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Smith Begolka W, Johnson JK, Thibau IJ. Patient Burden of Atopic Dermatitis and Opportunities for Real-World Self-Monitoring. Dermatol Clin 2024; 42:537-548. [PMID: 39278707 DOI: 10.1016/j.det.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2024]
Abstract
Atopic dermatitis (AD) is a complex, chronic disease with multiple negative impacts to patients' health, lives, and overall well-being. The lived experience of AD is multidimensional, heterogeneous, and ever-changing, yet an essential contributor to a holistic understanding of disease burden. Real-world self-monitoring of disease burden by patients has potential as a valuable adjunct to clinical and patient-reported assessments in health care settings. Newer digital tools are available to support these activities, providing opportunity for patients and health care providers to identify aspects of self-monitoring that can best support AD care and management goals, treatment outcomes, and minimize patient burden.
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Affiliation(s)
- Wendy Smith Begolka
- National Eczema Association, 505 San Marin Drive, #B300, Novato, CA 94945, USA.
| | - Jessica K Johnson
- National Eczema Association, 505 San Marin Drive, #B300, Novato, CA 94945, USA
| | - Isabelle J Thibau
- National Eczema Association, 505 San Marin Drive, #B300, Novato, CA 94945, USA
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2
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Narla S, Silverberg JI. Atopic Dermatitis: A Disorder of both Adults and Children with Varying Longitudinal Course. Dermatol Clin 2024; 42:513-518. [PMID: 39278704 DOI: 10.1016/j.det.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2024]
Abstract
The longitudinal course of atopic dermatitis (AD) is heterogeneous and complex. While previously thought to be a childhood disorder, recent studies demonstrated that childhood-onset AD may take several different courses that may involve persistence into adulthood becoming a lifelong condition. Other patients only demonstrated adult-onset AD. Different factors may play a role in the timing of AD onset. Assessing the longitudinal course also involves understanding the changing temporal pattern of AD. Understanding the dynamic course of AD is important in identifying individualized treatment recommendations for patients.
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Affiliation(s)
- Shanthi Narla
- Department of Dermatology, Medical College of Wisconsin, Office A3698, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Suite 2B-430, 2150 Pennsylvania Avenue, Washington, DC 20037, USA.
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3
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De Greef A, Degraeuwe A, Nielens N, Darrigade A, Bugli C, de Montjoye L, Baeck M. Atopic Dermatitis Activity Score 7 (ADAS7): A tool for disease activity assessment. Clin Transl Allergy 2024; 14:e12393. [PMID: 39266939 PMCID: PMC11392654 DOI: 10.1002/clt2.12393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 07/24/2024] [Accepted: 08/28/2024] [Indexed: 09/14/2024] Open
Affiliation(s)
- Axel De Greef
- Department of DermatologyCliniques universitaires Saint‐LucUniversité catholique de Louvain (UCLouvain)BrusselsBelgium
- Institute of Experimental and Clinical Research (IREC)Pneumology, ENT and Dermatology Pole (LUNS)Université catholique de Louvain (UCLouvain)BrusselsBelgium
| | - Alexia Degraeuwe
- Department of DermatologyCliniques universitaires Saint‐LucUniversité catholique de Louvain (UCLouvain)BrusselsBelgium
| | - Nina Nielens
- Department of DermatologyCliniques universitaires Saint‐LucUniversité catholique de Louvain (UCLouvain)BrusselsBelgium
| | - Anne‐Sophie Darrigade
- Department of DermatologyCliniques universitaires Saint‐LucUniversité catholique de Louvain (UCLouvain)BrusselsBelgium
| | - Céline Bugli
- Plateforme Technologique de Support en Méthodologie et Support Statistique (SMCS)Université catholique de Louvain (UCLouvain)Louvain‐la‐NeuveBelgium
| | - Laurence de Montjoye
- Department of DermatologyCliniques universitaires Saint‐LucUniversité catholique de Louvain (UCLouvain)BrusselsBelgium
- Institute of Experimental and Clinical Research (IREC)Pneumology, ENT and Dermatology Pole (LUNS)Université catholique de Louvain (UCLouvain)BrusselsBelgium
| | - Marie Baeck
- Department of DermatologyCliniques universitaires Saint‐LucUniversité catholique de Louvain (UCLouvain)BrusselsBelgium
- Institute of Experimental and Clinical Research (IREC)Pneumology, ENT and Dermatology Pole (LUNS)Université catholique de Louvain (UCLouvain)BrusselsBelgium
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4
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Pereyra-Rodriguez JJ, Baldrich ES, Ruiz-Villaverde R, Torres EB, De la C Dobao P, Nart IF, Menéndez ÁF, Martin-Santiago A, Miquel JM, Silvestre JF, Armario-Hita JC. Clinical Approach to Patients with Moderate-to-Severe Atopic Dermatitis: A Spanish Delphi Consensus. Acta Derm Venereol 2023; 103:adv12314. [PMID: 37982727 PMCID: PMC10680463 DOI: 10.2340/actadv.v103.12314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/12/2023] [Indexed: 11/21/2023] Open
Abstract
Despite emerging evidence and advances in the management of atopic dermatitis there a lack of consensus regarding the diagnostic criteria, therapeutic approach, method to assess severity, and patient follow-up for this condition. An expert consensus study was conducted to provide recommendations on the management of patients with moderate-to-severe atopic dermatitis. The study used Delphi-like methodology based on a literature review, a summary of the scientific evidence, and a 2-round survey. The agreement of 60 panellists on 21 statements was evaluated. Consensus was pre-defined as ≥ 80% agreement of all respondents. In the first round 6 statements reached consensus. Unanimous consensus was achieved regarding therapeutic goals and patient satisfaction (maintained in the long term and periodic goals reassessment recommended every 3-6 months). In the second round, half of the statements reached consensus, all related to patient follow-up, treatment goals, and atopic comorbidities. The statements that did not reach consensus were related to diagnosis (biomarkers, allergy, and food testing) and starting patients on conventional systemic treatment rather than advanced treatment. The study assessed expert opinion regarding a variety of topics related to the clinical approach to patients with moderate-to-severe atopic dermatitis, in order to provide guidance on the diagnosis and management of patients with atopic dermatitis.
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Affiliation(s)
| | - Esther S Baldrich
- Department of Dermatology, Santa Creu i Sant Pau Hospital, Barcelona, Spain.
| | | | - Eulalia B Torres
- Department of Dermatology, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Pablo De la C Dobao
- Department of Dermatology, Infanta Leonor University Hospital, Madrid, Spain
| | - Ignasi F Nart
- Department of Dermatology, Bellvitge University Hospital, Barcelona, Spain
| | - Ángeles F Menéndez
- Department of Dermatology, Pontevedra University Hospital, Pontevedra, Spain
| | - Ana Martin-Santiago
- Department of Dermatology, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Javier M Miquel
- Department of Dermatology, Arnau de Vilanova Hospital, Valencia, Spain
| | - Juan F Silvestre
- Department of Dermatology, Alicante University General Hospital, Alicante, Spain
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5
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De Greef A, de Montjoye L, Bieber T, Baeck M. Atopic dermatitis: a need to define the disease activity. Front Med (Lausanne) 2023; 10:1293185. [PMID: 38020127 PMCID: PMC10654964 DOI: 10.3389/fmed.2023.1293185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Axel De Greef
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Laurence de Montjoye
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Thomas Bieber
- Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Marie Baeck
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
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6
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Rossi M, Damiani C, Arisi M, Tomasi C, Tonon F, Venturini M, Calzavara-Pinton P. Definition of the Clinical Characteristics of Patients with Moderate and Severe Atopic Dermatitis for Whom Narrow-Band UVB (NB-UVB) and Medium-Dose UVA1 Phototherapies Are Still Valuable Treatment Options at the Age of Biologics. J Clin Med 2023; 12:jcm12093303. [PMID: 37176743 PMCID: PMC10179382 DOI: 10.3390/jcm12093303] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
Narrow-band (NB) UVB and UVA1 have been successfully used for the treatment of atopic dermatitis (AD) since the 1980s, but the clinical indications for their use "at the age of biologics" remain to be assessed. From 2013 to 2017, 145 patients underwent a first treatment cycle with phototherapy. They achieved a median final EASI score of 9.90 with UVA1 and 13.70 with NB-UVB. The rates of patients achieving an IGA score of 0/1 persistent for at least 6 months were 33% with UVA1 and 28% with NB-UVB, and the rates with an EASI90 improvement were 10.9% with UVA1 and 11.0% with NB-UVB. The cut-off baseline EASI values for a good probability to achieve a 0/1 IGA were 24.4 with UVA1 and 24.7 with NB-UVB. A 0/1 IGA persistent for at least 6 months was more likely to be achieved by patients with a history of flares interspersed with periods of mild or no disease. From 2018, we only enrolled patients with the above-mentioned characteristics. The number of treated patients was lower, but the final EASI score, the rate of patients achieving IGA 0/1 persistent for at least 6 months, and EASI90 were significantly higher. Medium-dose UVA1 and NB-UVB phototherapies remain useful for the treatment of AD patients with a baseline EASI score lower than 24.4 and 24.7, respectively, and a medical history of flares followed by prolonged periods of complete or near-complete remission.
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Affiliation(s)
- Mariateresa Rossi
- Dermatology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy
| | - Caterina Damiani
- Dermatology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy
| | - Mariachiara Arisi
- Dermatology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy
| | - Cesare Tomasi
- Department of Experimental and Applied Medicine, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy
| | - Francesco Tonon
- Dermatology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy
| | - Marina Venturini
- Dermatology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy
| | - Piergiacomo Calzavara-Pinton
- Dermatology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy
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7
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Chovatiya R, Silverberg JI. Evaluating the Longitudinal Course of Atopic Dermatitis: Implications for Clinical Practice. Am J Clin Dermatol 2022; 23:459-468. [PMID: 35639253 PMCID: PMC10166131 DOI: 10.1007/s40257-022-00697-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 11/01/2022]
Abstract
Atopic dermatitis (AD) is characterized by a heterogenous longitudinal course with varying severity, flares, and persistence. However, AD course is not routinely assessed in clinical practice or controlled trials. Our objective was to review the longitudinal course of AD in children and adults and discuss implications for routine practice and clinical trials. We conducted a focused review of the published literature, including retrospective, prospective, and interventional studies, clinical trials, and consensus guidelines. Estimates of AD persistence varied widely across studies but suggested that AD can indeed persist through childhood and into adulthood. Predictors of persistence are broad and include both disease-intrinsic and disease-extrinsic (i.e., environmental) factors. In real-world practice, most individuals with AD experience fluctuations in the signs and symptoms over time and do not experience persistent clearance of skin lesions. Clinical trials use mainly static measurements that do not take into account fluctuations in course, which may confound treatment effects. The heterogenous temporal pattern of AD can be incorporated into routine practice to better set expectations and offer a realistic prognosis. AD course should be routinely incorporated into clinical decision making. Future studies are needed to develop a standardized approach to AD assessment and treatment that includes longitudinal course.
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8
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Chovatiya R, Silverberg JI. Evaluating the Longitudinal Course of Atopic Dermatitis: a review of the literature. J Am Acad Dermatol 2022; 87:688-689. [PMID: 35150759 PMCID: PMC10115241 DOI: 10.1016/j.jaad.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/31/2022] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Raj Chovatiya
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC USA.
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9
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Murota H, Koike Y, Morisaki H, Matsumoto M, Takenaka M. Exacerbating factors and disease burden in patients with atopic dermatitis. Allergol Int 2022; 71:25-30. [PMID: 34764038 DOI: 10.1016/j.alit.2021.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Indexed: 11/01/2022] Open
Abstract
The number of patients with atopic dermatitis is on the rise worldwide, and Japan is no exception. According to recent estimates of the percentage of patients with atopic dermatitis in Japan by age, the majority of patients are between 20 and 44 years old. Because the peak age of onset of atopic dermatitis is during infancy, many patients may experience prolonged symptoms from infancy to adulthood. A prolonged clinical course also increases the burden of atopic dermatitis on affected patients. Decreased productivity due to work disruptions, reduced daily activity, higher direct medical costs, fatigue, and daytime sleepiness due to sleep disturbances are typical burdens on patients with atopic dermatitis. In order to reduce these burdens, it is necessary to shorten its clinical course and achieve long-term control without relying on medications, possibly by using avoidance or coping measures of aggravating factors. Typical aggravating factors of atopic dermatitis include irritant dermatitis, food allergy in children, sweating, and psychological stress in adults. Food allergy places a heavy burden on the quality of life of affected patients and their families. The effectiveness of educational interventions for sweating and psychological stress is unclear. We must also evaluate the economic burden and cost-effectiveness of interventions on the patient as aggravating factors to be addressed.
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DESCRIBE-AD: A novel classification framework for atopic dermatitis. J Am Acad Dermatol 2021; 87:541-550. [PMID: 34774658 PMCID: PMC10119387 DOI: 10.1016/j.jaad.2021.10.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/27/2021] [Accepted: 10/29/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic, inflammatory skin disease associated with heterogeneous morphology, distribution, symptoms, severity, extent, longitudinal courses, quality of life burden, comorbidities, and treatment responses. This heterogeneity contributes to challenges in diagnosis, the characterization of disease activity, and therapeutic stratification. OBJECTIVE To develop a framework to standardize AD assessment. METHODS We propose a novel framework to assess AD based on a literature review and clinical experience. RESULTS DESCRIBE-AD is a framework that can effectively capture the clinical domains contributing to AD heterogeneity and includes both patient- and clinician-reported perspectives. DESCRIBE-AD includes assessments of Dermatitis morphology and phenotype, Evolution of disease, Symptom severity, Comorbid health disorders, Response to therapy, Intensity of lesions, Burden of disease, and Extent of lesions. Rather than placing the focus on any single, specific aspect of AD, DESCRIBE-AD allows for a comprehensive approach to the assessment and clinical management of AD. CONCLUSIONS DESCRIBE-AD is a novel framework that can be used to better describe the heterogeneity of AD and guide treatment decisions.
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Chovatiya R, Begolka WS, Thibau IJ, Silverberg JI. Financial burden and impact of atopic dermatitis out-of-pocket healthcare expenses among black individuals in the United States. Arch Dermatol Res 2021; 314:739-747. [PMID: 34580770 PMCID: PMC9399197 DOI: 10.1007/s00403-021-02282-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 05/13/2021] [Accepted: 09/16/2021] [Indexed: 10/27/2022]
Abstract
Black race is associated with increased atopic dermatitis (AD) severity and healthcare resource utilization. However, the burden of out-of-pocket (OOP) expenses among black individuals with AD is not well understood. We sought to characterize the categories and impact of OOP healthcare expenses associated with AD management among black individuals. A 25-question voluntary online survey was administered to National Eczema Association members (N = 113,502). Inclusion criteria (US residents age ≥ 18 years; self-report of AD or primary caregivers of individuals with AD) was met by 77.3% (1118/1447) of respondents. Black individuals with AD were younger, had lower household income, Medicaid, urban residence, poor AD control and frequent skin infections (P ≤ 0.02). Blacks vs. non-blacks reported more OOP costs for prescription medications covered (74.2% vs. 63.6%, P = 0.04) and not covered (65.1% vs. 46.5%, P = 0.0004) by insurance, emergency room visits (22.1% vs. 11.8%, P = 0.005), and outpatient laboratory testing (33.3% vs. 21.8%, P = 0.01). Black race was associated with increased household financial impact from OOP expenses (P = 0.0009), and predictors of financial impact included minimally controlled AD (adjusted OR [95% CI] 13.88 [1.63-117.96], P = 0.02), systemic therapy (4.34 [1.63-11.54], 0.003), > $200 monthly OOP expenses (14.28 [3.42-59.60], P = 0.0003), and Medicaid (4.02 [1.15-14.07], P = 0.03). Blacks with Medicaid had higher odds of harmful financial impact (3.32 [1.77-6.24], P = 0.0002) than those of black race (1.81 [1.04-3.15], P = 0.04) or with Medicaid (1.39 [1.02-1.88], P = 0.04) alone. Black race is associated with increased OOP costs for AD and significant household financial impact. Targeted interventions are needed to address financial disparities in AD.
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Affiliation(s)
- Raj Chovatiya
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Wendy Smith Begolka
- National Eczema Association, 505 San Marin Dr #B300, Novato, CA, 94945, USA.
| | - Isabelle J Thibau
- National Eczema Association, 505 San Marin Dr #B300, Novato, CA, 94945, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC, 20037, USA
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12
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Hong MR, Lei D, Yousaf M, Chavda R, Gabriel S, Silverberg JI. A real-world study of the longitudinal course of skin pain in adult atopic dermatitis. J Am Acad Dermatol 2021; 86:1123-1127. [PMID: 33872718 DOI: 10.1016/j.jaad.2021.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/17/2021] [Accepted: 04/02/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Mindy R Hong
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Donald Lei
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Muhammad Yousaf
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rajeev Chavda
- Galderma SA
- Rx Strategy & Innovation Group, La Tour-de-Peliz, Switzerland
| | - Sylvie Gabriel
- Galderma SA
- Rx Strategy & Innovation Group, La Tour-de-Peliz, Switzerland
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington.
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13
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Chovatiya R, Lei D, Ahmed A, Chavda R, Gabriel S, Silverberg JI. Clinical phenotyping of atopic dermatitis using combined itch and lesional severity: A prospective observational study. Ann Allergy Asthma Immunol 2021; 127:83-90.e2. [PMID: 33819616 DOI: 10.1016/j.anai.2021.03.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/08/2021] [Accepted: 03/18/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Patients with atopic dermatitis (AD) have heterogeneous clinical phenotypes, including different combinations of itch and lesional severity. Little is known about the characteristics and course of these subtypes. OBJECTIVE To determine the characteristics, associations, burden, and course of patients with AD using combined itch and lesional severity. METHODS A prospective practice-based study was performed using questionnaires and physical examination (n=592). AD subsets were defined using verbal rating scale for average itch combined with either eczema area and severity index, objective-scoring atopic dermatitis (SCORAD), or validated investigator's global assessment as follows: mild-moderate itch and lesions (MI-ML), mild-moderate itch and severe lesions (MI-SL), severe itch and mild-moderate lesions (SI-ML), and severe itch and lesions (SI-SL). RESULTS At baseline, there were only weak-moderate correlations of numerical rating scales for worst itch or average itch or SCORAD itch with eczema area and severity index, objective-SCORAD, body surface area, and validated investigator's global assessment (Spearman's rho = 0.32-0.62). Most patients had MI-ML (59.4%-62.3%), followed by SI-ML (21.3%-29.1%), SI-SL (6.0%-12.9%), and MI-SL (3.8%-6.4%). Patients with SI-SL, followed by SI-ML and MI-SL, described their AD as being more severe overall and had worse impairment in sleep, mental health, and quality of life. However, those with MI-SL or SI-SL were far more likely to be classified as severe by a physician (multivariable logistic and linear regression, P < .005 for all). Baseline MI-SL, SI-ML, and SI-SL were associated with similar longitudinal courses over time and more AD flares and itch triggers than MI-ML. CONCLUSION Combined itch and lesional severity seem to describe unique AD phenotypes. Further studies are needed to confirm these findings and understand the optimal treatments for these groups.
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Affiliation(s)
- Raj Chovatiya
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
| | - Donald Lei
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
| | - Adnan Ahmed
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
| | - Rajeev Chavda
- Galderma SA, Rx Strategy & Innovation Group, La Tour-de-Peliz, Switzerland
| | - Sylvie Gabriel
- Galderma SA, Rx Strategy & Innovation Group, La Tour-de-Peliz, Switzerland
| | - Jonathan I Silverberg
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, Illinois; Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC.
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14
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Atopic Dermatitis Is Associated With Lower Patient Satisfaction in US Adults. Dermatitis 2021; 33:323-331. [PMID: 33675329 DOI: 10.1097/der.0000000000000733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is complex with unmet needs and management challenges in clinical practice. Little is known about patient satisfaction among adults with AD. OBJECTIVE The aim of the study was to determine patterns and predictors of patient satisfaction among adults with AD. METHODS Data were analyzed from the 2000-2015 Medical Expenditure Panel Survey. Patient satisfaction was assessed by the Consumer Assessment of Healthcare Providers and Systems survey. RESULTS Atopic dermatitis (linear regression; adjusted β [95% confidence interval {95% CI}] = -0.75 [-1.25 to -0.25]) was associated with lower patient satisfaction compared with no AD. Adults with 1 or more office-based visits had increased odds of high satisfaction (>75th percentile; logistic regression; adjusted odds ratio [95% CI] = 1.81 [1.30-2.52]). Adults who saw an outpatient dermatologist or allergist had lower satisfaction (adjusted β [95% CI] = -0.65 [-1.27 to -0.03]). Patient satisfaction among adults with AD was associated with older age (adjusted β [95% CI] = 40-59 years, 1.85 [0.90-2.80]; ≥60 years, 6.13 [5.18-7.09]) and inversely associated with lower income (-1.82 [-2.68 to -0.96]) or middle income (-0.85 [-1.59 to -0.12]), race/ethnicity (Hispanic, -1.40 [-2.42 to -0.38]; other/multiracial, -2.34 [-3.53 to -1.15]), public (-4.50 [-6.43 to -2.58]) or no insurance (-4.53 [-6.47 to -2.59]), and multimorbidity (-0.48 [-0.61 to -0.35]). CONCLUSIONS Adults with AD in the United States had decreased patient satisfaction, particularly those with lower income, fewer outpatient visits, and multimorbidity. There are substantial unmet needs in patient satisfaction for AD.
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Murota H, Koike Y, Ishii K, Calimlim BM, Ludwikowska M, Toumi M, Kawaguchi I. Evaluating the burden of pruritus due to atopic dermatitis in Japan by patient-reported outcomes. J Med Econ 2021; 24:1280-1289. [PMID: 34816787 DOI: 10.1080/13696998.2021.2002559] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIMS Although pruritus is a hallmark feature of atopic dermatitis, no study has investigated the associated impact of pruritus, due to atopic dermatitis in Japan. The study aimed to evaluate the real-life burden of atopic dermatitis by pruritus severity in adult Japanese patients. The primary objective was to assess the correlation between pruritus severity and work productivity and activity impairment. A secondary objective was to characterize the impact of pruritus on quality of life and to evaluate the burden of symptoms severity and frequency. MATERIALS AND METHODS A cross-sectional internet-based survey was conducted. Eligible patients were currently employed and working adults with atopic dermatitis for at least 6 months. Stratification on pruritus severity assessed by the Worst Pruritus Numerical Rating Scale at the screening was performed to ensure that different severity groups are represented. Correlations were assessed using Spearman's rank-order correlation coefficient. Multivariate regression analyses were performed to assess the impact of pruritus severity on work productivity and quality of life. RESULTS The study analyzed 370 patients. Pruritus severity significantly correlated with work impairment (Rho = 0.622, P value (H0: Rho > 0.5) <.001). A greater pruritus severity was associated with greater work productivity and activity impairment and a greater impact on quality of life, sleep, emotional state, and everyday activities. Patients with a greater pruritus severity carried a higher economic burden of treatment and were more often not satisfied with the received therapy. LIMITATIONS All data were self-reported by patients via an online survey, which is associated with the risk of misclassification for diagnosis, recall bias, and limited participation of patients. CONCLUSIONS The study provides evidence that pruritus is associated with the overall disease burden and impacts many important life aspects of patients with atopic dermatitis in Japan.
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Affiliation(s)
- Hiroyuki Murota
- Department of Dermatology, Nagasaki University, Nagasaki, Japan
| | - Yuta Koike
- Department of Dermatology, Nagasaki University, Nagasaki, Japan
| | | | - Brian M Calimlim
- Health Economics and Outcomes Research, AbbVie Inc, Chicago, IL, USA
| | - Maja Ludwikowska
- Health Economics and Outcomes Research, Creativ-Ceutical, Krakow, Poland
| | - Mondher Toumi
- Health Economics and Outcomes Research, Creativ-Ceutical, Paris, France
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