Moderate/Severe Atopic Dermatitis Is Often Inadequately Controlled

Inadequate control of atopic dermatitis (AD) is common in patients with moderate/severe disease, according to the results of a recent study.

“There remain substantial gaps in our understanding of the impact of AD on the lives of adults with this disease, especially those with moderate-to-severe disease,” the study authors wrote.

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Previous studies have highlighted the presence of a multidimensional baseline disease burden including substantial disease activity, symptoms, and comorbid conditions that has a significant impact on health-related quality-of-life.

To further explore and characterize this association, the researchers conducted a cross-sectional study using data from 6 academic medical centers collected by a self-administered internet-based questionnaire. The participants included 1519 adults with AD who were stratified by disease severity as either mild or moderate/severe using the Patient-Oriented Scoring Atopic Dermatitis scale. Those patients with moderate/severe disease were further stratified as having either adequate or inadequate disease control.

Overall, 689 participants had mild AD and 830 had moderate/severe AD. Compared with those with mild disease, those with moderate/severe AD reported more itching and pain, greater effects on sleep, higher prevalence of anxiety and depression, and greater impairment of health-related quality-of-life. Those with moderate/severe AD that is inadequately controlled with immunomodulators of phototherapy (n = 103) reported higher burdens of itch and sleeping symptoms compared with those with controlled disease, including more days per week with itchy skin (5.7 vs 2.7) and higher proportions with itch duration greater than half a day (190 [22.8%] vs 20 [2.9%]).

“Inadequate disease control among patients with moderate/severe AD despite treatment with immunomodulators or phototherapy is high. These results highlight the need for more effective therapies to better control AD and support the importance of incorporating the patient perspective into assessment of AD beyond using measures of disease activity,” the researchers concluded.

“It should be noted that this study characterized the patient-reported burden before the introduction of the first biologic agent approved for the treatment of patients with moderate-to-severe AD.”

—Michael Potts

Reference:

Simpson EL, Guttman-Yassky E, Margolis DJ, et al. Association of inadequately controlled disease and disease severity with patient-reported disease burden in adults with atopic dermatitis [published online July 3, 2018]. JAMA Dermatol. doi:10.1001/jamadermatol.2018.1572