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Silverberg JI, Gooderham M, Katoh N, Aoki V, Pink AE, Binamer Y, Rademaker M, Fomina D, Gutermuth J, Ahn J, Valenzuela F, Ameen M, Steinhoff M, Kirchhof MG, Lio P, Wollenberg A. Combining treat-to-target principles and shared decision-making: International expert consensus-based recommendations with a novel concept for minimal disease activity criteria in atopic dermatitis. J Eur Acad Dermatol Venereol 2024. [PMID: 38989857 DOI: 10.1111/jdv.20229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/30/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Current treat-to-target recommendations for atopic dermatitis (AD) may not include high enough treatment targets and do not fully consider patient needs. OBJECTIVE To develop recommendations for optimized AD management, including disease severity assessments, treatment goals and targets, and guidance for treatment escalation/modification. METHODS An international group of expert dermatologists drafted a series of recommendations for AD management using insights from a global patient study and 87 expert dermatologists from 44 countries. Experts voted on recommendations using a modified eDelphi voting process. RESULTS The Aiming High in Eczema/Atopic Dermatitis (AHEAD) recommendations establish a novel approach to AD management, incorporating shared decision-making and a concept for minimal disease activity (MDA). Consensus (≥70% agreement) was reached for all recommendations in 1 round of voting; strong consensus (≥90% agreement) was reached for 30/34 recommendations. In the AHEAD approach, patients select their most troublesome AD feature(s); the clinician chooses a corresponding patient-reported severity measure and objective severity measure. Treatment targets are chosen from a list of 'moderate' and 'optimal' targets, with achievement of 'optimal' targets defined as MDA. CONCLUSIONS Patient and expert insights led to the development of AHEAD recommendations, which establish a novel approach to AD management. Patients were not involved in the eDelphi voting process used to generate consensus on each recommendation. However, patient perspectives were captured in a global, qualitative patient research study that was considered by the experts in their initial drafting of the recommendations.
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Affiliation(s)
- Jonathan I Silverberg
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Melinda Gooderham
- Queen's University, Kingston, Ontario, Canada
- SKiN Centre for Dermatology, Peterborough, Ontario, Canada
| | - Norito Katoh
- Department of Dermatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Valeria Aoki
- University of São Paulo School of Medicine, São Paulo, Brazil
| | - Andrew E Pink
- St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Yousef Binamer
- Alfaisal University, Riyadh, Saudi Arabia
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Marius Rademaker
- Waikato Clinical Campus, Auckland Medical School, Waikato, New Zealand
| | - Daria Fomina
- Moscow City Center of Allergy and Immunology, Clinical City Hospital 52, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Astana Medical University, Astana, Kazakhstan
| | - Jan Gutermuth
- Department of Dermatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
- Vrije Universiteit Brussel (VUB), SKIN Research Group, Brussels, Belgium
| | | | | | | | - Martin Steinhoff
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
- College of Health and Life Sciences, Hamad-Bin Khalifa University-Qatar, Doha, Qatar
- Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Mark G Kirchhof
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Peter Lio
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andreas Wollenberg
- Department of Dermatology and Allergy, Ludwig-Maximilian University of Munich, Munich, Germany
- Department of Dermatology, Augsburg University Hospital, Augsburg, Germany
- Comprehensive Center for Inflammatory Medicine CCIM, University Hospital Schleswig-Holstein UKSH, Luebeck, Germany
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2
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Wan V, Habibi A, Abdi P, Mukovozov I, Asiniwasis RN, Maibach HI. Systematic scoping review on the barriers to access of biologics in moderate-to-severe adult atopic dermatitis. Australas J Dermatol 2024; 65:387-389. [PMID: 38439194 DOI: 10.1111/ajd.14243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/10/2023] [Accepted: 02/01/2024] [Indexed: 03/06/2024]
Affiliation(s)
- Vincent Wan
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alireza Habibi
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Parsa Abdi
- Faculty of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland, Canada
| | | | - Rachel N Asiniwasis
- Division of Dermatology, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
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3
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Pierce EJ, Burge RT, Hirst AJ, Fox AM, Suokas AK, Yi Y. Economic Burden of Itch-Related Sleep Loss in Moderate-to-Severe Atopic Dermatitis in the United Kingdom. Dermatol Ther (Heidelb) 2024; 14:1103-1114. [PMID: 38652379 PMCID: PMC11116356 DOI: 10.1007/s13555-024-01153-9] [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: 07/13/2023] [Accepted: 03/27/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION Atopic dermatitis is associated with intense itch, which has been shown to cause sleep disruption that significantly impacts the lives of patients with atopic dermatitis. Despite this, little is known about its burden to the healthcare system and society. This study aimed to quantify the economic burden of itch-related sleep loss in moderate-to-severe atopic dermatitis in the UK. METHODS A literature-based decision-analytic model was developed from a healthcare payer and societal perspective. The model quantifies the economic burden by linking the severity of itch to the number of days of sleep disruption. The model captures the direct costs of healthcare resource utilization and treatment alongside the indirect costs of productivity loss from absenteeism and presenteeism at work over a 5-year time horizon. The patient population considered was patients aged ≥ 15 years with moderate-to-severe atopic dermatitis and itch-related sleep disruption. RESULTS The model estimated that itch-related sleep disruption as a result of moderate-to-severe atopic dermatitis would affect an average of 821,142 people over the time horizon (2022 to 2026). This translates into an average net economic burden of £3.8 billion (£4687 per patient), with an average of 172 million days being affected by sleep disruption per year in the UK. The greatest contributor to the annual average net economic burden was productivity loss from absenteeism and presenteeism, each accounting for 34%. The direct costs (treatment costs and healthcare resource use) accounted for 32% of the net economic burden. The results showed a high and gradually increasing economic burden over the 5-year time horizon. CONCLUSIONS Sleep disruption has a high economic burden and reducing itch may provide substantial direct and indirect savings. Quantifying the economic burden of itch-related sleep loss may provide support for analyses to inform public health policies for treatment of atopic dermatitis, particularly within the moderate-to-severe level.
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Affiliation(s)
- Evangeline J Pierce
- Lilly Corporate Center, Eli Lilly and Company, 893 Delaware St, Indianapolis, IN, 46285, USA.
| | - Russel T Burge
- Lilly Corporate Center, Eli Lilly and Company, 893 Delaware St, Indianapolis, IN, 46285, USA
| | | | | | | | - Yunni Yi
- Adelphi Values PROVE, Cheshire, England, UK
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4
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Vittrup I, Frøstrup AG, Gren ST, Thomsen SF, Wu JJ, Schmid-Grendelmeier P, Maul JT, Egeberg A, Thyssen JP. Disease burden of moderate-severe atopic dermatitis by use of systemic treatment: Results from the Danish Skin Cohort. J Eur Acad Dermatol Venereol 2023; 37:e688-e690. [PMID: 36688332 DOI: 10.1111/jdv.18912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/16/2023] [Indexed: 01/24/2023]
Affiliation(s)
- I Vittrup
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | | | - S T Gren
- Pfizer Denmark, Ballerup, Denmark
| | - S F Thomsen
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - J J Wu
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - P Schmid-Grendelmeier
- Department of Dermatology and Venereology, University Hospital of Zurich, Zurich, Switzerland
| | - J-T Maul
- Department of Dermatology and Venereology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - A Egeberg
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - J P Thyssen
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Igarashi A, Yuasa A, Yonemoto N, Kamei K, LoPresti M, Murofushi T, Ikeda S. A Systematic Literature Review of Economic Evaluations and Cost Studies of the Treatment of Psoriasis, Atopic Dermatitis, and Chronic Urticaria. Dermatol Ther (Heidelb) 2022; 12:1729-1751. [PMID: 35909186 PMCID: PMC9357586 DOI: 10.1007/s13555-022-00774-2] [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: 05/06/2022] [Accepted: 07/07/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Psoriasis (PSO), atopic dermatitis (AD), and chronic urticaria (CU) are common manifestations of immunological skin and subcutaneous conditions and have been shown to have a substantial impact on the quality of life of patients. The cost of treating those conditions can also be high, as the use of biologic treatments has become more common for moderate to severe patients. In this review, we examine characteristics of economic evaluations and cost studies conducted for the three conditions. Methods A literature search was conducted using PubMed, Embase, and the Cochrane Library from January 1, 2016 to October 26, 2020 to identify economic evaluations where the cost of one or more drug treatment was evaluated and cost studies covering any intervention type. Each database was searched using keyword and MeSH terms related to treatment costs (e.g., health care cost, drug cost, etc.) and each condition (e.g., PSO, AD, eczema, CU, etc.). Results A total of 123 studies were reviewed, including 104 studies (85%) of PSO (including psoriasis, plaque psoriasis, psoriatic arthritis, and psoriasis vulgaris), 14 studies (11%) of AD, and 5 studies (4%) of CU. Seventy-two studies (59%) reviewed reported the inclusion of biologic treatments, 10 studies (8%) did not include biologic treatments, and 41 studies (33%) did not report whether or not a biologic treatment was included. While nearly all studies (98%) included direct costs, only 22 studies (18%) included indirect costs. Conclusions Economic evaluations for AD and CU may be needed in order to better understand the value of new treatments. Moreover, a clearer delineation for biologic treatments and indirect costs (i.e., productivity losses and gains) may be required. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-022-00774-2.
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Affiliation(s)
| | - Akira Yuasa
- Pfizer Japan Inc., Shinjuku Bunka Quint Building, 3-22-7, Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan.
| | - Naohiro Yonemoto
- Pfizer Japan Inc., Shinjuku Bunka Quint Building, 3-22-7, Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan
| | - Kazumasa Kamei
- Pfizer Japan Inc., Shinjuku Bunka Quint Building, 3-22-7, Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan
| | | | | | - Shunya Ikeda
- Department of Public Health, School of Medicine, International University of Health and Welfare, Narita, Japan
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Augustin M, Misery L, von Kobyletzki L, Armario-Hita JC, Mealing S, Redding M. Unveiling the true costs and societal impacts of moderate-to-severe atopic dermatitis in Europe. J Eur Acad Dermatol Venereol 2022; 36 Suppl 7:3-16. [PMID: 35801296 DOI: 10.1111/jdv.18168] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/01/2022] [Accepted: 04/21/2022] [Indexed: 11/26/2022]
Abstract
Atopic dermatitis (AD) is a chronic, auto-immune condition that imposes a high burden on individuals, society, and the healthcare system. Approximately 4.4% of adults and up to 18.6% of children/adolescents have AD in Europe, with 20% of all cases accounting for moderate-to-severe forms. This form of the condition in adults results in annual societal costs across Europe of an estimated €30 billion; €15.2 billion related to missed workdays or reduced work productivity, €10.1 billion related to direct medical costs and €4.7 billion related to personal expenditure of patients/families. AD can also substantially impact physical, emotional, and social quality-of-life. Several studies have shown the debilitating itch-scratch cycle is the main cause of the multifaceted burden, as it causes substantial sleep deprivation and stigmatisation due to the physical appearance of the skin, and confidence issues. These factors lead to psychosocial issues and can cumulate over time and prohibit patients reaching their 'full life potential'. Despite this, many patients with the condition are undertreated, resulting in uncontrolled symptoms and a further strain placed on patients, society, and the economy. The authors of this White Paper comprise the European Atopic Dermatitis Working Group, which is a network of international specialists with expertise in dermatology and healthcare policy decisions. Their programme of action is focused on harnessing their expertise to build consensus, advance research, share knowledge, and ultimately seek to improve AD care outcomes through achieving long-term symptom control. This White Paper presents a systematic evaluation of the overall financial and humanistic burden of moderate-to-severe AD and the current challenges that exist with AD care. It introduces recommendations for how, collaboratively, key stakeholders and policy makers can support improvements in AD management to achieve better disease control, thus reducing the costs and associated burden placed on individuals, society, and the economy.
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Affiliation(s)
- M Augustin
- University Medical Center Hamburg, Hamburg, Germany
| | - L Misery
- University Hospital of Brest, Brest, France
| | | | | | - S Mealing
- York Health Economics Consortium (YHEC), York, UK
| | - M Redding
- Eczema Outreach Support, Linlithgow, UK
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7
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Ameen M, Meller S, Pinter A, Shear NH, Soria A. Perception and Experience of Biologic Therapy in Atopic Dermatitis: A Qualitative Focus Group Study of Physicians and Patients in Europe and Canada. Dermatol Ther (Heidelb) 2021; 11:2159-2177. [PMID: 34704230 PMCID: PMC8547298 DOI: 10.1007/s13555-021-00631-8] [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: 09/13/2021] [Accepted: 10/05/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The Biologics in Atopic Dermatitis: Experiences & Learnings (BADEL) project aims to improve real-life understanding of how, where, and when biologics can play a role in the treatment of atopic dermatitis (AD) from the perspective of healthcare professionals (HCPs) and patients. METHODS Individual experiences of 24 patients with moderate-to-severe AD and who had been treated with biologic therapy (dupilumab) for ≥ 3-6 months, and 20 HCPs with a sub-specialty interest in AD were collected by means of focus groups held in Canada, Germany, France, Italy and the United Kingdom. Dupilumab was the only biologic therapy available at the time of the study. RESULTS Most patients had suffered from AD for many years, particularly from itch and psychosocial issues, with AD negatively impacting all aspects of their life. They had experienced a long treatment journey and seen many dermatologists, enduring treatment delays and failures. They had been prescribed various therapies without long-term success. Biologics provided symptom improvement, offering many patients a near-normal quality of life. Side effects, especially conjunctivitis, were the greatest drawback, and there were a few issues with incomplete or unreliable efficacy. HCPs agreed that biologic therapy for AD in the majority of patients demonstrated rapid onset, good efficacy and tolerability, and are a viable option in patients who had exhausted all other treatment options. However, those patients who failed to sufficiently respond or developed intolerable adverse effects, particularly ocular symptoms, require alternative therapeutic options. CONCLUSION Biologics can provide a near-normal quality of life for many patients with AD. Patients with AD who have failed conventional therapies should be offered all such novel therapies. Education and good patient-HCP communication will enable patients to manage their disease and treatment expectations. Patients and HCPs alike eagerly await alternative targeted therapies, which will offer greater choice and flexibility.
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Affiliation(s)
- Mahreen Ameen
- Royal Free London NHS Foundation Trust, Belsize Park, London, NW3 2QG, UK.
| | - Stephan Meller
- Department of Dermatology, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Andreas Pinter
- Department of Dermatology, University Hospital Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Neil H Shear
- Professor Emeritus, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Angele Soria
- Department of Dermatology and Allergology, Sorbonne University, Tenon Hospital, Assistance Publique Hôpitaux de Paris, 4 rue de la Chine, 75020, Paris, France
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8
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Fougerousse AC, Jacobzone C, Mery-Bossard L, Reguiai Z, Droitcourt C, Taieb C, Maccari F. Use of Systemic Medications for Treating Adult Atopic Dermatitis in France: Results of a Practice Survey. Clin Cosmet Investig Dermatol 2021; 14:179-183. [PMID: 33658822 PMCID: PMC7920512 DOI: 10.2147/ccid.s300402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/16/2021] [Indexed: 12/22/2022]
Abstract
Purpose Recent studies have illustrated that systemic medications are underused for treating adult atopic dermatitis (AD) and that dermatologists have concerns regarding the safety profile of cyclosporine in AD. Patients and Methods We performed a national online practice survey between March and April 2020. Results A total of 305 dermatologists responded, 57% with hospital-based activity and 43% with private practice. Overall, 46.9% prescribed cyclosporine for adult AD. Before initiating treatment, 56.9% did not perform evaluation scoring. Reasons for not prescribing cyclosporine were no eligible patients (24.7%), lack of information (52.6%), need for hospital prescription (31.2%), and lack of experience (79.2%). Fifty-four percent of the dermatologists prescribed methotrexate for adult AD. Before initiating treatment, 50.5% did not perform evaluation scoring. Reasons for not prescribing methotrexate were no eligible patients (46.7%), lack of information (39.3%), lack of experience (25.2%), and not approved for AD (47.4%). A total of 2.1% dermatologists prescribed other systemic treatments for adult AD, 9.8% prescribed corticosteroids and 56.4% prescribed dupilumab. Conclusion Systemic treatments for AD are used by half of dermatologists, although cyclosporine and dupilumab must be initiated in hospitals in France. Methotrexate is more frequently used than cyclosporine, although it is not approved for this indication in France. A vast majority of dermatologists do not perform any evaluation scoring before initiating systemic treatment for adult AD.
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Affiliation(s)
- Anne-Claire Fougerousse
- Dermatology Department, Hôpital d'Instruction des Armées Bégin, Saint Mandé, Val de Marne, France
| | - Caroline Jacobzone
- Dermatology Department, Hôpital du Scroff, Groupe Hospitalier Bretagne Sud, Lorient, Morbihan, France
| | - Laure Mery-Bossard
- Dermatology Department, Centre Hospitalier Intercommunal Poissy Saint Germain en Laye, Saint-Germain-en-Laye, Yvelines, France
| | - Ziad Reguiai
- Dermatology Department, Polyclinique Courlancy, Reims, Marne, France
| | - Catherine Droitcourt
- Dermatology Department, Centre Hospitalier Universitaire, Rennes, Ille et Vilaine, France
| | - Charles Taieb
- Emma Clinic, Fontenay-sous-Bois, Val de Marne, France
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Fougerousse AC. At the Dawn of a Therapeutic Revolution for Atopic Dermatitis: An Interview with Dr Anne-Claire Fougerousse. Dermatol Ther (Heidelb) 2021; 11:331-338. [PMID: 33523410 PMCID: PMC7848038 DOI: 10.1007/s13555-021-00489-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Indexed: 11/30/2022] Open
Abstract
Dr Anne-Claire Fougerousse is Head of Dermatology at the Bégin Hospital in Saint-Mandé, France, and scientific coordinator of a French network of dermatologists and allergists (ResoEczema). The focus of her work is to improve the care of adolescent and adult patients with atopic dermatitis (AD), a chronic, pruritic inflammatory skin disease that substantially impacts patient quality of life. In this interview, Dr Fougerousse provides an overview of the clinical presentation of adult patients with AD and describes available treatments. Today, topical agents like emollients and corticosteroids are the mainstay of AD therapy, and patients with lesions that are resistant to optimally administered topical treatment can also receive phototherapy or systemic therapy with ciclosporin. Dr Fougerousse discusses her hopes for the future of AD therapy with the recent development of biologicals like dupilumab, which may provide improvements in clinical outcomes and quality of life for patients with moderate-to-severe AD. In the next few years, the therapeutic arsenal for AD will likely expand to include more systemic therapies providing sustained symptom control. The real challenge will be to ensure that the maximum number of patients with AD achieve clinical benefits from these new treatments.
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Affiliation(s)
- Anne-Claire Fougerousse
- Service de Dermatologie, Hôpital Bégin, Saint-Mandé, France. .,Groupe d'Etudes Multicentriques Reso, Saint-Maur-des-Fossés, France.
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10
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Gisondi P, Girolomoni G. Undertreatment in adult patients with moderate‐to‐severe atopic dermatitis and other chronic inflammatory skin diseases. J Eur Acad Dermatol Venereol 2020; 34:2168-2169. [DOI: 10.1111/jdv.16876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 12/31/2022]
Affiliation(s)
- P. Gisondi
- Section of Dermatology and Venereology Department of Medicine University of Verona Verona Italy
| | - G. Girolomoni
- Section of Dermatology and Venereology Department of Medicine University of Verona Verona Italy
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