Disease Severity and Control in Adults with a History of Moderate to Severe Atopic Dermatitis: Results from a Large Patient-Physician Survey in the United Kingdom, Germany, and France

Abstract

Objectives: To characterize unmet medical needs among adults with a history of moderate-to-severe atopic dermatitis (AD) in the United Kingdom (UK), Germany, and France. MethOds: Data were from the 2014 Adelphi AD Disease-Specific Programme, a cross-sectional survey of physicians from UK (n= 136), Germany (n= 134), France (n= 137) and their patients with history of moderate-to-severe AD (UK, n= 666; Germany, n= 649; France, n= 661). Each physician completed a Patient Record Form for up to 5 patients on demographic/disease characteristics, treatment, and physician-perceived current AD severity. AD was classified as controlled or uncontrolled, with uncontrolled defined by either currently flaring AD; deteriorating/changeable AD; or physician dissatisfaction with current control. Patients voluntarily completed a questionnaire including the Dermatology Life Quality Index (DLQI) scale. Descriptive statistics characterized the populations. Results: Patient demographics were similar across countries. Disease onset was predominantly during adolescence. Current severity was mainly moderate (54%-65%); 10% (Germany) and 16% (France, UK) were severe. Substantial proportions of patients in each country were uncontrolled (54%-59%) even though 23%-39% of uncontrolled patients were currently receiving any systemic immunosuppressant or phototherapy including cyclosporine (6%-10%). Uncontrolled AD was high regardless of current severity: 85%-88% of severe patients were uncontrolled, as were 56% (France) to 70% (UK) of moderate patients. Quality-of-life was worse among uncontrolled patients, and in particular among patients treated with immunosuppressants or phototherapy in the past 12 months: 68%, 40%, and 40% of uncontrolled patients previously on immunosuppressants or phototherapy in UK, Germany, and France, respectively, had DLQI > 10 (threshold for very large effect on patient's life). cOnclusiOns: Adults with history of moderate-to-severe AD have poor disease control even when treated with systemic agents. A substantial proportion of uncontrolled patients previously treated with immunosuppressants or phototherapy report a very large effect of AD on their quality-of-life. These results demonstrate high unmet medical needs associated with AD.

Impact of atopic dermatitis on health-related quality of life and productivity in adults in the United States: An analysis using the National Health and Wellness Survey

“…Within AD, patients with moderate or severe disease generally report significantly greater disease burden than do patients with mild AD, including in terms of itch, pain, sleep disturbance, anxiety, depression, and HRQoL. 25,26 The nonsignificant differences between severity levels in this study were likely due to lack of adequate power on account of small sample size. In addition, less than one-fifth of the patients in the moderate or severe group selfreported their disease as severe; thus, the burden reported for these patients reflects outcomes for patients with moderate AD much more so than for patients with severe disease.…”

Emotional distress and quality of life in allergic diseases

“…There is a significant relationship between quality of life in AD and mental disorders. Problems in the domains of daily activity, the occurrence of pain and discomfort associated with symptoms of the disease, the presence of depressive and anxiety disorders and sleep disorders that worsen the quality of life and professional activity are reported among patients burdened with AD [41,42]. Therefore, patients reported poorer quality of life (HRQoL) in both the physical (PCS) and mental (MCS) domains [42].…”