Do Atopic Dermatitis Patient-Reported Outcomes Correlate With Validated Investigator Global Assessment? Insights From TARGET-AD Registry
April 2023 | Volume 22 | Issue 4 | 344 | Copyright © April 2023
Published online March 29, 2023
Emma Guttman-Yassky MD PhDa, Jonathan Bar MDa,b, Camille Rothenberg Lausell MSa,c, Lawrence F. Eichenfield MDd, Ayman Grada MDe, Katrina Abuabara MDf, M. Shane Chapman MDg, Brian Calimlim DrPHe, Colleen Wegzyn PharmDe, Amy Gamelli PhDe, Whitney Krueger PhDe, Breda Munoz PhDh, Keith Knapp PhDh, Rachel W. Faller PhDh, Julie M. Crawford MDh, Jonathan I. Silverberg MD PhD MPHi
aIcahn School of Medicine at Mount Sinai Medical Center, New York, NY; bSackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel;
cUniversity of Puerto Rico School of Medicine, San Juan, Puerto Rico; dUniversity of California San Diego, San Diego, CA;
eAbbVie Inc., North Chicago, IL; fUniversity of California San Francisco, San Francisco, CA
gDartmouth Hitchcock Medical Center, Lebanon, NH; hTarget RWE, Durham, NC;
iGeorge Washington University, Washington DC, DC
Abstract
Background: Research examining associations between the clinician-reported validated Investigator Global Assessment for AD (vIGA-AD) and patient-reported disease burden is sparse. This study aims to evaluate the relationship between vIGA-AD with patient-reported disease severity and quality of life (QoL).
Methods: A cross-sectional analysis was conducted using a September 2021 data cut from the TARGET-DERM AD study, a real-world, longitudinal cohort of children, adolescents, and adults with AD enrolled at 44 academic and community dermatology and allergy sites in the US. Clinical AD severity was measured using vIGA-AD while disease severity and QoL were assessed by the Patient Oriented Eczema Measure (POEM) and (Children’s) Dermatology Life Quality Index (C/DLQI), respectively. Patient characteristics, clinical- and patient reported-outcomes were assessed by stratified POEM and C/DLQI categories using descriptive statistics. Associations with vIGA-AD were evaluated using unadjusted and adjusted ordinal logistic regression and linear regression models.
Results: The analysis cohort (n=1,888) primarily consisted of adults (57%), females (56%), and patients with private insurance (63%). Unadjusted analyses suggest that clinical AD severity was associated with age, with more adolescents and adults having moderate/severe vIGA-AD than pediatric patients. Clinical AD severity was also associated with disease severity, with greater POEM scores observed at greater vIGA-AD severity levels (r = 0.496 and 0.45 for adults and pediatrics, respectively). Clinical AD severity and QoL were positively correlated, with greater CDLQI/DLQI scores at greater vIGA-AD severity levels (r = 0.458 and 0.334 for DLQI and CDLQI, respectively). After adjusting for demographics and other risk factors, vIGA-AD continued to show significant associations with POEM and DLQI/CDLQI. Compared to patients with clear/almost clear disease, adults and pediatrics with moderate-to-severe AD were 8.19 and 5.78 times as likely to be in a more severe POEM category, respectively. Similarly, compared to patients with clear/almost clear disease, adults and pediatrics with moderate/severe AD were 6.69 and 3.74 times as likely to be in a more severe DLQI/CDLQI category. Adjusted linear regression analyses of DLQI in adults showed significant differences by vIGA-AD level, with mild AD and moderate/severe AD associated with a 2.26-point and 5.42-point greater DLQI relative to clear/almost clear AD.
Conclusions: In this real-world study of patients with AD, greater clinician-reported disease severity is positively correlated with higher patient-reported disease severity and lower QoL.
J Drugs Dermatol. 2023;22(4): doi:10.36849/JDD.7473
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here Citation: Guttman-Yassky E, Bar J, Rothenberg Lausell C, et al. Do atopic dermatitis patient-reported outcomes correlate with validated investigator global assessment? Insights from TARGET-AD registry.
J Drugs Dermatol. 2023;22(4):344-355. doi:10.36849/JDD.7473
INTRODUCTION
Atopic dermatitis (AD) is a chronic, immune-mediated skin condition characterized by erythematous, pruritic lesions frequently first diagnosed in childhood.1 Its pathophysiology is complex and multifactorial, with clinical presentation and severity differing between various patient populations.2 Studies show that greater AD severity, irrespective of age or other disease subtypes, can be linked to lower quality of life (QoL) due to persistent symptoms such as pruritus, sleep disturbance, or psychological comorbidities such as anxiety or depression.3-7 Frequent doctor visits and costly medications can also lead to increased disease and health care burden.8
