Treatment Patterns among Patients with Atopic Dermatitis in Secondary Care: A National, Observational, Non-interventional, Retrospective Study in Sweden

Abstract

This non-interventional, observational, longitudinal study describes treatment patterns of atopic dermatitis (AD) in Sweden. Data from 3 Swedish registries were merged, and data were included in the study for those patients who received an AD diagnosis (during the period 1997 to 2019) and had AD treatment prescribed (during the period 2006 to 2020). Treatment persistence, treatment sequencing, time-to-event analysis, and 12-month prevalence were analysed. Overall, data for 99,885 patients with AD were included, of whom 4,086 (4.1%) received systemic treatments. Median persistence rates were 12.6 (95% CI 11.9, 13.4) months for methotrexate, 10.8 (9.1, 13.0) months for azathioprine, 5.6 (3.8, 6.2) months for mycophenolate, 5.1 (4.4, 5.7) months for alitretinoin and 3.4 (3.2, 3.7) months for cyclosporine. Median (Q1, Q3) time from first secondary care visit for AD to first systemic treatment was 5.8 (2.2, 11.0) years overall and 4.4 (1.3, 9.1) years in the Stockholm region. Methotrexate was a prominent first- and second-line treatment used during the period 2006 to 2020. Dupilumab was introduced during the study period and moved into earlier lines of therapy over time. The 12-month prevalence of AD generally remained steady, with a gradual increase observed over time for the overall population. A steep increase was observed in Stockholm from 2011. This study shows that a small proportion of patients with AD are offered systemic treatments in Sweden, with long periods in secondary care prior to systemic treatments and low persistence on systemic treatments. Regional differences highlight a need for national treatment guidelines.

Real‐world treatment patterns of Finnish adult patients with atopic dermatitis: From topicals to systemic therapy

“…18 Moreover, TCIs are reimbursed only when initiated by a dermatologist, directing initiations to secondary care. Consistent with previous studies, 2,14,19 the results showed low level of phototherapy and systemic therapy use among AD patients.…”

“…Atopic dermatitis (AD) is a chronic skin condition with an overall estimated prevalence of up to 10% and a life‐long incidence of up to 20%–30% in the adult population 1 . In the absence of curative medication, the treatment of AD aims at minimising symptoms and reducing the number of flares 2–4 . The basis of care in all AD severity classes relies on self‐management of skin with regular use of emollients combined with intermittent topical corticosteroids (TCS) 5–7 .…”

“…1 In the absence of curative medication, the treatment of AD aims at minimising symptoms and reducing the number of flares. [2][3][4] The basis of care in all AD severity classes relies on self-management of skin with regular use of emollients combined with intermittent topical corticosteroids (TCS). [5][6][7] Topical calcineurin inhibitors (TCI), tacrolimus and pimecrolimus, are also widely used options in AD, especially in the more sensitive skin regions.…”

Referral Pathways for Children with Atopic Diseases in Denmark

“…Previous referral pathway studies have been registerbased in the main and often dealing with a single atopic disease (7,14,15). According to a study that included 2 atopic diseases, children with both AD and asthma visited hospital emergency departments and outpatient clinics more frequently than those with asthma alone (16).…”