Atopic Dermatitis Treatment with Topical Therapy Alone Results in Persistent Elevated Disease Severity and High Disease Control Dissatisfaction: Real-World Health Care Professional and Patient Perspectives

Abstract

Background: Given the changing treatment landscape in atopic dermatitis (AD), it is important to understand real-world disease severity and health care professional (HCP) and patient treatment expectations and goals. This study assesses HCP-reported current disease severity and rates of HCP and patient dissatisfaction with current disease control in patients with a history of moderate-to-severe AD.

Methods: This study was an analysis of data from the United States Adelphi AD Disease Specific Programme™, a cross-sectional, descriptive, real-world study of HCP-completed medical records and patient surveys including retrospective data. The study included patients with a current diagnosis or a history of moderate-to-severe AD. HCPs provided information on current AD severity and treatments. Both HCPs and patients provided information on satisfaction with disease control on current treatment, and reasons for any dissatisfaction. Patients were stratified by their current treatment (systemic + topicals, systemic only, or topicals only). Systemic treatments included injectable biologics, oral small molecules, oral and injected corticosteroids, and immunosuppressants; topical treatments included corticosteroids, calcineurin inhibitors, crisaborole, and ruxolitinib.

Results A total of 146 HCPs (70 dermatologists, 19 allergists/immunologists, and 57 primary care practitioners) provided data for 747 patients, 215 of whom filled out a patient survey. Based on defined systemic and topical treatments, there were 191 (26%) patients on systemic + topical therapy, 143 (19%) patients on systemics only, and 200 (27%) patients on topicals only. Dissatisfaction rates for AD disease control on current treatment were reported by HCPs and patients for systemic + topicals [20%, 21%], systemic only [10%, 11%], and topicals only [23%, 30%]). The most common reasons for patient dissatisfaction with AD control were the “constant problem of itch,” “lack of clear skin,” “skin lesions that were visible to other people,” and “unresolved flaring.” Despite extended mean treatment duration (MTD), HCPs reported current moderate-to-severe disease severity in 64% of patients on systemic + topicals (MTD 496 days), 50% on systemics only (MTD 456 days), and 61% on topicals only (MTD 268 days).

Conclusion: These descriptive results suggest that many patients still have moderate-to-severe AD despite available treatments. A higher proportion of HCPs and patients were dissatisfied with the current level of disease control when topical therapies alone were prescribed. Patient dissatisfaction with disease control was due to itch, lack of clear skin, visible skin lesions, and flares.