Patient-Reported Disease Burden and Unmet Therapeutic Needs in Atopic Dermatitis

November 2021 | Volume 20 | Issue 11 | Original Article | 1222 | Copyright © November 2021


Published online November 1, 2021

Elizabeth D. Bacci PhDa, Anne M. Rentz MSPHb, Julia Correll MPHa, Evangeline J. Pierce PhDc, Amy M. DeLozier MPHc, Maria Jose Rueda MDd, Wendy Smith Begolka MBSe, Lisa Butler MBAe

aPatient-Centered Research, Evidera, Seattle, WA
bPatient-Centered Research, Evidera, Bethesda, MD
cGlobal Patient Outcomes and Real World Evidence, Eli Lilly and Company, Indianapolis, IN
dMedical Affairs, Eli Lilly and Company, Indianapolis, IN
eNational Eczema Association, Novato, CA

Abstract
Background: Atopic dermatitis (AD) is a common, chronic, relapsing, inflammatory skin disease causing a variety of dermatologic signs and symptoms, affecting patient’s quality of life. While treatment options are available, they are of variable effectiveness. This study sought to characterize patient-reported AD signs and symptoms, flare, and associated bother, by disease severity and control.
Methods: Adults diagnosed with AD were recruited through the National Eczema Association (NEA) and clinical sites and completed a web-based survey including the Patient-Oriented SCORing Atopic Dermatitis (PO-SCORAD), Recap of Atopic Eczema (RECAP), and Skin Pain numeric rating scale (NRS), as well as questions on previous/current clinical presentation, flare frequency and severity, past/ present AD treatment, and sociodemographic characteristics.
Results: A total of 186 participants completed the survey (mean age 39.7 years, 80% female). The most frequently reported current AD signs and symptoms included dryness, itch, redness, roughness, and flaking skin, and the most bothersome were itch, dryness, and redness (63%). The majority of participants (84%) were either currently experiencing a flare or had experienced one within the past month. The most common signs and symptoms that grew worse during the most recent flare were itch and redness across all disease severity groups. Participants most often experienced one to three flares in the last three months. Flare frequency, duration, and average severity increased with greater disease severity and lack of disease control.
Conclusions: The results of this study demonstrate the diverse and considerable symptomatic burden experienced by people with AD, even while being treated for AD.

J Drugs Dermatol. 2021;20(11):1222-1230. doi:10.36849/JDD.6329

INTRODUCTION

Atopic dermatitis (AD) is a chronic, relapsing, inflammatory skin disease, with a prevalence in the United States (US) of 7.3%.1 AD causes a variety of dermatologic signs and symptoms, resulting in numerous impacts on quality of life, such as sleep disturbance due to itching,2 and can negatively impact patients’ emotional and social functioning, and impede occupational and academic pursuits.3

Standard approaches to treatment typically include basic skin care and emollient agents, topical corticosteroid therapy and topical calcineurin inhibitors, which may be supplemented by the addition of phototherapy, off-label immunosuppressants, or the biologic, dupilumab.4,5 Dupilumab is currently the only FDAapproved biologic for AD in the US; a number of new systemic treatments are anticipated to become available in the US later this year.6,7 A recent consensus guidance recommends systemic therapy be considered for patients with AD after considering both disease severity and impact of AD on quality of life.8

Given the evolving treatment landscape and prescribing guidance, it is important to understand the symptomatic experience from the patient’s viewpoint, including perceived control of AD symptoms and the nature and frequency of AD flares. While flare triggers and flare management are an important aspect of AD, limited research has been conducted on flare severity and symptomology, especially in those currently treated for AD. Moreover, there is lack of consistency in how flares are defined in AD studies.9

The primary objective of this study was to gain a greater understanding of AD signs and symptoms, flares, and associated bother to patients with AD. Of further interest was to characterize the association of the symptomatic experience by disease severity and control.