the statement "my eczema is adequately controlled" ("inadequately controlled") with varying experience with approved biologic treatment (dupilumab), completed a second, enriched survey. Outcome measures evaluated included self-reported disease control and severity and validated measures including Patient-Oriented Scoring Atopic Dermatitis (PO-SCORAD), Dermatology Life Quality Index (DLQI), Recap of Atopic Eczema (RECAP), and Treatment Satisfaction Questionnaire for Medication (TSQM-9).
Results: Of 3,285 patients who participated in the primary survey, 1,935 self-reported moderate-to-severe AD, 979 (51%) of whom reported inadequate control. A total of 371 completed the enriched survey, leading to an analytic sample with 87 controlled patients and 284 inadequately controlled patients (178/284 inadequately controlled patients never received dupilumab, 23 previously received it, and 83 were currently receiving it). Mean RECAP, PO-SCORAD, and DLQI scores were significantly worse (P<0.01) for inadequately controlled vs controlled patients: 7.26 vs 13.9; 38.3 vs 26.9; and 9.9 vs 7.0, respectively. Mean TSQM-9 scores for inadequately controlled vs controlled patients were significantly worse across all domains—effectiveness, convenience, and global satisfaction (P<0.01): 45.5 vs 69.5, 62.3 vs 72.5, 48.3 vs 69.3, respectively.
Conclusions and Relevance: This study found about half of the patients had inadequate control of their disease. This may partially be due to underuse of systemic biologics in eligible patients. There remains an unmet need for additional education on current and new systemic biologics that could allow patients to achieve better AD control, improved QoL, and greater overall treatment satisfaction.

J Drugs Dermatol. 2023;22(2):119-131. doi:10.36849/JDD.7071

Citations: Lio P, Mackie dS, Bates DT, et al. Burden, control, and treatment of moderate to severe atopic dermatitis in 2021: A United States patient survey study. J Drugs Dermatol. 2023;22(2):119-127. doi:10.36849/JDD.7071

INTRODUCTION

Atopic dermatitis (AD) is a chronic disease which can be debilitating for some patients.1-3 Symptoms range from mild to persistent and can include uncontrollable itching, skin pain, and eczematous lesions, which have a wide array of sequelae impacting quality of life (QoL) including sleep loss, anxiety, and depression.3-6 AD is highly heterogeneous, even among patients classified as having similar disease severity; this can result in variability in clinical manifestations and treatment response.1

Current systemic treatment options are limited, especially for patients with more severe disease.7,8 Currently, moderate-to-severe AD is treated with systemics or phototherapy concomitantly with topicals. At the time of this study, the only FDA-approved systemic biologic for treatment of moderate-to-severe AD was dupilumab, which blocks IL4Rα and subsequent downstream IL-4 and IL-13 signaling.9 Additional clinical trials and real-world evidence suggest a significant proportion of patients may benefit from additional treatment options given the significant burden and heterogeneity of AD.10-13

Previous studies quantifying inadequate control of AD in real-world populations were conducted prior to dupilumab approval, limited to patients under the care of dermatologists, and/or did not include US patients.12,14,15 This study sought to quantify and further understand disease control in a broader population with moderate-to-severe AD in the US, including those with prior dupilumab exposure.
Close Menu