Inadequate Eczema Control Observed in 30% of Patients on Topicals, Systemic Therapies

Approximately 30% of individuals with atopic dermatitis taking topical therapies only or any systemic therapies continue to have uncontrolled disease despite medication, according to recent findings, with patient-reported outcomes (PROs) being affected by inadequate control in both treatment cohorts.¹

These findings represented the conclusion of a recent study led by Peter A. Lio, MD, clinical assistant professor of dermatology at Northwestern Medicine Feinberg School of Medicine. The data was presented at Maui Derm NP+PA Fall 2024 in Nashville, Tennessee.

This research was titled ‘Inadequate disease control with current therapies among patients with a history of moderate-to-severe atopic dermatitis: Real-world health care provider and patient perspectives.’ Lio et al. sought to evaluate disease control and the effects on symptoms among those with atopic dermatitis given either systemic or topical-only therapy.

Trial Design and Background

In a previous interview with the HCPLive editorial team, Lio commented on the recent breakthroughs made in treatment indications across a number of drug classes for atopic dermatitis and other skin conditions.2

Using the Adelphi Atopic Dermatitis (AD) Disease Specific Programme, a cross-sectional, real-world study conducted from August 2022 - March 2023 in the US, the investigators drew their data. Health care professionals provided detailed information in forms, though patients would contribute their data through the use of surveys.

Participants with either a current atopic dermatitis diagnosis or a history of moderate to severe disease were included in the analysis. Providers documented the subjects’ disease severity as well as the medications being implemented.

Uncontrolled atopic dermatitis was identified by them based upon the subjective evaluations of providers, such as whether the participant reported an unsatisfactory level of disease control, was experiencing a flare, or was struggling with a worsening disease course. Two cohorts were used to stratify subjects: Users of only topical therapies and users of only systemic options (with or without the use of topical therapies).

A total of 146 health care providers contributed information associated with 747 participants, with 215 of these individuals filling out a survey. The investigators looked into PROs through the Work Productivity and Activity Impairment Questionnaire for AD (WPAI-AD), the Dermatology Life Quality Index (DLQI), and the Patient-Oriented Eczema Measure (POEM).

Major Findings

There were 200 subjects on only topical therapies, and 34% of these individuals were classified as having uncontrolled atopic dermatitis. The research team noted that 28% of the 419 individuals placed in the systemic treatment arm met the same criteria.

The team looked at subjects with uncontrolled disease in either cohort, highlighting the average DLQI scores. It was reported that 79% of those in the topical arm and 33% of those in the systemic arm reported DLQI scores of 5 or lower, indicating minimal effects on their life quality.

The investigators looked at mean POEM scores among those in the topical arm and the systemic arm. They concluded that 30% and 33% of individuals in each cohort, respectively, had POEM scores shown to be 7 or lower, highlighting the existence of mild disease.

In their WPAI results, the research team found that daily activity impairment was shown to be 13.9% among the topical cohort and 30.9% among the systemic cohort. Absenteeism was identified by the team as 0% among employed subjects with uncontrolled disease for cohort given topicals and 12.1% for those given systemics.

The team noted that presenteeism was found to be 9.0% for topicals and 31.0% for systemics, adding that overall impairment of work was shown to be 9.0% and 36.7% for these 2 groups, respectively. However, those reporting controlled atopic dermatitis on either medication were shown to have lower DLQI and POEM scores.

The investigators highlighted mean DLQI scores were shown to be 5 or less among 79% and 89% of those featured in each cohort, respectively. After looking at mean POEM scores, they found that 68% and 94% of those in the topical and systemic cohorts, respectively, were 7 or lower.

The research team also expressed that impairment of daily activities, as evaluated by WPAI, averaged 15.7% for those in the topical cohort and 13.4% for the systemic cohort. Looking at employed participants with controlled disease, the team found absenteeism was 0% in both cohorts, while presenteeism was 10.4% for the former cohort and 10.4% for the latter.

They added that overall work impairment was at 15.7% and 10.4% for the respective groups.

“This study suggests suboptimal AD treatment in some patients and the need for additional effective AD treatment options,” Lio and colleagues concluded.

References

1. ^{Lio P, Golant A, Stein Gold L, et al. Inadequate disease control with current therapies among patients with a history of moderate-to-severe atopic dermatitis: Real-world health care provider and patient perspectives. Abstract presented at Maui Derm NP+PA Fall 2024. Nashville, TN. September 15-18, 2024.}
2. ^{Kunzmann K. Breakthroughs in Pediatric Atopic Dermatitis and More, with Peter A. Lio, MD. HCPLive. March 8, 2024. https://www.hcplive.com/view/breakthroughs-pediatric-atopic-dermatitis-peter-lio-md. Date accessed: September 16, 2024.}