Major Comorbidities of Atopic Dermatitis: Beyond Allergic Disorders

Paller, Amy S.; Jaworski, Jennifer C.; Simpson, Eric L.; Boguniewicz, Mark; Russell, John J.; Block, Julie; Tofte, Susan J.; Dunn, Jeffrey D.; Feldman, Steven R.; Clark, Adele; Schwartz, Gene; Eichenfield, Lawrence F.

doi:10.1007/s40257-018-0383-4

Cited by 199 publications

(246 citation statements)

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“…Comorbid conditions can decrease HRQoL on the EQ-5D-5L [48], but is unlikely to affect the DLQI, therefore, it may weaken the correlation between EQ-5D and DLQI. However, excluding participants with comorbidities may make the study sample less representative of the general AD population, which is likely to have comorbidities [49,50]. Additionally, because different HRQoL aspects are measured by the EQ-5D and DLQI, they are complementary, with the DLQI more sensitive to changes in clinical outcomes related to AD that can affect HRQoL, and the EQ-5D being more broad to allow comparisons of HRQoL between different diseases and taking the effects of comorbidities into consideration [48].…”

Section: Discussionmentioning

confidence: 99%

Mapping Dermatology Life Quality Index (DLQI) scores to EQ-5D utility scores using data of patients with atopic dermatitis from the National Health and Wellness Study

et al. 2020

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Purpose To develop a mapping algorithm for generating EQ-5D-5-level (EQ-5D-5L) utility scores from the Dermatology Life Quality Index (DLQI) in patients with atopic dermatitis (AD). Methods The algorithm was developed using data from 1232 patients from four countries participating in the National Health and Wellness Study. Spearman's rank correlation coefficient was used to evaluate the conceptual overlap between DLQI and EQ-5D-5L. Six mapping models (ordinary least squares [OLS], Tobit, three different two-part models, and a regression mixture model) were tested with different specifications to determine model performance and were ranked based on the sum of mean absolute error (MAE), and root mean squared error (RMSE). Results The mean DLQI score was 7.23; mean EQ-5D-5L score was 0.78; and there were moderate negative correlations between DLQI and EQ-5D-5L scores (p = − 0.514). A regression mixture model with total DLQI, and age and sex as independent variables performed best for mapping DLQI to EQ-5D-5L (RMSE = 0.113; MAE = 0.079). Conclusion This was the first study to map DLQI to EQ-5D-5L exclusively in patients with AD. The regression mixture model with total DLQI, and age and sex as independent variables was the best performing model and accurately predicted EQ-5D-5L. The results of this mapping can be used to translate DLQI data from clinical studies to health state utility values in economic evaluations.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Section: Discussionmentioning

confidence: 99%

Mapping Dermatology Life Quality Index (DLQI) scores to EQ-5D utility scores using data of patients with atopic dermatitis from the National Health and Wellness Study

et al. 2020

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“…Patients with AD are at a slightly, but significantly, increased risk of all-cause mortality compared to the general population. 5 The relation between AD and food allergy, asthma, and allergic rhinitis as part of the 'atopic march' has been extensively documented. AD is also associated with an increased risk of irritant and allergic contact dermatitis, and hand dermatitis.…”

Section: Comorbiditiesmentioning

confidence: 99%

“…[1][2][3][4] AD has become a global health issue as it causes high health-care costs worldwide and is associated with considerable morbidity and quality of life (QoL) impairment, disease burden comparable to other chronic conditions like epilepsy, diabetes mellitus and cystic fibrosis. 1,2,[5][6][7][8] AD often develops during childhood, and has a wide spectrum of symptoms and signs which contribute towards profound functional disturbances, limits the ability to perform daily life activities and causes psychosocial distress and stigma. 2,9 The psychosocial and financial implications of AD affect patients, their families, health care providers, and society in general.…”

Section: Introductionmentioning

confidence: 99%

“…2,9 The psychosocial and financial implications of AD affect patients, their families, health care providers, and society in general. 1,5,8 Torres T, et al Update on atopic dermatitis, Acta Med Port 2019 Sep; 32(9): [606][607][608][609][610][611][612][613] The pathophysiological concepts underlying AD have shifted towards an integrated view, in which genetic and environmental factors interact contributing to varying degrees of epidermal barrier disruption, activation of different T cell subsets, and commensal skin microbiota dysbiosis, causing the varying clinical presentations, presumably encompassing a variety of subtypes with distinct and overlapping pathological mechanisms. 2 Although the underlying mechanisms causing these conditions are largely unknown and the absolute magnitude of the risks has not yet been well defined, AD has been considered more recently as a systemic disorder associated with increased risk of various allergic and non-allergic comorbidities, namely food allergies, respiratory disorders, cutaneous and extra-cutaneous infections, neuropsychiatric conditions, other inflammatory and autoimmune diseases, lymphoma, and cardiovascular disease, with important implications for management and treatment.…”

Section: Introductionmentioning

confidence: 99%

“…2 Although the underlying mechanisms causing these conditions are largely unknown and the absolute magnitude of the risks has not yet been well defined, AD has been considered more recently as a systemic disorder associated with increased risk of various allergic and non-allergic comorbidities, namely food allergies, respiratory disorders, cutaneous and extra-cutaneous infections, neuropsychiatric conditions, other inflammatory and autoimmune diseases, lymphoma, and cardiovascular disease, with important implications for management and treatment. 1,2,5,6,[9][10][11][12][13] Therapeutic goals require a multistep approach, focused on reducing pruritus and establishing disease control. Treatment selection is based primarily on disease severity but also on the patient's age, comorbidities, compliance, and costs.…”

Section: Introductionmentioning

confidence: 99%

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Update on Atopic Dermatitis

Torres¹,

et al. 2019

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With an increasing prevalence during the past decades, atopic dermatitis has become a global health issue. A literature search following a targeted approach was undertaken to perform this non-systematic review, which intends to provide an overview of the epidemiology, pathophysiology, clinical features, comorbidities, and current therapies for the treatment of atopic dermatitis. In sum, this is a heterogeneous skin disorder associated with variable morphology, distribution, and disease course. Although not completely understood, its pathogenesis is complex and seems to result from a combination of genetic and environmental factors that induce skin barrier dysfunction, cutaneous and systemic immune dysregulation, skin microbiota dysbiosis, and a strong genetic influence. Diagnosis is based on specific criteria that consider patient and family history and clinical manifestations. Overall disease severity must be determined by evaluating both objective signs and subjective symptoms. Therapeutic goals require a multistep approach, focusing on reducing pruritus and establishing disease control. Patients should be advised on basic skin care and avoidance of triggers. Topical anti-inflammatory agents should be considered in disease flares or chronic/recurrent lesions. In case of inadequate response, phototherapy, systemic immunosuppressants and, more recently, dupilumab, should be added. Nevertheless, the treatment of moderate-to-severe atopic dermatitis remains challenging and novel, efficacious, safe and targeted treatments are urgently needed. In conclusion, although the last few years have seen important improvement in the understanding of the disease, future research in atopic dermatitis will continue exploring gene-environment interactions and how it affects pathophysiology, disease severity, and treatment outcomes.

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Efficacy and Safety of Dupilumab in Adolescents With Uncontrolled Moderate to Severe Atopic Dermatitis

et al. 2020

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IMPORTANCE Adolescents with atopic dermatitis (AD) have high disease burden negatively affecting quality of life, with limited treatment options. The efficacy and safety of dupilumab, a monoclonal antibody, approved for treatment in adolescent patients with inadequately controlled AD, remain unknown in this patient population. OBJECTIVE To assess the efficacy and safety of dupilumab monotherapy in adolescents with moderate to severe inadequately controlled AD. DESIGN, SETTING, AND PARTICIPANTS A randomized, double-blind, parallel-group, phase 3 clinical trial was conducted at 45 US and Canadian centers between March 21, 2017, and June 5, 2018. A total of 251 adolescents with moderate to severe AD inadequately controlled by topical medications or for whom topical therapy was inadvisable were included. INTERVENTIONS Patients were randomized (1:1:1; interactive-response system; stratified by severity and body weight) to 16-week treatment with dupilumab, 200 mg (n = 43; baseline weight <60 kg), or dupilumab, 300 mg (n = 39; baseline weight Ն60 kg), every 2 weeks; dupilumab, 300 mg, every 4 weeks (n = 84); or placebo (n = 85). MAIN OUTCOMES AND MEASURES Proportion of patients with 75% or more improvement from baseline in Eczema Area and Severity Index (EASI-75) (scores range from 0 to 72, with higher scores indicating greater severity) and Investigator's Global Assessment (IGA) 0 or 1 on a 5-point scale (scores range from 0 to 4, with higher scores indicating greater severity) at week 16. RESULTS A total of 251 patients were randomized (mean [SD] age, 14.5 [1.7] years; 148 [59.0%] male). Of 250 patients with data available on concurrent allergic conditions, most had comorbid type 2 diseases (asthma, 134 [53.6%]; food allergies, 60.8%; allergic rhinitis, 65.6%). A total of 240 patients (95.6%) completed the study. Dupilumab achieved both coprimary end points at week 16. The proportion of patients with EASI-75 improvement from baseline increased (every 2 weeks, 41.5%; every 4 weeks, 38.1%; placebo, 8.2%) with differences vs placebo of 33.2% (95% CI, 21.1%-45.4%) for every 2 weeks and 29.9% (95% CI, 17.9%-41.8%) for every 4 weeks (P < .001). Efficacy of the every-2-week regimen was generally superior to the every-4-week regimen. Patients in the dupilumab arms had higher percentage values of conjunctivitis (every 2 weeks, 9.8%; every 4 weeks, 10.8%; placebo, 4.7%) and injection-site reactions (every 2 weeks, 8.5%; every 4 weeks, 6.0%; placebo, 3.5%), and lower nonherpetic skin infections (every 2 weeks, 9.8%; every 4 weeks, 9.6%; placebo, 18.8%). CONCLUSIONS AND RELEVANCE In this study, dupilumab significantly improved AD signs, symptoms, and quality of life in adolescents with moderate to severe AD, with an acceptable safety profile. Placebo-corrected efficacy and safety of dupilumab were similar in adolescents and adults. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03054428

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Major Comorbidities of Atopic Dermatitis: Beyond Allergic Disorders

Cited by 199 publications

References 169 publications

Mapping Dermatology Life Quality Index (DLQI) scores to EQ-5D utility scores using data of patients with atopic dermatitis from the National Health and Wellness Study

Mapping Dermatology Life Quality Index (DLQI) scores to EQ-5D utility scores using data of patients with atopic dermatitis from the National Health and Wellness Study

Update on Atopic Dermatitis

Efficacy and Safety of Dupilumab in Adolescents With Uncontrolled Moderate to Severe Atopic Dermatitis

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