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Schneeweiss MC, Glynn RJ, Wyss R, Anand P, Jin Y, Landon J, Mostaghimi A, Merola JF, Silverberg JI, Rosmarin DM, Sidbury R, Schneeweiss S. A scalable approach to assess the safety of recently marketed systemic treatments for atopic dermatitis in clinical practice. J Invest Dermatol 2024:S0022-202X(24)02169-9. [PMID: 39362623 DOI: 10.1016/j.jid.2024.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 08/26/2024] [Accepted: 08/27/2024] [Indexed: 10/05/2024]
Abstract
Targeted systemic immune-modulating drugs (IMDs) to treat atopic dermatitis (AD) were highly efficacious in randomized trials. Trials with limited number of subjects leave questions about their safety. We describe a data and analytics structure for the production of timely, high-quality evidence on the comparative safety of recently approved IMDs in patients with AD in clinical practice. We established a series of sequential propensity score (PS)-balanced cohorts that grow in size with each annual data refresh. Nine health outcomes of interest plus conjunctivitis as a positive tracer outcome were identified. The initial treatment comparison was dupilumab, an interleukin-4/13 inhibitor, or tralokinumab, an interleukin-13 inhibitor, versus abrocitinib/upadacitinib, both JAK inhibitors. The first analysis cycle (December 2021-February 2023) compared 269 patients initiating JAK inhibitors and 2,650 initiating IL-4/IL-13 inhibitors. Patient characteristics were well balanced after PS-matching. Outpatient infections within 180 days occurred in 18% of JAK-1 inhibitor initiators versus 12% of dupilumab/ tralokinumab initiators (RR=1.50; 0.96 to 2.33) whereas acne risks were 7% vs. 3%, respectively (RR=2.29, 0.96 to 5.46). This sequential monitoring system will produce essential knowledge on the safety of IMDs to treat AD based on its growing study size of patients observed in clinical practice.
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Affiliation(s)
- Maria C Schneeweiss
- Dermato-Pharmacoepidemiology Work Group, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Robert J Glynn
- Dermato-Pharmacoepidemiology Work Group, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Richard Wyss
- Dermato-Pharmacoepidemiology Work Group, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Priyanka Anand
- Dermato-Pharmacoepidemiology Work Group, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Yinzhu Jin
- Dermato-Pharmacoepidemiology Work Group, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Joan Landon
- Dermato-Pharmacoepidemiology Work Group, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Arash Mostaghimi
- Harvard Medical School, Boston, MA, United States; Department of Dermatology, Brigham and Women's Hospital, Boston, MA, United States
| | - Joseph F Merola
- Department of Dermatology, University of Texas, SouthWestern Medical Center, Dallas, TX, United States
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University, Washington, DC, United States
| | - David M Rosmarin
- Department of Dermatology, Indiana University, Indianapolis, IN, United States
| | - Robert Sidbury
- Division of Dermatology, Seattle Children's Hospital, University of Washington School of Medicine, WA, United States
| | - Sebastian Schneeweiss
- Dermato-Pharmacoepidemiology Work Group, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
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Ramot Y, Rosenberg V, Zhou L, Harbers S. Epidemiology and Treatment Patterns of Patients with Vitiligo: A Real-World Analysis. Adv Ther 2024; 41:2890-2906. [PMID: 38802636 PMCID: PMC11213800 DOI: 10.1007/s12325-024-02875-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/12/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Vitiligo, a chronic autoimmune skin depigmentation disease with an unpredictable course, has been associated with several comorbid autoimmune and psychological conditions. Our current understanding of vitiligo burden and management in the real world is limited. This real-world analysis presents data on vitiligo epidemiology, comorbidities, and treatment of patients in Israel. METHODS This retrospective study analyzed data from the Maccabi Health Services database. Prevalent patients with vitiligo in 2021 were matched to patients in the general population on the basis of age group, gender, and socioeconomic status. Patient demographics, vitiligo incidence and prevalence, comorbidities, and treatment patterns are reported. Data are presented as percentages, mean, median, P values, and standard mean differences (SMD). RESULTS In this analysis, 11,412 patients with vitiligo were matched to patients from the general population. Incidence and prevalence rates increased over time from 2005 to 2021. Compared to the general population, patients with vitiligo were more likely to have an immune-mediated comorbidity (29.7% vs 18.4% [P < 0.001; SMD 0.27]) or psychological comorbidity (18.7% vs 15.9% [P < 0.001; SMD 0.07]). Comorbidities included atopic dermatitis (patients with vitiligo vs general population 12.5% vs 8.4%), psoriasis (5.8% vs 3.6%), Hashimoto's thyroiditis (2.9% vs 1.1%), alopecia areata (2.2% vs 0.9%), depression (10.8% vs 9.5%), and sleep disorder/insomnia (5.9% vs 4.4%). Only 74.8% of all patients with vitiligo had ever received treatment, with topical corticosteroids (51.5%) and calcineurin inhibitors (36.5%) most commonly prescribed. At the end of 2021, 83.7% of patients were untreated. CONCLUSION Patients with vitiligo are more likely to have various immune-related and psychological comorbidities, highlighting the significant impact of the condition on well-being. Nearly a quarter of patients had never received treatment, with many receiving only topical treatments, and medication persistence was low. This highlights the lack of adequate treatment in this population and the need for more effective management options.
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Affiliation(s)
- Yuval Ramot
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Dermatology, Hadassah Medical Center, Jerusalem, Israel
| | - Vered Rosenberg
- Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, Tel Aviv, Israel
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Chen C, Song X, Murdock DJ, Marcus A, Hussein M, Jalbert JJ, Geba GP. Association between allergic conditions and COVID-19 susceptibility and outcomes. Ann Allergy Asthma Immunol 2024; 132:637-645.e7. [PMID: 38242353 DOI: 10.1016/j.anai.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/28/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND The relationship between underlying type 2 inflammation and immune response to COVID-19 is unclear. OBJECTIVE To assess the relationships between allergic conditions and COVID-19 susceptibility and outcomes. METHODS In the Optum database, adult patients with and without major allergic conditions (asthma, atopic dermatitis [AD], allergic rhinitis, food allergy, anaphylaxis, or eosinophilic esophagitis) and patients with and without severe asthma/AD were identified. Adjusted incidence rate ratios for COVID-19 were compared among patients with vs without allergic conditions or severe asthma/AD vs non-severe asthma/AD during April 1, 2020, to December 31, 2020. Among patients with COVID-19, adjusted hazard ratios (aHRs) of 30-day COVID-19-related hospitalization/all-cause mortality were estimated for the same comparisons during April 1, 2020, to March 31, 2022. RESULTS Patients with (N = 1,273,231; asthma, 47.2%; AD, 1.5%; allergic rhinitis, 58.6%; food allergy, 5.1%; anaphylaxis, 4.1%; eosinophilic esophagitis, 0.9%) and without allergic conditions (N = 2,278,571) were identified. Allergic conditions (adjusted incidence rate ratios [95% CI], 1.22 [1.21-1.24]) and asthma severity (1.12 [1.09-1.15]) were associated with increased incidence of COVID-19. Among patients with COVID-19 (patients with [N = 261,076] and without allergic conditions [N = 1,098,135] were matched on age, sex, region, index month), having an allergic condition had minimal impact on 30-day COVID-19-related hospitalization/all-cause mortality (aHR [95% CI] 0.96 [0.95-0.98]) but was associated with a lower risk of mortality (0.80 [0.78-0.83]). Asthma was associated with a higher risk of COVID-19-related hospitalization/all-cause mortality vs non-asthma allergic conditions (aHR [95% CI], 1.27 [1.25-1.30]), mostly driven by higher hospitalization. CONCLUSION Allergic conditions were associated with an increased risk of receiving COVID-19 diagnosis but reduced mortality after infection.
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Affiliation(s)
- Chao Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | - Xue Song
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | | | - Andrea Marcus
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
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Ezzedine K, Soliman AM, Li C, Camp HS, Pandya AG. Economic Burden among Patients with Vitiligo in the United States: A Retrospective Database Claims Study. J Invest Dermatol 2024; 144:540-546.e1. [PMID: 37739338 DOI: 10.1016/j.jid.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/07/2023] [Accepted: 08/30/2023] [Indexed: 09/24/2023]
Abstract
Patients with vitiligo incur direct and indirect costs associated with their condition; however, data regarding the economic burden of vitiligo are scarce and outdated. In this retrospective cohort analysis of the Merative MarketScan Commercial Database, healthcare costs and healthcare resource utilization (HCRU) were evaluated among United States patients with vitiligo. Patients with vitiligo were matched (1:2) with individuals without vitiligo (controls) between January 2007 and December 2021. Outcomes included all-cause and vitiligo-related costs (2021 dollars) and all-cause HCRU, including mental health-related HCRU, during a 1-year postindex period. Subgroup analyses were completed for patients on vitiligo treatments with systemic effects (such as phototherapy and oral steroids) or a new mental health diagnosis. The analysis was focused solely on direct costs. Baseline demographics were well-balanced between matched vitiligo (49,512) and control (99,024) cohorts. Patients with vitiligo incurred significantly higher all-cause ($15,551 vs $7735) and vitiligo-related ($3490 vs $54) costs than controls (P < .0001). All-cause and mental health-related HCRU were also significantly higher among patients with vitiligo (P < .0001). Differences in all-cause and vitiligo-related healthcare costs remained significantly higher in patients on treatments with systemic effects/mental health diagnoses than in controls (P < .0001). Taken together, healthcare costs and HCRU were significantly higher among patients with vitiligo than among controls.
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Affiliation(s)
- Khaled Ezzedine
- Department of Dermatology, AP-HP, Henri Mondor University Hospital, Université Paris-Est Créteil (UPEC), Créteil, France; Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Université Paris-Est Créteil (UPEC), Créteil, France.
| | - Ahmed M Soliman
- Health Economics and Outcomes Research Strategy Team, AbbVie, North Chicago, Illinois, USA
| | - Chao Li
- Health Economics and Outcomes Research Strategy Team, AbbVie, North Chicago, Illinois, USA
| | - Heidi S Camp
- Immunology Clinical Development, AbbVie, North Chicago, Illinois, USA
| | - Amit G Pandya
- Department of Dermatology, Palo Alto Foundation Medical Group, Sunnyvale, California, USA; Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Cork MJ, Danby SG, Rossi AB, Bansal A. Dupilumab Treatment in Pediatric Patients Aged 6-11 Years with Severe Atopic Dermatitis Whose Disease Is Not Adequately Controlled: A Review. Drug Des Devel Ther 2024; 18:277-289. [PMID: 38333897 PMCID: PMC10849907 DOI: 10.2147/dddt.s426947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/03/2024] [Indexed: 02/10/2024] Open
Abstract
Atopic dermatitis (AD) is the most common inflammatory skin disease in children. Children with severe AD have a multidimensional disease burden characterized by skin lesions, itching, frequent infections, sleep deprivation, and a high rate of comorbidities. These impact the mental health and overall quality of life of not only the children but also of their parents and caregivers. There are few effective available treatment options for young children with severe AD that are suitable for long-term use. Due to their adverse effects, practice guidelines consider systemic agents inappropriate for this age group, although they are still used off-label in extreme cases. The biologic dupilumab has recently been approved for children aged 6-11 years with severe (EU) and moderate-to-severe (USA) AD, offering hope to this population of patients with a high unmet clinical need. The purpose of this review is to describe the unmet needs of AD patients aged 6-11 years prior to dupilumab approval and to summarize existing clinical data supporting dupilumab's safety and efficacy in these children.
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Affiliation(s)
- Michael J Cork
- Sheffield Dermatology Research, University of Sheffield, Sheffield, UK
- Sheffield Children’s Hospital, Sheffield, UK
| | - Simon G Danby
- Sheffield Dermatology Research, University of Sheffield, Sheffield, UK
- Sheffield Children’s Hospital, Sheffield, UK
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Weil C, Adiri R, Chodick G, Gersten M, Cohen Barak E. Trends of Diagnosis, Disease Course, and Treatment of Atopic Dermatitis 2012-2021: Real-World Data from a Large Healthcare Provider. J Clin Med 2024; 13:281. [PMID: 38202289 PMCID: PMC10779695 DOI: 10.3390/jcm13010281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/31/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
In the last decade, new treatments for atopic dermatitis (AD) have emerged. We aimed to describe trends of the diagnosis, disease course, and treatment of AD over a decade (2012-2021) using data from Maccabi Healthcare Services (a 2.7-million-member healthcare provider in Israel). The AD prevalence was stable (4.0% on 31 December 2021 vs. 4.3% on 31 December 2012). The annual AD incidence was also stable (5.8/1000 in 2012 and 5.7/1000 in 2021). AD-related treatment use was highest in the first year post-diagnosis, and it included, among children (n = 87,414) vs. adults (n = 36,865), low-potency topical corticosteroids (TCS) (41.8% vs. 27.1%), mid-potency TCS (30.1% vs. 28.1%), high-potency TCS (34.9% vs. 60.3%), topical calcineurin inhibitor (10.8% vs. 10.1%), phosphodiesterase-4-inhibitor (0.3% vs. 0.7% overall; approved in 2019), phototherapy (0.1% vs. 2.3%), and systemic/biologic treatments (13.0% vs. 13.3%). Among children diagnosed in 2012 and followed through to 2021 (n = 5248), 21.5% had ≥1 AD diagnosis/treatment 10 years later (among 3223 adults: 38.3%). We conclude that the incidence and prevalence rates of AD were comparable to those in similar database studies and remained relatively stable over the past decade. The results underscore the burden of medication use among children and adults, particularly in the first year after AD diagnosis, and the low rate of AD diagnosis among patients originally diagnosed as children 10 years earlier.
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Affiliation(s)
- Clara Weil
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv 68125, Israel
| | - Roni Adiri
- Pfizer Pharmaceuticals Israel Ltd., Herzliya 4672509, Israel
| | - Gabriel Chodick
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv 68125, Israel
- School of Public Health, Faculty of Medicine, Tel Aviv University, Ramat Aviv 6997801, Israel
| | - Merril Gersten
- Pfizer Pharmaceuticals Israel Ltd., Herzliya 4672509, Israel
| | - Eran Cohen Barak
- Department of Dermatology, Emek Medical Center, Afula 18101, Israel
- Bruce and Ruth Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa 3200003, Israel
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Calzavara-Pinton P, Čelakovská J, Lapeere H, Holzer G, Al-Ahmad M, Chu CY, Ferrucci SM, Kataoka Y, Rossi M, Fomina DS, Chung WH, Tzellos T, Fougerousse AC, Wu J, Ardeleanu M, Ozturk ZE. Baseline Demographics, Comorbidities, Treatment Patterns and Burden of Atopic Dermatitis in Adults and Adolescents from the GLOBOSTAD Long-Term Observational Study. Adv Ther 2023; 40:5366-5382. [PMID: 37801232 PMCID: PMC10611842 DOI: 10.1007/s12325-023-02644-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/10/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION Insights into real-world treatment of atopic dermatitis (AD) are relevant to clinical decision making. The aim of this analysis was to characterize patients who receive dupilumab for AD in a real-world setting. METHODS The GLOBOSTAD registry is an ongoing, longitudinal, prospective, observational study of patients with AD who receive dupilumab according to country-specific prescribing information. We report baseline characteristics, comorbidities and treatment patterns for patients enrolled from July 11, 2019 to March 31, 2022. Analyses are descriptive; no formal statistical comparisons were performed. RESULTS Nine hundred fifty-two adults and adolescents were enrolled in GLOBOSTAD. Patients had a high disease burden before starting dupilumab: (mean [standard deviation]) percent body surface area affected (44.8 [24.42]), Eczema Area and Severity Index total score (24.8 [12.95]), SCORing Atopic Dermatitis total score (60.5 [16.34]), Patient-Oriented Eczema Measure total score (19.7 [6.37]) and Dermatology Life Quality Index total score (13.7 [7.02]). Overall, 741 (77.8%) patients reported ≥ 1 type 2 inflammatory comorbidities, most frequently allergic rhinitis (492 [51.7%]), asthma (323 [33.9%]), food allergy (294 [30.9%]) or another allergy (274 [28.8%]). In the previous 12 months, 310 (32.6%) patients had received systemic non-steroidal immunosuppressants and 169 (17.8%) systemic corticosteroids; 449 (47.2%) had received topical corticosteroids, most commonly potent topical corticosteroids; 141 (14.8%) had received topical calcineurin inhibitors and 32 (3.4%) ultraviolet therapy. Most (713 [74.9%]) patients started dupilumab because of prior treatment failure. CONCLUSION Patients enrolled in GLOBOSTAD demonstrated considerable multidimensional burden of disease across AD signs, symptoms and quality of life despite previous use of systemic and non-systemic AD treatments. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier NCT03992417. Video Abstract.
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Affiliation(s)
| | - Jarmila Čelakovská
- Department of Dermatology and Venereology, Faculty Hospital and Medical Faculty of Charles University, Hradec Králové, Czech Republic
| | - Hilde Lapeere
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Gregor Holzer
- Sozialmedizinisches Zentrum Ost-Donauspital, Vienna, Austria
| | - Mona Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Silvia M Ferrucci
- Unit of Dermatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Yoko Kataoka
- Department of Dermatology, Osaka Habikino Medical Center, Osaka, Japan
| | | | - Daria S Fomina
- City Clinical Hospital No. 52, Moscow, Russian Federation
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
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Sivesind TE, Oganesyan A, Bosma G, Hochheimer C, Schilling LM, Dellavalle R. Prescribing Patterns of Dupilumab for Atopic Dermatitis in Adults: Retrospective, Observational Cohort Study. JMIR DERMATOLOGY 2023; 6:e41194. [PMID: 37647114 PMCID: PMC10500357 DOI: 10.2196/41194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 06/28/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Atopic dermatitis (AD) is a common inflammatory disease caused by a type 2 T helper cell-mediated immune response to environmental antigens. Approximately 1 in 5 patients with AD presents with moderate to severe disease, and treatments approved by the Food and Drug Administration include emollients, topical glucocorticoids, and calcineurin inhibitors. Dupilumab, a fully human monoclonal antibody, improves AD via inhibition of interleukin-4 and interleukin-13. OBJECTIVE Our aim was to characterize the prescribing patterns of dupilumab for AD in adults at a large university-affiliated health system. METHODS A retrospective, observational cohort study was conducted using electronic data from the Observational Health Data Sciences and Informatics database, assessing data from the University of Colorado Medical Campus and its affiliates. The outcome measured was the prevalence of dupilumab prescribed for adults with AD (n=6421), between March 28, 2013, and March 28, 2021. We assessed whether the characteristics of patients who received dupilumab were different from those who did not. Each patient characteristic was assessed using a univariate logistic regression with the binary outcome of receiving or not receiving dupilumab. RESULTS We found a population prevalence of 5.6% (6421/114,476) for AD. In our cohort, Black patients with AD were more than twice as likely to have received dupilumab compared to White patients (odds ratio 2.352, 95% CI 1.58-3.39). Patients with a diagnosis of atopic neurodermatitis were approximately twice as likely to have received dupilumab compared to those with other diagnostic variants of AD (odds ratio 1.87, 95% CI 1.01-3.22). CONCLUSIONS Our results demonstrate that both patient racial characteristics and specific AD diagnoses were associated with variations in dupilumab prescription patterns.
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Affiliation(s)
- Torunn E Sivesind
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Ani Oganesyan
- University of Colorado School of Medicine, Aurora, CO, United States
| | - Grace Bosma
- Center for Innovative Design and Analysis, The Colorado School of Public Health, University of Colorado School of Medicine, Aurora, CO, United States
| | - Camille Hochheimer
- Center for Innovative Design and Analysis, The Colorado School of Public Health, University of Colorado School of Medicine, Aurora, CO, United States
| | - Lisa M Schilling
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Robert Dellavalle
- The Colorado School of Public Health, University of Colorado School of Medicine, Aurora, CO, United States
- Dermatology Service, Eastern Colorado Health Care System, US Department of Veterans Affairs, Denver, CO, United States
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LEE EM, CHO YT, CHAN TC, SHEN D, CHU CY, TANG CH. Economic Burden of Atopic Dermatitis in Taiwan. Acta Derm Venereol 2023; 103:adv00866. [PMID: 36789754 PMCID: PMC9944199 DOI: 10.2340/actadv.v103.4556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/06/2022] [Indexed: 02/16/2023] Open
Abstract
Atopic dermatitis is a prevalent inflammatory skin disease that manifests clinically as pruritus and eczema. Severe forms of atopic dermatitis can be chronic and relapsing or associated with other dermatological complications and comorbidities, resulting in lifelong impacts across multiple aspects for patients. This study was conducted to calculate the atopic dermatitis-related economic burden in Taiwan. First, the out-of- pocket costs incurred by 200 patients with atopic dermatitis were estimated using a specifically designed questionnaire. Secondly, work impairment was converted into quantifiable costs. The costs reimbursed by the Taiwan National Health Insurance (NHI), which were estimated in our previous work, were included in the final calculation. The atopic dermatitis-related economic burden for patients in Taiwan in 2018 was estimated as (2018 New Taiwan dollars; NT$) 37.90 billion, which is 0.207% of Taiwan's gross domestic product. This substantial economic burden suggests an existing need for more effective and equitable treatment for atopic dermatitis.
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Affiliation(s)
| | - Yung-Tsu CHO
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Tom C. CHAN
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Dereck SHEN
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Chia-Yu CHU
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Chao-Hsiun TANG
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
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Moini Jazani A, Ayati MH, Nadiri AA, Nasimi Doost Azgomi R. Efficacy of hydrotherapy, spa therapy, and balneotherapy for psoriasis and atopic dermatitis: a systematic review. Int J Dermatol 2023; 62:177-189. [PMID: 35347724 DOI: 10.1111/ijd.16080] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/23/2021] [Accepted: 01/03/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) and psoriasis are chronic inflammatory diseases that have significant skin complications. OBJECTIVE The purpose of this systematic study was to evaluate the evidence obtained from human studies on the effects of hydrotherapy, spa therapy, and balneotherapy in psoriasis and atopic dermatitis. METHODS The present systematic review was conducted according to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statements. Also, for this study databases such as Embase, PubMed, Scopus ProQuest, and sciences direct database were searched from the beginning to April 2021. RESULTS All human studies that examined the effect of balneotherapy, spa therapy, and hydrotherapy on psoriasis and atopic dermatitis were published in the form of a full article in English. In the end, only 22 of the 424 articles met the criteria for analysis. Most studies have shown that balneotherapy, spa therapy, and hydrotherapy may reduce the effects of the disease by reducing inflammation and improving living conditions. In addition, the results of the Downs and Black score show that seven studies received very good scores, three studies received good scores, nine studies received fair scores, and three studies received poor scores. CONCLUSIONS The results of studies also showed that hydrotherapy leads to an improvement in the PASI score index. Nevertheless, more clinical trials are needed to determine the mechanism of action of hydrotherapy on these diseases.
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Affiliation(s)
- Arezoo Moini Jazani
- Traditional Medicine and Hydrotherapy Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mohammad Hossein Ayati
- Traditional Medicine and Hydrotherapy Research Center, Ardabil University of Medical Sciences, Ardabil, Iran.,Department of Medical History, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ata Allah Nadiri
- Traditional Medicine and Hydrotherapy Research Center, Ardabil University of Medical Sciences, Ardabil, Iran.,Department of Earth Sciences, Faculty of Natural Sciences, University of Tabriz, Tabriz, East Azarbaijan, Iran
| | - Ramin Nasimi Doost Azgomi
- Traditional Medicine and Hydrotherapy Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
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Tang CH, Huang YH, Chuang PY, Wang BCM, Wei CY, Ng KJ, Treuer T, Chu CY. Patient Characteristics, Treatment Patterns, Healthcare Resource Utilization, and Costs of Targeted Therapy-Eligible Atopic Dermatitis Patients in Taiwan-A Real-World Study. Dermatol Ther (Heidelb) 2022; 12:2547-2562. [PMID: 36155881 PMCID: PMC9510234 DOI: 10.1007/s13555-022-00816-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/09/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The objective of this study was to conduct a retrospective analysis to understand the patient profile, treatment patterns, healthcare resource utilization, and cost of atopic dermatitis (AD) of patients eligible for targeted therapy in Taiwan. METHODS A retrospective, claims-based analysis was undertaken using Taiwan's National Health Insurance Research Database from 01 January 2014 to 31 December 2017. Patients aged ≥ 2 years and with at least one diagnosis code for AD during 2015 were identified. Patients with comorbid autoimmune diseases were excluded. Enrolled AD patients were categorized using claims-based treatment algorithms by disease severity and their eligibility for targeted therapy treatment. A cohort of targeted therapy-eligible patients was formed, and a matched cohort using patients not eligible for targeted therapy was derived using propensity score matching based on age, gender, and the Charlson Comorbidity Index (CCI). Treatment patterns, resource utilization, and costs were measured during a 1-year follow-up period. RESULTS A total of 377,423 patients with AD were identified for this study. Most patients had mild AD (84.5%; n = 318,830) with 11.9% (n = 45,035) having moderate AD, and 3.6% (n = 13,558) having severe AD. Within the 58,593 moderate-to-severe AD patients, 1.5% (n = 897) were included in the targeted therapy-eligible cohort. The matched cohort consisted of 3558 patients. During the 1-year follow-up period, targeted therapy-eligible patients utilized antihistamines (85.5%), topical treatments (80.8%), and systemic anti-inflammatories (91.6%) including systemic corticosteroids (51.4%) and azathioprine (59.1%). During the first year of follow-up, targeted therapy-eligible patients (70.5%; 7.01 [SD = 8.84] visits) had higher resource utilization rates and frequency of AD-related outpatient visits compared with the matched cohort (40.80%; 1.85 [SD = 4.71] visits). Average all-cause direct costs during 1-year follow-up were $2850 (SD = 3629) and $1841 (SD = 6434) for the eligible targeted therapy and matched cohorts, respectively. AD-related costs were 17.7% ($506) of total costs for the targeted therapy eligible cohort and 2.2% ($41) for the matched cohort. CONCLUSIONS AD patients eligible for targeted therapy in Taiwan experienced high resource and economic burden compared with their non-targeted-therapy-eligible counterparts.
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Affiliation(s)
- Chao-Hsiun Tang
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
| | | | | | | | - Ching-Yun Wei
- Eli Lilly and Company (Taiwan), Inc., Taipei, Taiwan
| | - Khai Jing Ng
- Eli Lilly and Company (Taiwan), Inc., Taipei, Taiwan
| | | | - Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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Schild M, Weber V, Thaçi D, Kisser A, Galetzka W, Enders D, Zügel F, Ohlmeier C, Gothe H. Treatment Patterns and Healthcare Resource Utilization Among Patients with Atopic Dermatitis: A Retrospective Cohort Study Using German Health Claims Data. Dermatol Ther (Heidelb) 2022; 12:1925-1945. [PMID: 35871680 PMCID: PMC9357591 DOI: 10.1007/s13555-022-00773-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Atopic dermatitis (AD) is a common inflammatory skin disease. Many patients are initiating a systemic therapy, if the disease is not adequately controlled with topical treatment only. Currently, there is little real-world evidence on the AD-related medical care situation in Germany. This study analyzed patient characteristics, treatment patterns, healthcare resource utilization and costs associated with systemically treated AD for the German healthcare system. Methods In this descriptive, retrospective cohort study, aggregated anonymized German health claims data from the InGef research database were used. Within a representative sample of four million insured individuals, patients with AD and systemic drug therapy initiation (SDTI) in the index year 2017 were identified and included into the study cohort. Systemic drug therapy included dupilumab, systemic corticosteroids (SCS) and systemic immunosuppressants (SIS). Patients were observed for one year starting from the date of SDTI in 2017. Results 9975 patients were included (57.8% female, mean age 39.6 years [SD 25.5]). In the one-year observation period, the most common systemic drug therapy was SCS (> 99.0%). Administrations of dupilumab (0.3%) or dispensations of SIS were rare (cyclosporine: 0.5%, azathioprine: 0.6%, methotrexate: 0.1%). Median treatment duration of SCS, cyclosporine and azathioprine was 27 days, 102 days, and 109 days, respectively. 2.8% of the patients received phototherapy; 41.6% used topical corticosteroids and/or topical calcineurin inhibitor. Average annual costs for medications amounted to € 1237 per patient. Outpatient services were used by 99.6% with associated mean annual costs of € 943; 25.4% had at least one hospitalization (mean annual costs: € 5836). 5.3% of adult patients received sickness benefits with associated mean annual costs of € 5026. Conclusions Despite unfavorable risk–benefit profile, this study demonstrated a common treatment with SCS, whereas other systemic drug therapy options were rarely used. Furthermore, the results suggest a substantial economic burden for patients with AD and SDTI. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-022-00773-3.
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Affiliation(s)
- Marie Schild
- Pfizer in Germany, Linkstraße 10, 10785, Berlin, Germany
| | - Valeria Weber
- IGES Institut GmbH, Friedrichstr. 180, 10117, Berlin, Germany
| | - Diamant Thaçi
- Institute and Comprehensive Center for Inflammation Medicine, University of Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Agnes Kisser
- Pfizer in Germany, Linkstraße 10, 10785, Berlin, Germany
| | - Wolfgang Galetzka
- InGef-Institute for Applied Health Research Berlin GmbH, Spittelmarkt 12, 10117, Berlin, Germany
| | - Dirk Enders
- InGef-Institute for Applied Health Research Berlin GmbH, Spittelmarkt 12, 10117, Berlin, Germany
| | | | | | - Holger Gothe
- IGES Institut GmbH, Friedrichstr. 180, 10117, Berlin, Germany.
- Department of Health Sciences/Public Health, Medical Faculty, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
- Department of Public Health, Health Services Research and HTA, UMIT, Eduard-Wallnöfer-Zentrum 1, 6060, Hall in Tirol, Austria.
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13
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Al Hammadi A, Pakran J, Farghaly M, Ahmed HM, Cha A, Balkan D, Afifi S, Ramachandrachar BC, Natarajan A, Linga S, Al Jefri K. Healthcare Resource Utilization and Direct Cost of Patients with Atopic Dermatitis in Dubai, United Arab Emirates: A Retrospective Cohort Study. Dermatol Ther (Heidelb) 2022; 12:1-25. [PMID: 35875408 PMCID: PMC9294752 DOI: 10.1007/s13555-022-00769-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Atopic dermatitis (AD) data are scarce in Dubai [United Arab Emirates (UAE)]. Therefore, this study aimed at understanding real-world healthcare resource utilization (HCRU) and related costs, specialties, treatment landscape, consultation-based prevalence and incidence, and patient characteristics. Methods This retrospective, longitudinal, insurance e-claims (Dubai Private Insurance-insured expatriates) database studied AD in Dubai between 1 January 2014 and 31 March 2020. Two cohorts of patients based on treatment status as the eligibility criteria were selected from 442,956 patients with at least two AD diagnosis claims: treated AD [mild to moderate (10,134 patients) and moderate to severe (3515 patients)] and untreated or on drugs not included in the treated AD cohort (10,806 patients). Results Across treated AD (mild to moderate and moderate to severe) and untreated AD cohorts, mean age was ~ 29 years; the majority were from dermatology (65-44%) and pediatrics (29-32%) specialty. Key HCRU cost contributors were hospitalizations and outpatient visits in both the treated AD groups. Mean annual disease-specific HCRU cost per patient was highest for the moderate-to-severe treated (531.5 USD) cohort, followed by the mild-to-moderate treated (378.4 USD) cohort, and lowest for the untreated (144.0 USD) cohort; patients with AD with any infection, asthma, or allergic rhinitis showed a similar trend. However, AD-diagnosed patients with Staphylococcus infection had the highest mean HCRU cost among the mild-to-moderate treated AD cohort, followed by the moderate-to-severe treated AD cohort. Conclusion This study indicated AD to be a common skin disease with a prevalence rate of 4-5% in Dubai (UAE), with the majority of patients (about 90%) being treated by specialists. However, there is a significant underuse of newer innovative therapies (including biologics). Also, disease severity (moderate-to-severe AD) was associated with high direct medical cost, which could be controlled by early intervention. Furthermore, AD treatment choice could focus on major direct HCRU cost contributors such as hospitalizations, comorbid conditions, and infections. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-022-00769-z.
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Affiliation(s)
| | - Jaheersha Pakran
- M.D. Dermatology, Rashid Hospital, Dubai Health Authority, Dubai, UAE
| | - Mohamed Farghaly
- Health Economics & Insurance Policies Department, Dubai Health Authority, Dubai, UAE
| | | | - Amy Cha
- Pfizer Inc. Ltd, New York, USA
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14
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Wu JJ, Lafeuille MH, Emond B, Fakih I, Duh MS, Cappelleri JC, Yin N, Feeney C, Myers DE, DiBonaventura M. Real-World Effectiveness of Newly Initiated Systemic Therapy for Atopic Dermatitis in the United States: A Claims Database Analysis. Adv Ther 2022; 39:4157-4168. [PMID: 35821555 PMCID: PMC9402759 DOI: 10.1007/s12325-022-02197-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/16/2022] [Indexed: 11/26/2022]
Abstract
Introduction Atopic dermatitis (AD) is associated with significant quality-of-life and economic burdens. Real-world evidence is needed to identify optimal treatment pathways for AD. Here we evaluate real-world effectiveness of systemic therapies for moderate-to-severe AD in the USA. Methods Data (September 2016 to December 2019) were from the IQVIA Health Plan Claims data set (IQVIA, Danbury, CT) from patients aged 12 years or older with AD (ICD-9/10-CM, 691.8/L20.x) initiating a systemic immunosuppressive (SIS) agent (methotrexate, cyclosporine, mycophenolate, or azathioprine) or dupilumab and continuously enrolled for at least 6 months before and after the index date. Indicators of non-response (i.e., adding on/switching systemic therapy, AD-related inpatient/emergency room visits, or incident staphylococcal/streptococcal skin infection) and predictors of non-response were evaluated. Descriptive statistics and Kaplan–Meier rates and times were obtained; Cox regression models were used. Results In 3249 patients, 45.4% exhibited at least one indicator of non-response, with median time to non-response being longer for dupilumab than for any SIS therapy (27.0 vs 4.0–7.7 months, respectively). Key non-response predictors were age, geographic region, and baseline number of annual AD-related medical visits. Conclusion Non-response was common in patients with AD who required systemic treatment, and non-response indicators occurred significantly more frequently with SIS treatment than with dupilumab treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02197-z.
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Affiliation(s)
- Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, CA, USA
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15
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Epidemiology and Economic Burden of Atopic Dermatitis: Real-World Retrospective Data from a Large Nationwide Israeli Healthcare Provider Database. Adv Ther 2022; 39:2502-2514. [PMID: 35352308 PMCID: PMC9329417 DOI: 10.1007/s12325-022-02120-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/08/2022] [Indexed: 12/02/2022]
Abstract
Introduction Real-world data on the epidemiology and economic burden of atopic dermatitis (AD) are limited. Here we describe the epidemiology and economic burden of AD using electronic healthcare data from Israel. Methods A retrospective study was performed using the Maccabi Healthcare Services database. AD incidence in 2008–2017 and point prevalence (ADprev) on 31 December 2017 were described using diagnosis codes for overall patients, and sex and age subgroups. For ADprev, severity was defined using recently dispensed treatments for AD. Annual healthcare resource utilization in AD prevalent patients was compared with non-AD matched controls using generalized linear modelling. Direct annual costs were estimated also. Results AD incidence was 7.0/1000 person-years; overall prevalence was 4.4% (female patients 4.5%, male patients 4.3%; age 0 to less than 6 months, 0.9%; 6 months to less than 12 years, 11.0%; 12 to less than 18 years, 5.8%; 18 years or older, 2.2%). Among ADprev (n = 94,483), mild, moderate, and severe AD comprised 57.7%, 36.2%, and 6.1% (adults 43.8%, 46.3%, 9.9%), respectively. Dermatologist and allergist visits and hospitalization rates (at least one) were 40.7%, 6.6%, and 3.8% in 2017. Compared with controls, overall and moderate-to-severe AD were associated with 36% and 52% increases in annual per-person costs (incremental costs $126 and $190). Conclusions AD epidemiology in Israel is comparable with other real-world database studies. AD imposes an economic burden that increases with disease severity. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02120-6. Occurrence and costs of atopic dermatitis in Israel Atopic dermatitis is a disease that causes the skin to be inflamed and itchy. Atopic dermatitis is most common in children but can also occur in adolescents and adults. Using data from a large healthcare provider in Israel, this study aimed to describe how common atopic dermatitis is within the population. Costs related to the use of healthcare services (such as visits to dermatologists and creams to treat atopic dermatitis) in the year 2017 were compared between persons with versus without atopic dermatitis. For the years 2008 to 2017, approximately 7 out of 1000 people were newly diagnosed with atopic dermatitis each year (incidence). Among people alive on 31 December 2017, 4.4% had atopic dermatitis (prevalence), with 42.3% suggestive of moderate to severe disease. Patients with atopic dermatitis, particularly those with more severe disease, used healthcare services more frequently. Compared with people without atopic dermatitis, medical costs among patients with atopic dermatitis were 36% higher (corresponding to added costs of $126 per person per year). This study helps to better understand how many people have atopic dermatitis, and what healthcare resources are needed to manage this disease.
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16
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Silverberg JI, Rubini NPM, Pires MC, Rossi AB, Zhang A, Chen Z, Levit NA, Chao J, Shumel B, Bégo-Le Bagousse G. Dupilumab Treatment Reduces Hospitalizations in Adults With Moderate-to-Severe Atopic Dermatitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1279-1285.e1. [PMID: 35032695 DOI: 10.1016/j.jaip.2021.11.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Refractory disease, flares, or infections in atopic dermatitis (AD) can lead to hospitalizations. OBJECTIVE To compare hospitalization rates among adults with moderate-to-severe AD treated with dupilumab versus control. METHODS Data from 7 randomized, placebo-controlled trials of dupilumab (300 mg every 2 weeks [q2w] and/or weekly [qw]; with or without topical corticosteroids) were analyzed. RESULTS Patients in the dupilumab 300 mg q2w, qw, and combined dupilumab (q2w and qw; n = 1,841) groups compared with patients in the control group (n = 1,091) had lower rates of all-cause hospitalizations (5.8, 2.7, and 3.8 events, respectively, vs 9.0 events per 100 patient-years [PY]; all P < .05 [49%, 71%, and 62% risk reduction, respectively]); AD-related hospitalizations (2.0, 0.4, 1.0 events vs 4.1 events per 100 PY; P < .05 for qw and dupilumab combined [91% and 79% risk reduction, respectively]); as well as reduced overall duration of AD-related hospitalization (10.9, 7.3, and 8.6 d vs 38.9 d per 100 PY). CONCLUSIONS Among adults with moderate-to-severe AD, treatment with dupilumab versus control was associated with significant reductions in all-cause and AD-related hospitalization rates, and shorter duration of AD-related hospitalization.
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Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Norma P M Rubini
- School of Medicine and Surgery, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Mario C Pires
- Dermatology Service, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
| | | | | | - Zhen Chen
- Regeneron Pharmaceutical, Inc., Tarrytown, NY
| | | | | | - Brad Shumel
- Regeneron Pharmaceutical, Inc., Tarrytown, NY
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17
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Lee EM, Cho YT, Hsieh WT, Chan TC, Shen D, Chu CY, Tang CH. Healthcare utilization and costs of atopic dermatitis in Taiwan. J Formos Med Assoc 2022; 121:1963-1971. [PMID: 35177295 DOI: 10.1016/j.jfma.2022.01.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 01/14/2022] [Accepted: 01/28/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Atopic dermatitis (AD) is a common chronic skin disease. Only relatively scant studies from Asian countries have attempted to quantify AD-associated healthcare utilization and costs by using population-based databases. This study aims to evaluate the AD-associated annual healthcare utilization and costs in Taiwan. METHODS A retrospective matched-cohort study was conducted by matching the AD cases with controls at a 1:4 (cases:controls) ratio, with the data for both the cases and controls being sourced from the 2017 National Health Insurance Research Database (NHIRD). The AD patients were stratified by disease severity based on their treatments. Differences in the regression-adjusted frequency of care and costs between the cases and controls were compared using t-tests by the severity level of AD. RESULTS The incremental frequency of outpatient visits per year increased with AD severity (9.60, 11.28, and 16.23 for mild, moderate, and severe cases, respectively). However, the frequency of inpatient care and emergency room visits per year showed no consistent pattern associated with disease severity. The incremental total costs per year were NT$9,511.64, NT$9,705.20, and NT$15,762.09 for mild, moderate, and severe cases, respectively, and the outpatient and drug costs accounted for 46.65%-54.82% and 17.01%-31.20% of the total costs, respectively. CONCLUSION AD was found to impose significant healthcare costs, with estimated total cost burdens of NT$3.61 billion in 2017, which is 0.314% of Taiwan's national health expenditure and 0.020% of Taiwan's gross domestic product.
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Affiliation(s)
- Ellen M Lee
- Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yung-Tsu Cho
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Ting Hsieh
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Tom C Chan
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Dereck Shen
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Chao-Hsiun Tang
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan.
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18
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AAD Guidelines: awareness of comorbidities associated with atopic dermatitis in adults. J Am Acad Dermatol 2022; 86:1335-1336.e18. [DOI: 10.1016/j.jaad.2022.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/21/2022]
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Gladys TE, Maczuga S, Flamm A. Characterizing demographics and cost of care for dyshidrotic eczema. Contact Dermatitis 2021; 86:107-112. [PMID: 34773262 DOI: 10.1111/cod.14007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dyshidrotic eczema (DE) is a common form of eczema affecting the hands, feet, or both areas. To date, there has been little research examining demographics and cost burden associated with this disease. OBJECTIVE This study seeks to characterize the demographics of patients affected and the direct costs of care associated with DE. METHODS This is a retrospective analysis utilizing insurance claim information from IBM MarketScan. Pertinent data including demographic information, healthcare provider type, medications prescribed, and average cost of care were identified using the ICD 10 code L30.1 for DE for the year 2018. RESULTS In 2018, 34 932 patients filed claims for DE, with 61% female and an average age of 37 years at first diagnosis. DE was mostly seen in employees from the service industry and the manufacturing of durable goods. The total annual direct cost was US $11 738 985. Average annual costs, however, did vary based on type of treating healthcare provider, level of care, and medications prescribed. CONCLUSIONS Patients with DE can face an economic burden due to their disease and providers should aim to recognize this disease and its treatments to minimize healthcare costs for patients and improve quality of life.
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Affiliation(s)
- Taylor E Gladys
- Department of Dermatology, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Steven Maczuga
- Department of Dermatology, Penn State Health Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Alexandra Flamm
- Department of Dermatology, Penn State Health Hershey Medical Center, Hershey, Pennsylvania, USA
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20
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Paller AS, Mina-Osorio P, Vekeman F, Boklage S, Mallya UG, Ganguli S, Kaur M, Robitaille MN, Siegfried EC. Prevalence of type 2 inflammatory diseases in pediatric patients with atopic dermatitis: real-world evidence. J Am Acad Dermatol 2021; 86:758-765. [PMID: 34756933 DOI: 10.1016/j.jaad.2021.10.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with atopic dermatitis (AD) are considered at increased risk of developing other type 2 inflammatory diseases. However, real-world evidence based on large US commercially insured pediatric populations is scarce. OBJECTIVE To use a large US claims database (IBM® MarketScan® 2013-2017) to assess prevalence and incidence of type 2 inflammatory diseases in pediatric AD patients. METHODS Pediatric AD patients were matched 1:1 to non-AD patients. Prevalence was assessed for conjunctivitis, rhinitis, urticaria, asthma, eosinophilic esophagitis and chronic rhinosinusitis/nasal polyps, 12 months post-index date (first AD diagnosis date for AD patients; a randomly selected outpatient visit for control patients). Incidence of other type 2 inflammatory diseases post-index was assessed among patients 0-2 years old. RESULTS 244,776 AD and matched non-AD patients were selected. The prevalence and incidence of type 2 inflammatory diseases were higher among AD patients. Overall, the prevalence more than doubled for asthma, eosinophilic esophagitis, urticaria, and rhinitis, and increased with AD severity. LIMITATIONS AD identification based on billing diagnoses; observation period of only 12 months; limited to commercially insured patients CONCLUSION: The burden of type 2 inflammatory diseases in pediatric AD patients is substantial, highlighting the need to optimize management of AD and its numerous associated morbidities.
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Affiliation(s)
- Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | | | | | | | | | - Elaine C Siegfried
- Department of Pediatrics, Division of Dermatology, Saint Louis University and Cardinal Glennon Children's Hospital, St. Louis, MO, USA.
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21
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Silverberg JI, Thyssen JP, Fahrbach K, Mickle K, Cappelleri JC, Romero W, Cameron MC, Myers DE, Clibborn C, DiBonaventura M. Comparative efficacy and safety of systemic therapies used in moderate-to-severe atopic dermatitis: a systematic literature review and network meta-analysis. J Eur Acad Dermatol Venereol 2021; 35:1797-1810. [PMID: 33991374 PMCID: PMC8453983 DOI: 10.1111/jdv.17351] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/02/2021] [Indexed: 12/19/2022]
Abstract
Given the lack of head-to-head studies of systemic therapies in moderate-to-severe atopic dermatitis (AD), network meta-analyses (NMAs) can provide comparative efficacy and safety data to inform clinical decision-making. In this NMA, eligible randomized controlled trials (RCTs) published before 24 October 2019 were identified by a systematic literature review. Short-term (12-16 weeks) efficacy (Investigator's Global Assessment [IGA] and Eczema Area and Severity Index [EASI] responses), patient-reported outcomes (PROs) and safety data from each trial were abstracted and analysed separately for monotherapy and combination therapy (systemic plus topical anti-inflammatory therapy). RCTs were analysed in fixed-effects and random-effects Bayesian NMA models. Overall, 19 phase 2 and phase 3 RCTs of abrocitinib, baricitinib, dupilumab, lebrikizumab, nemolizumab, tralokinumab and upadacitinib were included. In monotherapy RCTs, upadacitinib 30 mg once daily (QD) had the numerically highest efficacy (83.6% achieved ≥50% improvement in EASI [EASI-50 response]), followed by abrocitinib 200 mg QD (74.6%), upadacitinib 15 mg QD (70.5%), dupilumab 300 mg every 2 weeks (Q2W) (63.4%) and abrocitinib 100 mg QD (56.7%). Similar trends in EASI-75 and EASI-90 response were observed. In combination therapy RCTs, abrocitinib 200 mg QD had the highest EASI-50 (86.6%), followed by dupilumab 300 mg Q2W (82.4%) and abrocitinib 100 mg QD (79.7%). Similar findings were observed for IGA response and PROs. In monotherapy and combination therapy RCTs, the probability of treatment-emergent adverse events (TEAEs) was higher among all active treatments than with placebo (except for dupilumab 300 mg Q2W [odds ratio (OR), 0.96; 95% credible interval (CrI), 0.45-2.18] and abrocitinib 100 mg QD [OR, 0.95; 95% CrI, 0.35-2.66] in combination therapy RCTs), although active treatments did not significantly differ from one another. Abrocitinib, dupilumab and upadacitinib were consistently the most effective systemic therapies in adult and adolescent patients with AD, with no significant TEAE differences in short-term RCTs.
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Affiliation(s)
- J I Silverberg
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - J P Thyssen
- Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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Weidner J, Bartel S, Kılıç A, Zissler UM, Renz H, Schwarze J, Schmidt‐Weber CB, Maes T, Rebane A, Krauss‐Etschmann S, Rådinger M. Spotlight on microRNAs in allergy and asthma. Allergy 2021; 76:1661-1678. [PMID: 33128813 PMCID: PMC8246745 DOI: 10.1111/all.14646] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/16/2020] [Accepted: 10/25/2020] [Indexed: 12/14/2022]
Abstract
In past 10 years, microRNAs (miRNAs) have gained scientific attention due to their importance in the pathophysiology of allergic diseases and their potential as biomarkers in liquid biopsies. They act as master post‐transcriptional regulators that control most cellular processes. As one miRNA can target several mRNAs, often within the same pathway, dysregulated expression of miRNAs may alter particular cellular responses and contribute, or lead, to the development of various diseases. In this review, we give an overview of the current research on miRNAs in allergic diseases, including atopic dermatitis, allergic rhinitis, and asthma. Specifically, we discuss how individual miRNAs function in the regulation of immune responses in epithelial cells and specialized immune cells in response to different environmental factors and respiratory viruses. In addition, we review insights obtained from experiments with murine models of allergic airway and skin inflammation and offer an overview of studies focusing on miRNA discovery using profiling techniques and bioinformatic modeling of the network effect of multiple miRNAs. In conclusion, we highlight the importance of research into miRNA function in allergy and asthma to improve our knowledge of the molecular mechanisms involved in the pathogenesis of this heterogeneous group of diseases.
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Affiliation(s)
- Julie Weidner
- Department of Internal Medicine and Clinical Nutrition Krefting Research Centre Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Sabine Bartel
- Department of Pathology and Medical Biology GRIAC Research Institute University Medical Center Groningen University of Groningen Groningen The Netherlands
| | - Ayse Kılıç
- Channing Division of Network Medicine Brigham and Women's Hospital Boston MA USA
| | - Ulrich M. Zissler
- Center for Allergy and Environment (ZAUM) Technical University of Munich and Helmholtz Center MunichGerman Research Center for Environmental Health Munich Germany
| | - Harald Renz
- Institut für Laboratoriumsmedizin und Pathobiochemie Philipps University of Marburg Marburg Germany
| | - Jürgen Schwarze
- Centre for Inflammation Research The University of Edinburgh Edinburgh UK
| | - Carsten B. Schmidt‐Weber
- Center for Allergy and Environment (ZAUM) Technical University of Munich and Helmholtz Center MunichGerman Research Center for Environmental Health Munich Germany
| | - Tania Maes
- Department of Respiratory Medicine Ghent University Ghent Belgium
| | - Ana Rebane
- Institute of Biomedicine and Translational Medicine University of Tartu Tartu Estonia
| | - Susanne Krauss‐Etschmann
- Research Center Borstel Borstel Germany
- Institute of Experimental Medicine Christian‐Albrechts University Kiel Kiel Germany
| | - Madeleine Rådinger
- Department of Internal Medicine and Clinical Nutrition Krefting Research Centre Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
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23
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Mohr N, Naatz M, Zeervi L, Langenbruch A, Bieber T, Werfel T, Wollenberg A, Augustin M. Cost‐of‐illness of atopic dermatitis in Germany: data from dermatology routine care. J Eur Acad Dermatol Venereol 2021; 35:1346-1356. [DOI: 10.1111/jdv.17203] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 02/11/2021] [Indexed: 12/27/2022]
Affiliation(s)
- N. Mohr
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - M. Naatz
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - L. Zeervi
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - A. Langenbruch
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - T. Bieber
- Department of Dermatology and Allergy University Hospital Bonn Bonn Germany
| | - T. Werfel
- Department Dermatology and Allergy Hannover Medical School Hannover Germany
| | - A. Wollenberg
- Department Dermatology and Allergy Ludwig‐Maximilian University Munich Germany
| | - M. Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
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24
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Toron F, Neary MP, Smith TW, Gruben D, Romero W, Cha A, Patel K, Vasileva SZ, Ameen M. Clinical and Economic Burden of Mild-to-Moderate Atopic Dermatitis in the UK: A Propensity-Score-Matched Case-Control Study. Dermatol Ther (Heidelb) 2021; 11:907-928. [PMID: 33846907 PMCID: PMC8163940 DOI: 10.1007/s13555-021-00519-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/24/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction The burden of mild-to-moderate atopic dermatitis (AD) in the United Kingdom (UK) is not well understood. Long-lasting AD flares may lead to systemic inflammation resulting in reversible progression from mild to more severe AD. This study aimed to assess the clinical and economic burden of mild-to-moderate AD in the UK. Methods AD patients were identified in the Health Improvement Network (THIN) from 2013 to 2017 and propensity score matched to non-AD controls by demographics. Patients were identified based on continuous disease activity using validated algorithms and sufficient patient status to fully validate data integrity for the entire period. Mild-to-moderate AD patients were identified by using treatment as a surrogate. Demographics, clinical characteristics and healthcare resource use (HCRU) were obtained from THIN. Literature reviews were conducted to obtain additional outcomes. A cost-of-illness model was developed to extrapolate the burden in 2017 to the UK population and in subsequent years (2018–2022). Results In 2017, the prevalence of mild-to-moderate AD in THIN was 1.28%. These patients reported higher comorbidity rates and significantly higher (p < 0.0001) HCRU, encompassing mean general practitioner visits (5.57 versus 3.59), AD-related prescriptions (5.85 versus 0.68) and total referrals (0.97 versus 0.82) versus matched non-AD controls. The model projected total HCRU and drug excess costs of €462.99M over the 5 years. The excess cost decreased to €417.35M after excluding patients on very potent topical corticosteroids, who most likely had at least moderate disease. The excess costs increased to €1.21B and €7.06B when considering comorbidity burden and productivity losses, respectively. Conclusion Mild-to-moderate AD patients had higher comorbidity burden, HCRU and cost compared with matched non-AD controls. Overall, UK country-based economic burden was high given partly the high prevalence of this disease. Moreover, productivity burden and comorbidities had considerable impact on the economic burden, which further suggests the importance of optimal disease management. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00519-7.
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Affiliation(s)
- Farah Toron
- Health Economics and Outcomes Research, Real World Solutions, IQVIA, 210 Pentonville Road, London, N1 9JY, UK
| | - Maureen P Neary
- Inflammation & Immunology, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - Timothy W Smith
- Inflammation & Immunology, Pfizer Inc, New York, New York, USA
| | - David Gruben
- Global Biometrics and Data Management (Statistics), Pfizer Inc, Groton, Connecticut, USA
| | | | - Amy Cha
- Inflammation & Immunology, Pfizer Inc, New York, New York, USA
| | - Keyur Patel
- Health Economics and Outcomes Research, Real World Solutions, IQVIA, 210 Pentonville Road, London, N1 9JY, UK
| | - Simona Z Vasileva
- Health Economics and Outcomes Research, Real World Solutions, IQVIA, 210 Pentonville Road, London, N1 9JY, UK.
| | - Mahreen Ameen
- Royal Free London National Health Services Foundation Trust, London, UK
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25
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Knudgaard MH, Andreasen TH, Ravnborg N, Bieber T, Silverberg JI, Egeberg A, Halling AS, Thyssen JP. Rhinitis prevalence and association with atopic dermatitis: A systematic review and meta-analysis. Ann Allergy Asthma Immunol 2021; 127:49-56.e1. [PMID: 33684526 DOI: 10.1016/j.anai.2021.02.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/22/2021] [Accepted: 02/28/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) and rhinitis are common atopic diseases that may co-occur owing to an overlap in pathophysiology. Although most cases of both diseases are mild and managed with topical anti-inflammatory medicaments, the advent of new systemic and biologic treatments targeting type 2 inflammation in both diseases warrants further insight in the exact overlap of AD and rhinitis. OBJECTIVE To determine the association between AD and rhinitis. METHODS A systematic review and meta-analysis of the databases PubMed, Embase, and CNKI were performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled prevalence and pooled odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated. RESULTS The search resulted in 10,422 citations, and 341 and 302 articles were included in the qualitative and quantitative analyses, respectively. The pooled prevalence of rhinitis was 40.5% (95% CI 39.0-42.0) in patients with AD and 18.0% (95% CI 16.7-19.2) in the reference individuals without AD. The pooled prevalence of having both rhinitis and asthma was 14.2% (95% CI 13.0-15.5) in patients with AD. There was an association between AD and rhinitis (OR 3.00, 95% CI 2.83-3.18), allergic rhinitis (OR 3.25, 95% CI 2.26-4.66), and nonallergic rhinitis (OR 1.99, 95% CI 1.39-2.86), respectively. CONCLUSION Rhinitis, both allergic and nonallergic forms, is very common in patients with AD. Future investigations should clarify how medications targeting both diseases should be indicated in these patients.
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Affiliation(s)
- Mette Hjorslev Knudgaard
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Thomas Holger Andreasen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Nanna Ravnborg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Thomas Bieber
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany; Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Alexander Egeberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Anne-Sofie Halling
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Jacob P Thyssen
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, Hellerup, Denmark; Department of Dermatology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; LEO Foundation Skin Immunology Research Center, University of Copenhagen, Copenhagen, Denmark.
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26
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Psychosocial Comorbidities and Health Status Among Adults with Moderate-to-Severe Atopic Dermatitis: A 2017 US National Health and Wellness Survey Analysis. Adv Ther 2021; 38:1627-1637. [PMID: 33555555 PMCID: PMC7932976 DOI: 10.1007/s12325-021-01630-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/15/2021] [Indexed: 12/15/2022]
Abstract
Introduction Atopic dermatitis (AD) is associated with sleep difficulties, depression, and anxiety. We evaluated the relationship between these psychosocial comorbidities and health outcomes among adults with moderate-to-severe AD in the USA. Methods Data were analyzed from the 2017 US National Health and Wellness Survey. Respondents with a physician diagnosis of AD or eczema with moderate-to-severe AD based on a Dermatology Life Quality Index score of 6 or more were included. Generalized linear models were used to examine the relationship between psychosocial comorbidities (sleep difficulties and anxiety based on self-report, depression based on the Patient Health Questionnaire-9) and health outcomes [the 36-item Short Form Health Survey, version 2; EuroQol five-dimension, five-level; Work Productivity and Activity Impairment questionnaire; and healthcare resource utilization (HRU)]. Results Among respondents with moderate-to-severe AD (N = 1017), 56.6%, 70.7%, and 60.9% reported sleep difficulties, depression, and anxiety, respectively. These comorbidities were significantly associated with reduced physical and mental component summary scores and increased overall work impairment (P < 0.05 for all). Increased HRU was also observed. Conclusion Psychosocial comorbidities were frequently reported by respondents with moderate-to-severe AD and were significantly associated with health status, work loss, and HRU. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01630-z.
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27
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Bruin-Weller MD, Pink AE, Patrizi A, Gimenez-Arnau AM, Agner T, Roquet-Gravy PP, Ferrucci SM, Arenberger P, Svensson A, Schuttelaar MLA, Nosbaum A, Jayawardena S, Rizova E, Ardeleanu M, Eckert L, Ozturk ZE. Disease burden and treatment history among adults with atopic dermatitis receiving systemic therapy: baseline characteristics of participants on the EUROSTAD prospective observational study. J DERMATOL TREAT 2021; 32:164-173. [PMID: 33461356 DOI: 10.1080/09546634.2020.1866741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Insights into the real-world treatment paradigm and long-term burden of atopic dermatitis (AD) are needed to inform clinical and health policy decisions. METHODS The prospective, observational EUROSTAD study enrolled adults with moderate-to-severe AD starting or switching systemic therapy (51 sites in 10 European countries). We report the baseline characteristics, treatment patterns, and outcomes of these patients using descriptive statistics. RESULTS A 12-month enrollment period of EUROSTAD was completed and 308 patients were enrolled: average age 37 years, AD duration 25 years, 43% were female. Most patients reported use of systemic therapy (93%) and ≥1 atopic comorbidity (82%). Mean [standard deviation] disease severity/burden measures were high: Investigator's Global Assessment (3.1 [0.8]), Eczema Area and Severity Index (16.2 [10.9]), Peak Pruritus Numerical Rating Scale (5.5 [2.5]), sleep impairment Visual Analog Scale (49.8 [31.6]) scores, and time lost from work (4.1 [13.7] days/year) or usual activities (16.8 [38.7] days/year). Most patients showed borderline or clinical levels of anxiety (59%) and/or depression (63%) using the Hospital Anxiety and Depression Scale. CONCLUSIONS Adults with moderate-to-severe AD starting/switching systemic treatment enrolled in EUROSTAD have a high burden of longstanding disease despite continuous use of topical drugs, emollients, and systemic therapies.
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Affiliation(s)
- Marjolein de Bruin-Weller
- National Expertise Center of Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Andrew E Pink
- St. John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Annalisa Patrizi
- Department of Dermatology, IRCCS Policlinico di S. Orsola, Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Italy
| | - Ana M Gimenez-Arnau
- Department of Dermatology, Hospital del Mar, IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tove Agner
- Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Silvia M Ferrucci
- Department of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Marie L A Schuttelaar
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Audrey Nosbaum
- Allergy and Clinical Immunology Department, University of Lyon, Lyon Sud University Hospital, Pierre Benite, France
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Boguniewicz M, Beck LA, Sher L, Guttman-Yassky E, Thaçi D, Blauvelt A, Worm M, Corren J, Soong W, Lio P, Rossi AB, Lu Y, Chao J, Eckert L, Gadkari A, Hultsch T, Ruddy M, Mannent LP, Graham NMH, Pirozzi G, Chen Z, Ardeleanu M. Dupilumab Improves Asthma and Sinonasal Outcomes in Adults with Moderate to Severe Atopic Dermatitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:1212-1223.e6. [PMID: 33453450 DOI: 10.1016/j.jaip.2020.12.059] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/10/2020] [Accepted: 12/27/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dupilumab has demonstrated efficacy with acceptable safety in clinical trials in patients with moderate to severe atopic dermatitis (AD). OBJECTIVE To assess dupilumab's impact on asthma and sinonasal conditions in adult patients with moderate to severe AD in four randomized, double-blinded, placebo-controlled trials. METHODS In LIBERTY AD SOLO 1 (NCT02277743), SOLO 2 (NCT02755649), CHRONOS (NCT02260986), and CAFÉ (NCT02755649), patients received placebo, dupilumab 300 mg every 2 weeks (q2w), or dupilumab 300 mg weekly (qw). In CHRONOS and CAFÉ, patients received concomitant topical corticosteroids. This post hoc analysis assessed Asthma Control Questionnaire-5 (ACQ-5) scores in patients with asthma, Sino-Nasal Outcome Test-22 (SNOT-22) scores in patients with sinonasal conditions, and AD signs and symptoms in all patients. RESULTS Of the 2444 patients, 463 had asthma with baseline ACQ-5 ≥ 0.5 (19%); 1171 had sinonasal conditions (48%); and 311 had both (13%). At week 16, ACQ-5 scores (least squares mean change from baseline [standard error]) improved by 0.27 (0.07), 0.59 (0.08), and 0.56 (0.07) in placebo-, q2w-, and qw-treated patients with asthma, respectively, whereas SNOT-22 scores improved by 5.1 (0.8), 9.9 (0.9), and 10.8 (0.8) in patients with sinonasal conditions (P < .01 for all dupilumab vs placebo). Improvements in ACQ-5 and SNOT-22 were also seen in patients with both conditions. Dupilumab also significantly improved AD signs and symptoms among all subgroups. CONCLUSIONS In this first analysis of patients with comorbid moderate to severe AD, asthma, and/or chronic sinonasal conditions, dupilumab improved all three diseases in a clinically meaningful and statistically significant manner (vs placebo), based on validated outcome measures.
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Affiliation(s)
- Mark Boguniewicz
- National Jewish Health, Denver, Colo; University of Colorado School of Medicine, Denver, Colo.
| | - Lisa A Beck
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY
| | - Lawrence Sher
- Peninsula Research Associates, Rolling Hills Estates, Calif
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY; Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Diamant Thaçi
- Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | | | - Margitta Worm
- Division of Allergy and Immunology, Allergy Center Charité, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Weily Soong
- Alabama Allergy and Asthma Center, Birmingham, Ala
| | - Peter Lio
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | | | - Yufang Lu
- Regeneron Pharmaceuticals, Inc, Tarrytown, NY
| | | | | | | | | | | | | | | | | | - Zhen Chen
- Regeneron Pharmaceuticals, Inc, Tarrytown, NY
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29
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Effects of variations in access to care for children with atopic dermatitis. BMC DERMATOLOGY 2020; 20:24. [PMID: 33341118 PMCID: PMC7749983 DOI: 10.1186/s12895-020-00114-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 11/09/2020] [Indexed: 12/31/2022]
Abstract
Background An estimated 50% of children in the US are Medicaid-insured. Some of these patients have poor health literacy and limited access to medications and specialty care. These factors affect treatment utilization for pediatric patients with atopic dermatitis (AD), the most common inflammatory skin disease in children. This study assesses and compares treatment patterns and healthcare resource utilization (HCRU) between large cohorts of Medicaid and commercially insured children with AD. Methods Pediatric patients with AD were identified from 2 large US healthcare claims databases (2011–2016). Included patients had continuous health plan eligibility for ≥6 months before and ≥12 months after the first AD diagnosis (index date). Patients with an autoimmune disease diagnosis within 6 months of the index date were excluded. Treatment patterns and all-cause and AD-related HCRU during the observation period were compared between commercially and Medicaid-insured children. Results A minority of children were evaluated by a dermatology or allergy/immunology specialist. Several significant differences were observed between commercially and Medicaid-insured children with AD. Disparities detected for Medicaid-insured children included: comparatively fewer received specialist care, emergency department and urgent care center utilization was higher, a greater proportion had asthma and non-atopic morbidities, high- potency topical corticosteroids and calcineurin inhibitors were less often prescribed, and prescriptions for antihistamines were more than three times higher, despite similar rates of comorbid asthma and allergies among antihistamine users. Treatment patterns also varied substantially across physician specialties. Conclusions Results suggest barriers in accessing specialty care for all children with AD and significant differences in management between commercially and Medicaid-insured children. These disparities in treatment and access to specialty care may contribute to poor AD control, especially in Medicaid-insured patients. Supplementary Information Supplementary information accompanies this paper at 10.1186/s12895-020-00114-x.
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30
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Halling AS, van Hauen M, Eggers-Lura VH, Knudgaard MH, Loft N, Thyssen JP. Association between atopic dermatitis and nasal polyposis: what is the evidence? J Eur Acad Dermatol Venereol 2020; 35:e290-e293. [PMID: 33230814 DOI: 10.1111/jdv.17048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/27/2020] [Accepted: 11/17/2020] [Indexed: 11/29/2022]
Affiliation(s)
- A-S Halling
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark
| | - M van Hauen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark
| | - V H Eggers-Lura
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark
| | - M H Knudgaard
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark
| | - N Loft
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark
| | - J P Thyssen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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31
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Reich K, DeLozier AM, Nunes FP, Thyssen JP, Eichenfield LF, Wollenberg A, Ross Terres JA, Watts SD, Chen YF, Simpson EL, Silverberg JI. Baricitinib improves symptoms in patients with moderate-to-severe atopic dermatitis and inadequate response to topical corticosteroids: patient-reported outcomes from two randomized monotherapy phase III trials. J DERMATOL TREAT 2020; 33:1521-1530. [DOI: 10.1080/09546634.2020.1839008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- K. Reich
- Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Skinflammation® Center, Hamburg and Dermatologikum Berlin, Berlin, Germany
| | | | - F. P. Nunes
- Eli Lilly and Company, Indianapolis, IN, USA
| | - J. P. Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital and University of Copenhagen, Copenhagen, Denmark
| | - L. F. Eichenfield
- Departments of Dermatology and Pediatrics, University of California, San Diego and Rady Children’s Hospital, San Diego, CA, USA
| | - A. Wollenberg
- Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany
| | | | - S. D. Watts
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Y.-F. Chen
- Eli Lilly and Company, Indianapolis, IN, USA
| | - E. L. Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - J. I. Silverberg
- Department of Dermatology, George Washington University School of Medicine, Washington, DC, USA
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32
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Girolomoni G, Luger T, Nosbaum A, Gruben D, Romero W, Llamado LJ, DiBonaventura M. The Economic and Psychosocial Comorbidity Burden Among Adults with Moderate-to-Severe Atopic Dermatitis in Europe: Analysis of a Cross-Sectional Survey. Dermatol Ther (Heidelb) 2020; 11:117-130. [PMID: 33180320 PMCID: PMC7858996 DOI: 10.1007/s13555-020-00459-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction Atopic dermatitis (AD) is a common inflammatory disease of the skin, which may have a substantial impact on patients' health-related quality of life (HRQoL). The aim of this study was to quantify the economic burden (direct and indirect costs) of moderate-to-severe AD and evaluate the prevalence and impact of psychosocial comorbidities among patients in the European Union-5 (France, Germany, Italy, Spain, and the UK). Methods Data were analyzed from the 2017 EU5 National Health and Wellness Survey. Respondents with a physician diagnosis of AD/eczema who were considered to have moderate-to-severe AD based on a Dermatology Life Quality Index (DLQI) score ≥ 6 were included. Direct costs, indirect costs, and psychosocial comorbidities (sleep difficulties and anxiety based on self-report, depression based on the Patient Health Questionnaire-9) were reported descriptively. Generalized linear models were used to examine the relationship between psychosocial comorbidities and health outcomes (the Short Form-36 version 2 [SF-36v2], EuroQoL 5-dimension 5-level, Work Productivity and Activity Impairment questionnaire, and healthcare resource utilization). Results Overall, 1014 patients were included in the analysis. Total annual direct costs ranged from €2242 to €6924 and total annual indirect costs ranged from €7277 to €14,236, depending on the level of disease severity. Sleep difficulties, anxiety, and depression were reported by 61.6%, 52.7%, and 75.8% of patients, respectively. These comorbidities were significantly associated with reduced physical and mental component summary scores from SF-36v2 and increased overall work impairment (p < 0.05 for all). Conclusions A significant economic burden was observed for patients with moderate-to-severe AD. Sleep difficulties, depression, and anxiety were observed in more than half of moderate-to-severe AD patients and were significantly associated with decrements in HRQoL and with work-related impairment. Reducing the burden of these psychosocial comorbidities in AD could have significant benefit to patients and society.
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Affiliation(s)
| | - Thomas Luger
- Department of Dermatology, University of Münster, Münster, Germany
| | - Audrey Nosbaum
- Department of Clinical Immunology and Allergy, Lyon-Sud University Hospital, Pierre-Bénite, France
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Johnson H, Anderson J, Moonie S, Gutierrez K, Hogan MB. Factors and cost associated with atopic dermatitis in Nevada. Postgrad Med 2020; 132:629-635. [DOI: 10.1080/00325481.2020.1764263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Hadley Johnson
- School of Medicine, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Julia Anderson
- School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Sheniz Moonie
- School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Karen Gutierrez
- School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Mary Beth Hogan
- Joan C. Edwards School of Medicine, Department of Pediatrics, Marshall University, Huntington, WV, USA
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Abstract
BACKGROUND Little is known about the impact of multimorbidity in childhood atopic dermatitis (AD). OBJECTIVE We sought to determine the likelihood and predictors of chronic disease multimorbidity in childhood AD. METHODS Data were examined for children (<18 years) in the 1996-2015 Medical Expenditure Panel Survey, an annual, representative sample of United States households. Multimorbidity was assessed using Charlson Comorbidity Index (CCI), Healthcare Utilization Project Chronic Comorbidity Indicator (HCUP-CCI) and frequency of atopic comorbidities. RESULTS Young children with mild-moderate and severe AD, and adolescents with mild-moderate AD had higher CCI scores. Similarly, young children and adolescents with mild-moderate and severe AD had increased HCUP-CCI scores. Children with AD and atopic disease had higher CCI and HCUP-CCI scores than children with either alone. Young children and adolescents with mild-moderate and severe AD had more atopic comorbidities. CONCLUSIONS Pediatric AD is associated with increased atopic and non-atopic multimorbidity. Comorbid atopic disease may identify a subset of children with AD who particularly benefit from enhanced screening and management of multimorbidity.
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Wang X, Li S, Liu J, Kong D, Han X, Lei P, Xu M, Guan H, Hou D. Ameliorative effects of sea buckthorn oil on DNCB induced atopic dermatitis model mice via regulation the balance of Th1/Th2. BMC Complement Med Ther 2020; 20:263. [PMID: 32843010 PMCID: PMC7449066 DOI: 10.1186/s12906-020-02997-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 06/22/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Atopic dermatitis (AD) is a worldwide chronic skin disease which burden public health. Sea buckthorn (SBT) (Hippophae rhamnoides L., Elaeagnaceae) oil, as a traditional herbal medicine, has been used for disease treatment for many years. The effects of SBT oil on AD mouse model induced by repeated administration of 2,4-dinitrochlorobenzene (DNCB) in BALB/c mice was evaluated in this study. METHODS Mice were divided into four groups including the normal control group, AD model group, AD model group treated with SBT oil (5 ml/kg) and AD model group treated with SBT oil (10 ml/kg). Same volume at different concentrations of SBT oil was applied daily on the latter two groups by gavage for 15 days following AD model induction. The function of skin barrier and the production of IL-4, IFN-γ, TNF-α and TSLP were examined after animal sacrifice. The migration and mature of langerhans cell (LCs) in lymph node was further assessed by flow cytometry. RESULTS SBT oil alleviated dermatitis scores, decreased ear thickness, prevented infiltration of mast cell, reduced lymph node weight and depressed activity of Th2 cells. SBT oil also reduced the expression of IL-4, IFN-γ, TNF-α and TSLP in ear tissue, IgE level in serum and mRNA relative expression of IL-4, IFN-γ, TNF-α in lymph node. Moreover, SBT oil inhibited the migration of LCs cells from local lesions to lymph node and it's mature in lymph node. CONCLUSIONS These results suggest SBT oil had a beneficial effect either systemic or regional on DNCB-induced AD mice via maintain the balance of Th1/Th2 and may be a potential complementary candidate for AD treatment.
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Affiliation(s)
- Xinxin Wang
- Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning, PR China.,Basic Medical and Forensic Medicine, Baotou Medical college, Baotou, Inner Mongolia, PR China
| | - Sijia Li
- Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning, PR China
| | - Jiping Liu
- Neurosurgery Department, Northern Hospital of Inner Mongolia, Baotou, Inner Mongolia, PR China
| | - Dongning Kong
- Liaoning Dongning Pharmceutical Co., Ltd., Fuxin, Liaoning, PR China
| | - Xiaowei Han
- College of Integrated Traditional Chinese and Western Medicine, Liaoning University of Traditional Chinese Medicine, Chongshan Road NO.79, Shenyang, Liaoning, 110847, P.R. China
| | - Ping Lei
- College of Integrated Traditional Chinese and Western Medicine, Liaoning University of Traditional Chinese Medicine, Chongshan Road NO.79, Shenyang, Liaoning, 110847, P.R. China
| | - Ming Xu
- College of Integrated Traditional Chinese and Western Medicine, Liaoning University of Traditional Chinese Medicine, Chongshan Road NO.79, Shenyang, Liaoning, 110847, P.R. China
| | - Hongquan Guan
- College of Integrated Traditional Chinese and Western Medicine, Liaoning University of Traditional Chinese Medicine, Chongshan Road NO.79, Shenyang, Liaoning, 110847, P.R. China.
| | - Diandong Hou
- College of Integrated Traditional Chinese and Western Medicine, Liaoning University of Traditional Chinese Medicine, Chongshan Road NO.79, Shenyang, Liaoning, 110847, P.R. China.
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Eichenfield LF, DiBonaventura M, Xenakis J, Lafeuille MH, Duh MS, Fakih I, Levenberg M, Cappelleri JC, Sikirica V. Costs and Treatment Patterns Among Patients with Atopic Dermatitis Using Advanced Therapies in the United States: Analysis of a Retrospective Claims Database. Dermatol Ther (Heidelb) 2020; 10:791-806. [PMID: 32607738 PMCID: PMC7367964 DOI: 10.1007/s13555-020-00413-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION For many, atopic dermatitis (AD) is not adequately controlled with topical regimens. This analysis examined treatment using advanced therapies and associated costs. METHODS The IQVIA Health Plan Claims data set was analyzed. Patients aged ≥ 12 years with AD who newly initiated advanced therapy after the availability of dupilumab (March 28, 2017) and had ≥ 6 months continuous enrollment before and after their first advanced therapy claim (index date) were included. Advanced therapies included dupilumab, systemic corticosteroids (SCSs), systemic immunosuppressants (SISs), and phototherapy. A multivariate regression model was used to predict annualized follow-up healthcare costs. RESULTS In total, 1980 patients were included (61.1% female; mean age, 41.2 years [SD, 17.4]; 11.3% < 18 years). Pre-index date, 65.2% of patients used topical corticosteroids (TCSs; 40.7% and 32.1% used medium and high potency, respectively). The most common advanced therapy was SCSs (N = 1453 [73.4%]; 69.2% prednisone) followed by dupilumab (N = 265 [13.4%]), SISs (N = 99 [5.0%]; 47.5% methotrexate), and phototherapy (N = 163 [8.2%]). Of patients treated with dupilumab, SISs, and phototherapy, 17.4%, 26.3%, and 14.1%, respectively, were prescribed SCSs post-index date. Overall, 62.6% of patients initiating SCSs, 49.1% initiating dupilumab, 64.6% initiating SISs, and 36.2% initiating phototherapy were prescribed TCSs post-index date. Mean annualized total costs (SD) post-index date were $20,722 ($47,014): $11,196 ($41,549) in medical costs ($7973 [$35,133] in outpatient visit costs) and $9526 ($21,612) in pharmacy costs. Mean annualized total cost (SD) varied significantly (P < 0.05) by index treatment: dupilumab, $36,505 ($14,028); SCSs, $17,924 ($49,019); SISs, $24,762 ($47,583); phototherapy, and $17,549 ($57,238). CONCLUSIONS Switching to combination therapy with SCSs and TCSs was common within 6 months of initiating advanced therapy in patients with AD. Patients also incurred significant pharmacy and outpatient costs. These results highlight the difficulty of managing AD with these existing treatment options.
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Affiliation(s)
- Lawrence F Eichenfield
- Department of Dermatology and Pediatrics, UC San Diego, San Diego, CA, USA
- Rady Children's Hospital, San Diego, San Diego, CA, USA
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Paller AS, Guttman-Yassky E, Irvine AD, Baselga E, de Bruin-Weller M, Jayawardena S, Zhang A, Mina-Osorio P, Rizova E, Ozturk ZE. Protocol for a prospective, observational, longitudinal study in paediatric patients with moderate-to-severe atopic dermatitis (PEDISTAD): study objectives, design and methodology. BMJ Open 2020; 10:e033507. [PMID: 32209624 PMCID: PMC7202692 DOI: 10.1136/bmjopen-2019-033507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Atopic dermatitis (AD) is a chronic inflammatory skin disease often associated with atopic comorbidities and has significant impact on children and their families. There is a lack of robust and longitudinal long-term data on disease characteristics and typical clinical practice with currently available treatments in children with moderate-to-severe AD. Hence, an observational study is needed to evaluate AD characteristics and progression in paediatric patients with moderate-to-severe AD. METHODS AND ANALYSIS Pediatric Study in Atopic Dermatitis (PEDISTAD) is a prospective, observational, longitudinal study in paediatric patients with moderate-to-severe AD who are currently receiving systemic or topical treatment and whose disease is not adequately controlled by topical prescription therapies or for whom those therapies are not medically advisable. 1300 children at 100-150 sites in approximately 20 countries worldwide will be enrolled and followed for 5 years. AD therapy is at the discretion of the investigator. Data collected will include: AD disease characteristics and comorbidities; current therapy for AD and initiation of new treatments/changes in current treatment; patient-reported/caregiver-reported outcomes; days missed from school/work for the patient/caregiver; healthcare professional visits; safety and biomarkers. ETHICS AND DISSEMINATION This study is conducted in accordance with the principles established by the 18th World Medical Assembly and all subsequent amendments and the guidelines for Good Epidemiology Practice. Each individual country assures that ethics approval has been received and local regulatory requirements are met. Ethics approval has been obtained in all countries currently participating in PEDISTAD. Study data will be disseminated in manuscripts submitted to peer-reviewed medical journals as well as in abstracts submitted to congresses and in the resulting posters and presentations. TRIAL REGISTRATION NUMBER NCT03687359; pre-results.
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Affiliation(s)
- Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alan D Irvine
- Trinity College Dublin, Dublin, Ireland
- National Children's Research Centre, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - Eulalia Baselga
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Annie Zhang
- Sanofi Genzyme, Cambridge, Massachusetts, USA
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Ravnborg N, Ambikaibalan D, Agnihotri G, Price S, Rastogi S, Patel KR, Singam V, Andersen Y, Halling AS, Silverberg JI, Egeberg A, Thyssen JP. Prevalence of asthma in patients with atopic dermatitis: A systematic review and meta-analysis. J Am Acad Dermatol 2020; 84:471-478. [PMID: 32112994 DOI: 10.1016/j.jaad.2020.02.055] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/07/2020] [Accepted: 02/14/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND It is well established that asthma is common in patients with atopic dermatitis (AD). OBJECTIVES We performed a systematic review and meta-analysis to determine the prevalence of asthma and respiratory symptoms in individuals with AD as well as the association between AD and asthma. METHODS At least 2 authors independently searched the medical databases PubMed, EMBASE, LILACS, and SCOPUS for all English-language studies with data on asthma prevalence among patients with AD or the association between AD and asthma. Pooled odds ratios with 95% confidence intervals (CIs) and pooled proportions were estimated with random-effects models. The Newcastle-Ottawa scale was used to assess study quality. RESULTS The search yielded 39,503 articles. Of these, 213 studies were included in a quantitative analysis. The overall pooled prevalence of asthma was 25.7% (95% CI, 23.7-27.7) in patients with AD and 8.1% (95% CI, 7.0-9.4) among reference individuals. There was a significant association between AD and asthma when compared with reference individuals (odds ratio, 3.03; 95% CI, 2.64-3.47). LIMITATIONS The definitions of AD and asthma differed across the included studies and varied from self-report to physician diagnosed. CONCLUSIONS Asthma is a common comorbidity of AD. Physicians should be cognizant of this relationship and address asthma symptoms in their patients.
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Affiliation(s)
- Nanna Ravnborg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark
| | - Danni Ambikaibalan
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark
| | | | - Shmuel Price
- Midwestern University Chicago College of Osteopathic Medicine, Illinois
| | - Supriya Rastogi
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kevin R Patel
- Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Vivek Singam
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Yuki Andersen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark
| | - Anne-Sofie Halling
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark
| | - Jonathan I Silverberg
- Northwestern University Feinberg School of Medicine, Chicago, Illinois; Northwestern Medicine Multidisciplinary Eczema Center, Chicago, Illinois
| | - Alexander Egeberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark
| | - Jacob P Thyssen
- Department of Dermatology and Venereology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
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Paller AS, Bansal A, Simpson EL, Boguniewicz M, Blauvelt A, Siegfried EC, Guttman-Yassky E, Hultsch T, Chen Z, Mina-Osorio P, Lu Y, Rossi AB, He X, Kamal M, Graham NMH, Pirozzi G, Ruddy M, Eckert L, Gadkari A. Clinically Meaningful Responses to Dupilumab in Adolescents with Uncontrolled Moderate-to-Severe Atopic Dermatitis: Post-hoc Analyses from a Randomized Clinical Trial. Am J Clin Dermatol 2020; 21:119-131. [PMID: 31823222 PMCID: PMC6989562 DOI: 10.1007/s40257-019-00478-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Atopic dermatitis is a chronic inflammatory condition with substantial burden and limited treatment options for adolescents with moderate-to-severe disease. Significantly more patients treated with dupilumab vs. placebo achieved Investigator’s Global Assessment 0/1 at week 16. Objective The objective of this study was to assess the impact of dupilumab treatment vs. placebo on the achievement of clinically meaningful improvements in atopic dermatitis signs, symptoms and quality of life. Methods R668-AD-1526 LIBERTY AD ADOL was a randomized, double-blinded, parallel-group, phase III clinical trial. Two hundred and fifty-one adolescents with moderate-to-severe atopic dermatitis received dupilumab 300 mg every 4 weeks (q4w; n = 84), dupilumab 200 or 300 mg every 2 weeks (q2w; n = 82), or placebo (n = 85). A post-hoc subgroup analysis was performed on 214 patients with Investigator’s Global Assessment > 1 at week 16. Measures of atopic dermatitis signs, symptoms, and quality of life were assessed. Clinically meaningful improvement in one or more of three domains of signs, symptoms, and quality of life was defined as an improvement of ≥ 50% in Eczema Area and Severity Index, ≥ 3 points in Peak Pruritus Numerical Rating Scale, or ≥ 6 points in the Children’s Dermatology Life Quality Index from baseline. Results Of patients receiving dupilumab q2w, 80.5% [66/82] experienced clinically meaningful improvements in atopic dermatitis signs, symptoms, or quality of life at week 16 (vs. placebo, 20/85 [23.5%], difference 57.0% [95% confidence interval 44.5–69.4]; q4w vs. placebo, 53/84 [63.1%], difference 39.6% [95% confidence interval 25.9–53.3]; both p < 0.0001). Results were similar in adolescents with Investigator’s Global Assessment > 1 at week 16 (q2w, 46/62 [74.2%] vs. placebo, 18/83 [21.7%], difference 52.5% [95% confidence interval 38.5–66.6]; q4w, 38/69 [55.1%] vs. placebo, difference 33.4% [95% confidence interval 18.7–48.1]; both p < 0.0001). Conclusions Dupilumab provided clinically meaningful improvements in signs, symptoms, and quality of life in adolescents with moderate-to-severe atopic dermatitis among patients with Investigator’s Global Assessment > 1 at week 16. Treatment responses should be interpreted in the context of such clinically relevant patient-reported outcome measures. Trial Registration ClinicalTrials.gov; NCT03054428. Video abstract Adolescents with atopic dermatitis: does dupilumab improve their signs, symptoms, and quality of life? (MP4 212916 kb)
Electronic supplementary material The online version of this article (10.1007/s40257-019-00478-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 1600, Chicago, IL, 60611, USA.
| | | | - Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - Mark Boguniewicz
- Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine, Denver, CO, USA
| | | | - Elaine C Siegfried
- Department of Pediatrics, Saint Louis University and Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Emma Guttman-Yassky
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai and Laboratory for Investigative Dermatology, Rockefeller University, New York, NY, USA
| | | | - Zhen Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - Yufang Lu
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - Xinyi He
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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Simpson EL, Paller AS, Siegfried EC, Boguniewicz M, Sher L, Gooderham MJ, Beck LA, Guttman-Yassky E, Pariser D, Blauvelt A, Weisman J, Lockshin B, Hultsch T, Zhang Q, Kamal MA, Davis JD, Akinlade B, Staudinger H, Hamilton JD, Graham NMH, Pirozzi G, Gadkari A, Eckert L, Stahl N, Yancopoulos GD, Ruddy M, Bansal A. Efficacy and Safety of Dupilumab in Adolescents With Uncontrolled Moderate to Severe Atopic Dermatitis: A Phase 3 Randomized Clinical Trial. JAMA Dermatol 2020; 156:44-56. [PMID: 31693077 PMCID: PMC6865265 DOI: 10.1001/jamadermatol.2019.3336] [Citation(s) in RCA: 281] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 08/30/2019] [Indexed: 01/01/2023]
Abstract
Importance Adolescents with atopic dermatitis (AD) have high disease burden negatively affecting quality of life, with limited treatment options. The efficacy and safety of dupilumab, a monoclonal antibody, approved for treatment in adolescent patients with inadequately controlled AD, remain unknown in this patient population. Objective To assess the efficacy and safety of dupilumab monotherapy in adolescents with moderate to severe inadequately controlled AD. Design, Setting, and Participants A randomized, double-blind, parallel-group, phase 3 clinical trial was conducted at 45 US and Canadian centers between March 21, 2017, and June 5, 2018. A total of 251 adolescents with moderate to severe AD inadequately controlled by topical medications or for whom topical therapy was inadvisable were included. Interventions Patients were randomized (1:1:1; interactive-response system; stratified by severity and body weight) to 16-week treatment with dupilumab, 200 mg (n = 43; baseline weight <60 kg), or dupilumab, 300 mg (n = 39; baseline weight ≥60 kg), every 2 weeks; dupilumab, 300 mg, every 4 weeks (n = 84); or placebo (n = 85). Main Outcomes and Measures Proportion of patients with 75% or more improvement from baseline in Eczema Area and Severity Index (EASI-75) (scores range from 0 to 72, with higher scores indicating greater severity) and Investigator's Global Assessment (IGA) 0 or 1 on a 5-point scale (scores range from 0 to 4, with higher scores indicating greater severity) at week 16. Results A total of 251 patients were randomized (mean [SD] age, 14.5 [1.7] years; 148 [59.0%] male). Of 250 patients with data available on concurrent allergic conditions, most had comorbid type 2 diseases (asthma, 134 [53.6%]; food allergies, 60.8%; allergic rhinitis, 65.6%). A total of 240 patients (95.6%) completed the study. Dupilumab achieved both coprimary end points at week 16. The proportion of patients with EASI-75 improvement from baseline increased (every 2 weeks, 41.5%; every 4 weeks, 38.1%; placebo, 8.2%) with differences vs placebo of 33.2% (95% CI, 21.1%-45.4%) for every 2 weeks and 29.9% (95% CI, 17.9%-41.8%) for every 4 weeks (P < .001). Efficacy of the every-2-week regimen was generally superior to the every-4-week regimen. Patients in the dupilumab arms had higher percentage values of conjunctivitis (every 2 weeks, 9.8%; every 4 weeks, 10.8%; placebo, 4.7%) and injection-site reactions (every 2 weeks, 8.5%; every 4 weeks, 6.0%; placebo, 3.5%), and lower nonherpetic skin infections (every 2 weeks, 9.8%; every 4 weeks, 9.6%; placebo, 18.8%). Conclusions and Relevance In this study, dupilumab significantly improved AD signs, symptoms, and quality of life in adolescents with moderate to severe AD, with an acceptable safety profile. Placebo-corrected efficacy and safety of dupilumab were similar in adolescents and adults. Trial Registration ClinicalTrials.gov identifier: NCT03054428.
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Affiliation(s)
- Eric L. Simpson
- Department of Dermatology, Oregon Health & Science University, Portland
| | - Amy S. Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elaine C. Siegfried
- Department of Pediatrics, School of Medicine, Saint Louis University, St. Louis, Missouri
| | - Mark Boguniewicz
- Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine, Denver
| | - Lawrence Sher
- Peninsula Research Associates, Rolling Hills Estates, California
| | - Melinda J. Gooderham
- Skin Centre for Dermatology, Peterborough, Ontario, Canada
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Probity Medical Research, Waterloo, Ontario, Canada
| | - Lisa A. Beck
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
- Laboratory for Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
- Laboratory for Investigative Dermatology, Rockefeller University, New York, New York
| | - David Pariser
- Department of Dermatology, Eastern Virginia Medical School, Norfolk
| | | | | | - Benjamin Lockshin
- US Dermatology Partners, Rockville, Maryland
- Georgetown University, Washington, District of Columbia
| | | | - Qin Zhang
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | | | | | | | | | | | | | | | | | | | - Neil Stahl
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
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Coates S. Management of Moderate-to-Severe Atopic Dermatitis in the Era of Targeted Treatments. EUROPEAN MEDICAL JOURNAL 2019. [DOI: 10.33590/emj/10312260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Prof Augustin opened the symposium by underlining how the management of patients with moderate-to-severe atopic dermatitis (AD) has become more dynamic over the past 2 years following the approval of the first biologic agent, dupilumab, in 2017. Prof Augustin explained that moderate-to-severe AD is a chronic Type II inflammatory disease that has significant effects on patients’ and caregivers’ lives. The multidimensional disease burden of AD, which includes signs and symptoms that impact physical, mental, social wellbeing, and quality of life (QoL), is proportional to disease severity and lack of disease control. Sustained control of moderate-to-severe AD is essential to limit the burden caused by the disease. In the second presentation, Dr Simpson emphasised the importance of pointing out to each patient that AD is a chronic disease that requires long-term management. When discussing goals and treatment options with each patient, the importance of sustainable disease management should be emphasised. He presented outcomes from recent clinical trials investigating the long-term efficacy and safety of targeted agents in patients with AD. In the final presentation, Dr de Bruin-Weller discussed the importance of real-world evidence when considering treatment options for patients with AD. Real-world evidence for the effectiveness and tolerability of treatments can be gleaned from a number of sources, including registry-based clinical experience, survey data, centre-based clinical experience, and case studies. Consideration of real-world evidence, alongside outcomes from randomised controlled trials, enables selection of the most appropriate treatment option for each patient.
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Guo Q, Xiong X, Liang F, Tian L, Liu W, Wang Z, Pan X. The interactive effects between air pollution and meteorological factors on the hospital outpatient visits for atopic dermatitis in Beijing, China: a time‐series analysis. J Eur Acad Dermatol Venereol 2019; 33:2362-2370. [DOI: 10.1111/jdv.15820] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 07/10/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Q. Guo
- Department of Occupational and Environmental Health, School of Public Health Peking University Beijing China
- Chinese Research Academy of Environmental Sciences Beijing China
| | - X. Xiong
- Department of Occupational and Environmental Health, School of Public Health Peking University Beijing China
| | - F. Liang
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - L. Tian
- Department of Occupational and Environmental Health, School of Public Health Peking University Beijing China
| | - W. Liu
- Department of Dermatology The General Hospital of Air Force of People’s Liberation Army Beijing China
| | - Z. Wang
- Department of Occupational and Environmental Health, School of Public Health Peking University Beijing China
| | - X. Pan
- Department of Occupational and Environmental Health, School of Public Health Peking University Beijing China
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Hattangdi-Haridas SR, Lanham-New SA, Wong WHS, Ho MHK, Darling AL. Vitamin D Deficiency and Effects of Vitamin D Supplementation on Disease Severity in Patients with Atopic Dermatitis: A Systematic Review and Meta-Analysis in Adults and Children. Nutrients 2019; 11:nu11081854. [PMID: 31405041 PMCID: PMC6722944 DOI: 10.3390/nu11081854] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 12/16/2022] Open
Abstract
Research has investigated 25-hydroxyvitamin D (25(OH)D) levels in the Atopic Dermatitis (AD) population, as well as changes in AD severity after vitamin D (VitD) supplementation. We performed an up-to-date systematic review and meta-analysis of these findings. Electronic searches of MEDLINE, EMBASE and COCHRANE up to February 2018 were performed. Observational studies comparing 25(OH)D between AD patients and controls, as well as trials documenting baseline serum 25(OH)D levels and clinical severity by either SCORAD/EASI scores, were included. Of the 1085 articles retrieved, sixteen were included. A meta-analysis of eleven studies of AD patients vs. healthy controls (HC) found a mean difference of −14 nmol/L (95% CI −25 to −2) for all studies and −16 nmol/L (95% CI −31 to −1) for the paediatric studies alone. A meta-analysis of three VitD supplementation trials found lower SCORAD by −11 points (95% CI −13 to −9, p < 0.00001). This surpasses the Minimal Clinical Important Difference for AD of 9.0 points (by 22%). There were greater improvements in trials lasting three months and the mean weighted dose of all trials was 1500–1600 IU/daily. Overall, the AD population, especially the paediatric subset, may be at high-risk for lower serum 25(OH)D. Supplementation with around 1600 IU/daily results in a clinically meaningful AD severity reduction.
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Affiliation(s)
- Sonal R Hattangdi-Haridas
- Department of Nutritional Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Susan A Lanham-New
- Department of Nutritional Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Wilfred Hing Sang Wong
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Marco Hok Kung Ho
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Andrea L Darling
- Department of Nutritional Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK.
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Igarashi A, Fujita H, Arima K, Inoue T, Dorey J, Fukushima A, Taguchi Y. Health-care resource use and current treatment of adult atopic dermatitis patients in Japan: A retrospective claims database analysis. J Dermatol 2019; 46:652-661. [PMID: 31245879 PMCID: PMC6771943 DOI: 10.1111/1346-8138.14947] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 05/01/2019] [Indexed: 12/23/2022]
Abstract
The real-world evidence on the profiles of patients suffering from atopic dermatitis (AD) in Japan is sparse. A retrospective claim database analysis was conducted to estimate the health-care resource use (HCRU) and current AD treatment. Data from October 2013 to September 2016 were extracted from the JMDC (Tokyo, Japan) claims database. HCRU was assessed by a comparison of AD patients and matched non-AD controls. A multivariate analysis was performed to estimate HCRU attributable to AD. AD patients (n = 39 893) have more claims of certain diagnoses such as rhinitis, viral and fungal infections, sleep disorders and conjunctivitis as well as higher HCRU (outpatient visits, prescriptions of AD-related and non-AD-related medications, phototherapy, laboratory tests) than matched non-AD controls (n = 39 893). Treatment pattern analysis included treatment-naive patients (n = 8478) and previously treated AD patients (n = 30 109). Approximately 20% of previously treated patients were on the continuous systemic treatment during 18-month follow up. Systemic corticosteroids were the most frequently used systemic treatments. Oral cyclosporin was less frequently used in both groups, but for the longest duration. Almost half of previously treated patients with oral cyclosporin continued treatment for more than 3 months. In conclusion, HCRU was higher in AD patients than non-AD controls, indicating a high burden of the disease imposed on AD patients. Continuous administration of systemic treatment, such as oral cyclosporin, systemic corticosteroids and phototherapy, observed in AD patients sheds light on the difficulties of managing AD in Japanese clinical practise.
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A real-world study evaluating adeQUacy of Existing Systemic Treatments for patients with moderate-to-severe Atopic Dermatitis (QUEST-AD): Baseline treatment patterns and unmet needs assessment. Ann Allergy Asthma Immunol 2019; 123:381-388.e2. [PMID: 31325566 DOI: 10.1016/j.anai.2019.07.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/02/2019] [Accepted: 07/11/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Systemic therapies are commonly used for patients with uncontrolled moderate-to-severe atopic dermatitis (AD) and impaired quality of life (QoL). However, real-world treatment patterns and unmet needs of adults with moderate-to-severe AD receiving systemic therapies are poorly quantified. OBJECTIVE To evaluate unmet needs in patients with moderate-to-severe AD treated with systemic therapies. METHODS Adults with AD diagnosis in past 5 years and a prescription for systemic treatment or phototherapy in past 6 months were identified from the Optum Research Database. Patients completed a survey about symptoms, treatment, and QoL. Chi-squared and t tests analyzed bivariable comparisons of demographics and outcomes. Spearman's rank-order correlation analyses examined the relationship between frequency of flares and outcomes. RESULTS Eight hundred and one participants were included (mean age, 45.2 years; 71.8% female). In the 12 months before baseline survey, 38.3% reported no remission from AD. In the month before baseline survey, 63.6% used topical corticosteroids, and 81.3% of patients experienced 1 or more flares. Patients experiencing flares reported worse Patient-Orientated Eczema Measure (POEM), Peak Pruritus Numeric Rating Scale (NRS), and Dermatology Life Quality Index scores (DLQI), lower treatment satisfaction, and greater work productivity loss than patients without flares (all P < .001). Patients with severe atopic dermatitis reported worse POEM, Peak Pruritus NRS, and DLQI, lower treatment satisfaction, and greater work productivity loss than patients with moderate AD (all P < .001). CONCLUSION Despite receiving systemic therapies, adults with moderate-to-severe AD reported disease symptoms, recurrent flares, and impaired QoL, suggesting unmet therapeutic needs.
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Ständer S, Yosipovitch G, Bushmakin A, Cappelleri J, Luger T, Tom W, Ports W, Zielinski M, Tallman A, Tan H, Gerber R. Examining the association between pruritus and quality of life in patients with atopic dermatitis treated with crisaborole. J Eur Acad Dermatol Venereol 2019; 33:1742-1746. [DOI: 10.1111/jdv.15712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/17/2019] [Indexed: 11/27/2022]
Affiliation(s)
- S. Ständer
- Center for Chronic Pruritus University Hospital Münster Münster Germany
| | - G. Yosipovitch
- Miami Itch Center Miller School of Medicine University of Miami Miami FL USA
| | | | | | - T. Luger
- University Hospital Münster Münster Germany
| | - W.L. Tom
- University of California San Diego CA USA
- Rady Children's Hospital–San Diego San Diego CA USA
| | | | | | | | - H. Tan
- Pfizer Inc. Groton CT USA
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Mihara R, Kabashima K, Furue M, Nakano M, Ruzicka T. Nemolizumab in moderate to severe atopic dermatitis: An exploratory analysis of work productivity and activity impairment in a randomized phase II study. J Dermatol 2019; 46:662-671. [PMID: 31166620 PMCID: PMC6771858 DOI: 10.1111/1346-8138.14934] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/06/2019] [Indexed: 11/28/2022]
Abstract
Atopic dermatitis negatively impacts work productivity. This study investigated the impact of nemolizumab on work productivity and activity impairment in adults with moderate to severe atopic dermatitis inadequately controlled by topical treatments in a two‐part, phase II, randomized control trial. The Work Productivity and Activity Impairment – Atopic Dermatitis questionnaire was an exploratory end‐point. Part A was a 12‐week, placebo‐controlled study in which patients received s.c. nemolizumab 0.1, 0.5 or 2.0 mg/kg every 4 weeks or 2.0 mg/kg every 8 weeks. Part B was a 52‐week extension in which all patients received active treatment. A total of 138 patients had Work Productivity and Activity Impairment – Atopic Dermatitis data; 104 were employed at baseline. At week 12, patients receiving nemolizumab every 4 weeks showed greater mean (standard error) Work Productivity and Activity Impairment – Atopic Dermatitis improvement (score reduction) from baseline versus placebo: Percent Work Time Missed (0.1, 0.5 or 2.0 mg/kg vs placebo): –4.0% (3.9%), –1.7% (4.2%) and –1.6% (4.2%) versus 4.9% (4.5%); Percent Impairment While Working, –15.8% (6.0%), –24.1% (6.5%) and –34.3% (6.4%) versus –16.5% (7.1%); Percent Overall Work Impairment, –16.3% (6.0%), –23.1% (6.5%) and –34.5% (6.3%) versus –16.6% (7.1%); and Percent Activity Impairment, –13.4% (5.3%), –23.5% (5.3%) and –41.9% (5.5%) versus –10.9% (5.7%). Improvements were sustained through week 64. Nemolizumab‐treated patients with moderate to severe atopic dermatitis reported improvements in Work Productivity and Activity Impairment through week 64.
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Affiliation(s)
| | | | - Masutaka Furue
- Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
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Feldman SR, Cox LS, Strowd LC, Gerber RA, Faulkner S, Sierka D, Smith TW, Cappelleri JC, Levenberg ME. The Challenge of Managing Atopic Dermatitis in the United States. AMERICAN HEALTH & DRUG BENEFITS 2019; 12:83-93. [PMID: 31057694 PMCID: PMC6485648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/17/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Atopic dermatitis is a chronic inflammatory skin disease that affects up to 13% of children and 10% of adults in the United States. Among patients and their families, atopic dermatitis has a considerable effect on quality of life and represents a substantial economic burden. OBJECTIVE To describe the impact and challenges of atopic dermatitis and to provide nondermatologists in the healthcare community an enhanced understanding of atopic dermatitis to facilitate treatment and pharmacy benefit discussions. DISCUSSION Atopic dermatitis is a heterogeneous disease, and its diagnosis is hampered by a lack of objective diagnostic criteria. The current management guidelines address the distinct clinical phenotypes as a single disease and do not incorporate recent clinical advances, such as the targeting of specific inflammatory processes. The treatment guidelines for atopic dermatitis are complex and challenge healthcare providers, patients, and caregivers. Novel treatments can provide additional therapeutic options for patients with atopic dermatitis. CONCLUSIONS Treatment options for atopic dermatitis are expanding with the development of novel anti-inflammatory therapies. An increased understanding of these advancements is necessary to optimize care for patients with atopic dermatitis.
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Affiliation(s)
- Steven R Feldman
- Professor of Dermatology, Pathology, and Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Linda S Cox
- Practicing Physician, Adult and Pediatric Allergy and Immunology Practice, and is Assistant Clinical Professor of Medicine, University of Miami School of Medicine and Nova Southeastern University School of Osteopathic Medicine, Ft Lauderdale, FL
| | - Lindsay C Strowd
- Assistant Professor of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - Steven Faulkner
- Medical Outcomes Specialists Team Manager, Pfizer, New York, NY
| | - Debra Sierka
- Director of Medical Affairs, Pfizer, Collegeville, PA, during manuscript development
| | - Timothy W Smith
- Director, Real World Data and Analytics, Pfizer, New York, NY
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Song HJ, Park H, Park SY, Lee EK, Ha SY, Park SY, Bae EJ, Ku H. Estimation of Health Utilities Based on the Response to Treatment in Atopic Dermatitis: a Population-based Study. Clin Ther 2019; 41:700-713. [PMID: 30827751 DOI: 10.1016/j.clinthera.2019.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/19/2019] [Accepted: 02/10/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE This study estimated utility weights based on the response to treatment for atopic dermatitis in the general population. METHODS The Korean general population aged 20-60 years was stratified by using a random sampling method based on age and sex. Two hypothetical health states of atopic dermatitis were developed: response to treatment and no response to treatment. Health utility values were estimated by using time trade-off (TTO) based on a period of 10 years, TTO based on life expectancy, and EuroQol 5-Dimension (EQ-5D) including a visual analog scale (VAS). The mean utility value and 95% CI were derived, and comparisons of subgroups using the t test and ANOVA were performed. We conducted a multilevel analysis after controlling the sociodemographic variables to consider repeated measures. FINDINGS A total of 155 participants were included in the survey. Their mean age was 39.7 years; 58.7% of participants were women. The mean health utility values for response and no response using TTO based on 10 years were 0.847 and 0.380, respectively. The estimated health utility values of response and no response were 0.865 and 0.476 using TTO based on life expectancy, and 0.814 and 0.279 using EQ-5D. For VAS, the response and no response were 0.744 and 0.322. After controlling the covariates, the important factors that affected utility values were response and no response to treatment (P < 0.001). IMPLICATIONS This study showed that the utility weights of people with no response to atopic dermatitis treatment were lower compared with response from the general population. Health care providers should therefore consider symptom control as an important factor affecting the quality of life of those with atopic dermatitis.
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Affiliation(s)
- Hyun Jin Song
- College of Pharmacy, University of Florida, Gainesville, FL, USA
| | | | | | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - So-Young Ha
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
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Chung J, Simpson EL. The socioeconomics of atopic dermatitis. Ann Allergy Asthma Immunol 2018; 122:360-366. [PMID: 30597208 DOI: 10.1016/j.anai.2018.12.017] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/03/2018] [Accepted: 12/19/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To review the current state of the literature regarding the socioeconomics of atopic dermatitis (AD)-more specifically how socioeconomic status (SES) affects AD risk and how the presence of AD may affect one's SES-as well as discuss the cost of the disease to society. DATA SOURCES A PubMed search was performed to include English-language articles with the keywords atopic dermatitis, cost, finances, economic, income, career, socioeconomic, with preference to those written in the last 5 years. STUDY SELECTIONS Studies were included if they provided information pertaining to socioeconomics in relation to disease severity, disease incidence, direct costs, indirect costs, and effects on work, education, and career choice. RESULTS Many studies have reported that higher SES is associated with increased AD prevalence, whereas lower SES is associated with increased AD severity. Regardless of patient SES, AD creates substantial direct costs that affect the patient, patient's family, and the payer. Additionally, the effects of the disease create indirect costs from absenteeism and presenteeism, as well as opportunity costs from hinderances in learning, affecting patient SES and the economy. CONCLUSION Given the substantial and growing burden on the patient and the economy when access to appropriate treatment is limited, the socioeconomic burden of AD represents a tangible public health concern that must be addressed.
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Affiliation(s)
- Janice Chung
- Creighton University, School of Medicine, Omaha, Nebraska
| | - Eric L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon.
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