Epidemiology of atopic dermatitis in Poland. Economedica AD

Abstract

Introduction Atopic dermatitis (AD) is a commonly diagnosed inflammatory disease of the skin, with a chronic and relapsing course, which clinically manifests itself through eczematous skin lesions. The diagnosis is mainly based on the clinical picture of the disease. The goal of this project was to quantify the total population of AD patients in Poland and to make an attempt to determine the clinical profile of the population of patients who are moderately or severely affected by the disease. Methods The Economedica AD project consisted of two parts. The core part of the study, carried out among a representative group of specialists in dermatology and venereology, concerned the information collected from these specialists regarding both the overall health condition of the AD patients, treated by these doctors, as well as the treatment methods used for adult patients with a severe or moderate course of the disease. The second part of the study was an omnibus study, carried out on a representative group of adult Poles, and it mainly included questions concerning the potential presence of clinical AD symptoms. The combination of the two research methods allowed for an extrapolation of the collected data onto the total Polish patient population and to present detailed characteristics of AD patients in Poland. Results On the basis of the omnibus study, the total number of adult AD patients in Poland was estimated to be 705,718 (2.24% of adult Poles). 178,234 adult patients (0.6%), who in the past 12 months experienced a severe or moderate exacerbation of clinical AD symptoms, are currently in the care of dermatologists. Study population, i.e. patients with moderate or severe exacerbation of clinical condition, was also analysed in terms of general course of the disease. As a result of the analysis, estimated number of patients with mild AD was 18,560 (10% of the surveyed population); those with moderate AD: 113,264 (64% of this population), whilst 46,410 (26%) had severe AD. It should be noted that the estimates excluded patients who had only mild disease symptoms in 12 months prior to the study. In the case of 20% of severe AD patients, systemic cyclosporine therapy was initiated within the 12 months prior to the study, while 26% of patients received it within the last 24 months. An analysis of EASI or SCORAD indexes, measured for these two patient groups after the end of cyclosporin therapy, demonstrated the inefficacy of treatment for 47% and 34% of the patients respectively. Despite the clinical indications for such treatment, 54% of the patients underwent systemic cyclosporin therapy in neither of the two analysed periods, mainly due to the patient’s refusal (66%) or contraindications (24%) of the use of cyclosporine (according to the binding guidelines concerning cyclosporine therapy). Conclusions The prevalence of AD among Polish adults was estimated to be 2.24%. The results of the Economedica AD project with respect to the number of adult AD patients are similar to results of the studies carried out both in Poland and in other European countries. A detailed analysis of the subgroup of patients with a severe course of atopic dermatitis has shown a high percentage of patients for whom cyclosporin therapy turned out to be either ineffective (in 47% and 34% of patients treated with CsA in 12 and 24 months prior to the study) or intolerable; this was due to the patient’s refusal (about 66%) or contraindications connected with the patient’s health status or comorbidities (24%).