Perception and Experience of Biologic Therapy in Atopic Dermatitis: A Qualitative Focus Group Study of Physicians and Patients in Europe and Canada

Abstract

Introduction The Biologics in Atopic Dermatitis: Experiences & Learnings (BADEL) project aims to improve real-life understanding of how, where, and when biologics can play a role in the treatment of atopic dermatitis (AD) from the perspective of healthcare professionals (HCPs) and patients. Methods Individual experiences of 24 patients with moderate-to-severe AD and who had been treated with biologic therapy (dupilumab) for ≥ 3–6 months, and 20 HCPs with a sub-specialty interest in AD were collected by means of focus groups held in Canada, Germany, France, Italy and the United Kingdom. Dupilumab was the only biologic therapy available at the time of the study. Results Most patients had suffered from AD for many years, particularly from itch and psychosocial issues, with AD negatively impacting all aspects of their life. They had experienced a long treatment journey and seen many dermatologists, enduring treatment delays and failures. They had been prescribed various therapies without long-term success. Biologics provided symptom improvement, offering many patients a near-normal quality of life. Side effects, especially conjunctivitis, were the greatest drawback, and there were a few issues with incomplete or unreliable efficacy. HCPs agreed that biologic therapy for AD in the majority of patients demonstrated rapid onset, good efficacy and tolerability, and are a viable option in patients who had exhausted all other treatment options. However, those patients who failed to sufficiently respond or developed intolerable adverse effects, particularly ocular symptoms, require alternative therapeutic options. Conclusion Biologics can provide a near-normal quality of life for many patients with AD. Patients with AD who have failed conventional therapies should be offered all such novel therapies. Education and good patient–HCP communication will enable patients to manage their disease and treatment expectations. Patients and HCPs alike eagerly await alternative targeted therapies, which will offer greater choice and flexibility.

Values and Preferences of Patients and Caregivers Regarding Treatment of Atopic Dermatitis (Eczema)

“…Fourteen studies addressed concern about adverse effects of treatment. 14,24,25,30,31,37,42,44,46,47,50,60,71,72 Patients and their caregivers consider the trade-off between the benefits and harms of treatments for AD (moderate certainty): "It really all boils down to side effects…As long as it's helping him, I want him to take it. But it all depends on what the side effects are."…”

“…Eleven studies reported patients preferring to use topical corticosteroids for as short as possible (low certainty evidence). 14,15,20,24,31,34,46,60,65,70,71 Participants preferred starting topical corticosteroids when AD is poorly controlled, and discontinuing topical corticosteroids when eczematous lesions resolved. This results in a treatment strategy where patients and caregivers use topical corticosteroids for the minimum time necessary to control flares: "Steroid creams…[make] your illness worse if they're used incorrectly.…”

“…Then you realise at some point that it [treatment] no longer works." 14 Patients may perceive decreased effectiveness with chronic topical corticosteroids as indication of inadequate treatment or progression of disease with a new baseline. While this is not specifically addressed in the literature, it is implied as a source of confusion for patients.…”

“…Treatments with decreased efficacy over time that also have substantial adverse effects may lead to trialing multiple therapies and medication nonadherence. 14…”

“…Twelve studies addressed the burden of AD self-management (low certainty). 14,16,22,24,31,40,41,46,54,61,69,70 We identified 3 subthemes: the effect on social interactions, ease of application, and route of treatment.…”