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Silverberg JI, Simpson B, Abuabara K, Guttman-Yassky E, Calimlim B, Wegzyn C, Krueger W, Gamelli A, Munoz B, Faller RW, Crawford JM, Grada A, Eichenfield LF. Prevalence and burden of atopic dermatitis involving the head, neck, face, and hand: A cross sectional study from the TARGET-DERM AD cohort. J Am Acad Dermatol 2023; 89:519-528. [PMID: 37150299 DOI: 10.1016/j.jaad.2023.04.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/02/2023] [Accepted: 04/07/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is severely burdensome, and there has been poor characterization of any differences in impact based on the area affected. OBJECTIVE To estimate the prevalence and HRQoL impact of head/face/neck/hand (HFNH) involvement among patients with moderate-to-severe atopic dermatitis. METHODS All TARGET-DERM AD registry patients with moderate/severe Investigator Global Assessment (vIGA-AD) were assessed using the Patient Oriented SCORing Atopic Dermatitis, Patient Oriented Eczema Measure (POEM) and the (Children's) Dermatology Life Quality Index ((C)DLQI). RESULTS 541 participants met the criteria (75.0% adults) and 84% (N = 453) reported HFNH involvement. HFNH and non-HFNH involved participants had similar characteristics; 55.2% female and 46.9% White. Compared to the non-HFNH involved, the involved had severe vIGA-AD (28.5% vs 16.3%, P = .02) and higher median body surface area affected (15% vs 10%, P ≤ .01) and were twice as likely to have higher (C)DLQI and POEM scores. LIMITATIONS This was an analysis of real-world and patient reported outcome data. CONCLUSION Real-world HFNH involved AD patients were associated with significantly worse quality of life, POEM/(C)DLQI, and more severe disease. Detailed assessments of specific areas affected by AD are needed to personalize treatment.
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Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, George Washington University, Washington, District of Columbia.
| | | | - Katrina Abuabara
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | | | - Breda Munoz
- Target RWE Health Evidence Solutions, Durham, North Carolina
| | - Rachel W Faller
- Target RWE Health Evidence Solutions, Durham, North Carolina
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De Bruin-Weller M, Deleuran M, Biedermann T, Bissonnette R, Foley P, Girolomoni G, Hercogová J, Hong CH, Katoh N, Pink A, Richard MA, Shumack S, Silvestre JF, Thyssen JP, Weidinger S. The Treat-to-Target Project in Atopic Dermatitis: One Year On. Acta Derm Venereol 2023; 103:adv5382. [PMID: 37083095 PMCID: PMC10134065 DOI: 10.2340/actadv.v103.5382] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/28/2023] [Indexed: 04/22/2023] Open
Abstract
Atopic dermatitis is a chronic skin condition for which a range of systemic treatments have recently been approved. A treat-to-target strategy has been developed previously alongside an algorithm to guide the management of patients with atopic dermatitis. Here, we review the strategy and algorithm in the context of the evolving therapeutic landscape, and identify areas for further refinement and development.
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Affiliation(s)
- Marjolein De Bruin-Weller
- Department of Allergology and Dermatology, UMC Utrecht, National Expertise Center for Eczema, Utrecht, The Netherlands.
| | - Mette Deleuran
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - Tilo Biedermann
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | | | - Peter Foley
- The University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Australia; Probity Medical Research, Skin Health Institute, Melbourne, Victoria, Australia
| | - Giampiero Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Italy
| | - Jana Hercogová
- Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Chih-Ho Hong
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - Norito Katoh
- Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Andrew Pink
- St John's Institute of Dermatology, Guy's and St, Thomas' NHS Foundation Trust, London, UK; Department of Dermatology, Kings College, London, UK
| | - Marie-Aleth Richard
- CEReSSEA 3279, Research Center in Health Services and Quality of Life, Aix Marseille University, Marseille, France; Department of Dermatology, University Hospital of La Timone, Marseille, France; Dermatology Department, Assistance Publique Hôpitaux de Marseille, APHM, Marseille, France
| | - Stephen Shumack
- Department of Dermatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | | | - Jacob P Thyssen
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Stephan Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Weisshaar E, Bentz P, Apfelbacher C, Haufe E, Heinrich L, Heratizadeh A, Abraham S, Harder I, Kleinheinz A, Wollenberg A, Schäkel K, Wiemers F, Ertner J, Augustin M, Wildberger J, Von Kiedrowski R, Worm M, Zink A, Effendy I, Asmussen A, Pawlak M, Sticherling M, Hilgers M, Handrick C, Quist S, Schwarz B, Bell M, Staubach-Renz P, Hong-Weldemann SH, Homey B, Brücher JJ, Weidinger S, Werfel T, Schmitt J. Itching in Atopic Dermatitis: Patient- and Physician-reported Outcomes in the German Atopic Dermatitis Registry TREATgermany. Acta Derm Venereol 2023; 103:adv00854. [PMID: 36688701 PMCID: PMC10391776 DOI: 10.2340/actadv.v103.4426] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/04/2023] [Indexed: 01/24/2023] Open
Abstract
TREATgermany is an investigator-initiated prospective disease registry. It investigates physician- and patient-reported disease severity (Eczema Area and Severity Index (EASI), objective Scoring Atopic Dermatitis (oSCORAD), Investigator Global Assessment, Patient-Oriented Eczema Measure (POEM), Patient Global Assessment (PGA)), patient-reported symptoms (itch, sleep loss, depressive symptoms), therapy courses and dermatological quality of life (DLQI) in moderate-to-severe atopic dermatitis with SCORAD > 20. 1,134 atopic dermatitis patients (mean age 41.0 ± 14.7 years, 42.5% females) were enrolled by 40 German recruiting sites (dermatological clinics and practices) between June 2016 and April 2021. The current analysis focuses on itch scores obtained with a numerical rating scale (NRS)) documented for the previous 3 days prior to baseline visit. The results show that 97.2% (1,090 of 1,121) patients experienced itch. Itch severity correlated moderately with severity of atopic dermatitis oSCORAD (rho = 0.44 (0.39-0.48)) and EASI score (rho = 0.41 (0.36-0.46)). A strong correlation was found with self-reported disease severity as PGA (rho = 0.68 (0.65-0.71)), POEM sum score (rho = 0.66 (0.63-0.69)) and dermatological quality of life impairment DLQI (rho = 0.61 (0.57-0.65)). Itch as a subjective complaint is more closely correlated with patient-reported outcomes than with objective assessments by the physician.
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Affiliation(s)
- Elke Weisshaar
- Occupational Dermatology, Department of Dermatology, University of Heidelberg.
| | - Philipp Bentz
- Occupational Dermatology, Department of Dermatology, University of Heidelberg
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany; Institute for Epidemiology and Preventive Medicine/Medical Sociology, University of Regensburg, Regensburg, Germany
| | - Eva Haufe
- Center of Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden
| | - Luise Heinrich
- 4. Center of Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden
| | - Annice Heratizadeh
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover
| | - Susanne Abraham
- Department of Dermatology, University Allergy Center, Medical Faculty Carl Gustav Carus, TU Dresden, Germany
| | - Inken Harder
- Center for Inflammatory Skin Diseases, Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel
| | | | | | - Knut Schäkel
- Department of Dermatology, University of Heidelberg
| | | | | | - Matthias Augustin
- Institute for Health Services Research in Dermatology, University Medical Center Hamburg Eppendorf
| | | | - Ralph Von Kiedrowski
- Focus Practice for chronic inflammatory dermatoses, skin cancer and allergology and also Study Center CMS3 (Company for Medical Study and Service), Selters/Westerwald
| | - Margitta Worm
- Department of Dermatology, Allergy and Venereology, Charité Berlin
| | | | - Isaak Effendy
- Department of Dermatology, OWL University Hospital of Bielefeld University, Campus Clinic Bielefeld
| | - Andrea Asmussen
- Practice Dr. med. Andrea Asmussen, Dermatology at Lesum, Bremen.
| | - Mario Pawlak
- Practice Dr. med. Anika Hünermund and Mario Pawlak, Heiligenstadt
| | - Michael Sticherling
- 21. Department of Dermatology, German Center for Immunotherapy, University of Erlangen
| | - Melanie Hilgers
- Clinics for Dermatology and Allergy, University Hospital Aachen
| | | | - Sven Quist
- Dermatology Clinic, Helix Medical Excellence Center, Mainz
| | | | | | | | | | - Bernhard Homey
- Department of Dermatology and Allergology, University Hospital Duesseldorf
| | | | - Stephan Weidinger
- Center for Inflammatory Skin Diseases, Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel
| | - Thomas Werfel
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover
| | - Jochen Schmitt
- Center of Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden
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Dupilumab Treatment in Adults with Moderate-to-Severe Atopic Dermatitis is Efficacious Regardless of Age of Disease Onset: a Post Hoc Analysis of Two Phase 3 Clinical Trials. Dermatol Ther (Heidelb) 2022; 12:2731-2746. [PMID: 36269503 DOI: 10.1007/s13555-022-00822-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/21/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Adults with atopic dermatitis (AD) commonly report adult-onset disease. AD is associated with different genetics, lesion morphology and distribution, and symptoms by age of onset. Yet little is known about possible differences in treatment efficacy between adults with adult-onset or childhood-onset AD. METHODS We evaluated the efficacy of dupilumab by age of AD onset in adults with moderate-to-severe AD, using pooled data from the LIBERTY AD SOLO 1 and 2 studies (NCT02277743, NCT02277769). Results were stratified based on self-reported age of AD onset, divided into four age subgroups: 0-4, 5-9, 10-19, and over 20 years. RESULTS This analysis included 460 patients treated with placebo and 457 treated with dupilumab 300 mg every 2 weeks (q2w), with a mean patient age of 38 years. Most patients (53.2%) reported AD onset at 0-4 years, with 14% at 5-9 years, 13.4% at 10-19 years, and 18.5% at 20 years or older. Dupilumab significantly improved AD signs and symptoms over 16 weeks compared with placebo, regardless of age of onset. Dupilumab treatment resulted in a significantly greater proportion of patients achieving Eczema Area and Severity Index (EASI)-50, EASI-75, and EASI-90 (50%, 75%, and 90% improvement from baseline EASI, respectively), and clear or almost clear skin (Investigator's Global Assessment score 0 or 1) across all age-of-onset subgroups compared with placebo. In addition, EASI improvements were significant across all anatomical regions in all subgroups. Weekly average peak pruritus Numerical Rating Scale and Dermatology Life Quality Index also improved consistently and significantly with dupilumab versus placebo, regardless of age of onset. CONCLUSION Despite possible differences in presentation and progression of AD linked to age of onset, dupilumab showed similar significant and sustained improvements in AD signs, symptoms, and quality of life in adults compared with placebo, over 16 weeks of treatment. TRIAL REGISTRATION LIBERTY AD SOLO 1: NCT02277743; LIBERTY AD SOLO 2: NCT02277769. Infographic available for this article.
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Atopic Dermatitis in Latin America: A Roadmap to Address Data Collection, Knowledge Gaps, and Challenges. Dermatitis 2022; 33:S83-S91. [PMID: 35648105 DOI: 10.1097/der.0000000000000904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a systemic, multifactorial disease that causes significant morbidity and health care burden in Latin America (LA). Data on AD are scarce in LA. Lack of disease registries and non-standardized study methodologies, coupled with region-specific genetic, immunological, and environmental factors, hamper data collection. A panel of LA experts in AD was given a series of relevant questions to address before a conference. Each narrative was discussed and edited through numerous rounds of deliberation until achieving consensus. Identified knowledge gaps in AD research were updated prevalence, adult-disease epidemiology, local phenotypes and endotypes, severe-disease prevalence, specialist distribution, and AD public health policy. Underlying reasons for these gaps include limited funding for AD research, from epidemiology and public policy to clinical and translational studies. Regional heterogeneity requires that complex interactions between race, ethnicity, and environmental factors be further studied. Informed awareness, education, and decision making should be encouraged.
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