Recap of the 4th Annual Revolutionizing Atopic Dermatitis Conference

The 4th Annual Revolutionizing Atopic Dermatitis (RAD) Conference took place virtually and in-person on April 9–11, 2022, in Baltimore, MD, with Jonathan I. Silverberg, MD, PhD, MPH, as the conference chair. He shared that the conference is aimed at increasing understanding of atopic dermatitis (AD) in addition to promoting its optimal management. Below is a summary of 3 RAD presentations.

Cognitive Impairment in Patients with Atopic Dermatitis

Patients with AD experience cognitive impairment (CI) that persists over time because AD is associated with a heterogeneous longitudinal course of cognitive function in adults.¹

Researchers conducted a prospective dermatology practice-based study using questionnaires and evaluations reviewed by a dermatologist (n = 210). The study consisted of patients who had 2 or more visits, with the mean follow-up time of 318 days. The Patient-Reported Outcomes Measurement Information System (PROMIS) 8-item cognitive function short form was used to assess cognitive function.

The researchers found that 20.85% of patients had PROMIS T-scores of ≤45 at baseline, indicating CI. About 59.09% had CI after 1 or more follow-up visits, and only 0.25% had CI after 2 or more follow-up visits. For patients with CI at baseline, 34.09% had persistent CI, 47.71% had a fluctuating course, and 18.18% had sustained improvement in cognitive function. Cognitive function scores were significantly lower in patients with increased itch, skin pain, sleep disturbance, and comorbid food allergy.

In multivariable logistic regression models, persistent CI was associated with increased SCORing AD, body surface area and xerosis in addition to depressive symptoms.

“AD is associated with a heterogeneous longitudinal course of cognitive function in adults, with some patients experiencing persistent CI over time,” concluded the authors.

Preference for Oral Versus Injectable Treatment

Understanding patient preferences could help physicians and other healthcare practitioners consider the best treatment choices for patients’ needs.²

Researchers conducted a Phase 3b clinical trial of adults with moderate to severe AD. These patients were randomized into 2 groups: those taking oral upadacitinib 30 mg once daily alongside a placebo prefilled syringe and those treated with subcutaneous dupilumab 300 mg every other week alongside 1 placebo tablet following a 600-mg loading dose. Patients from the United States completed a questionnaire that assessed preferences for either the oral (pill) or injection treatments in addition to an explanation of their preference.

Results showed that patients strongly prefered a pill over an injection (Wilcoxon signed-rank test; P = .0016). Of patients who specified a preference for either a pill or injection at the provider’s office (n = 114; patients with “no preference” excluded), 69.3% preferred a pill (exact binomial test; P < .0001). These results were similar to treatments received at home. The most common reasons for preferring oral treatments were easier to determine when/how to take, lack of time for office visits for injections, and lack of confidence in home injection.

The most common reasons for preferring injection treatments were not having to remember to take a pill once each day or worry about forgetting a pill and less frequent dosing.

According to the authors, “Shared patient-physician decision-making practices that consider patient preferences may contribute to greater patient satisfaction and overall well-being.”

Clinical and Economic Burden of Patients With AD Receiving Systemic Treatment

In a MEASURE-AD cross-sectional study, most patients with AD continued to experience flares in addition to substantial clinical and economic burden despite taking systemic therapy.³ These data suggest a prevalent medical need that is unmet among patients receiving systemic therapies.

The study consisted of patients enrolled between December 2019 and December 2020 whose characteristics, treatments, and outcomes were recorded during 1 office visit. Assessment of clinical burden for skin symptoms, itch, quality of life, and number of flares within the past 6 months was conducted using the Eczema Area and Severity Index (EASI), Worst Pruritus Numerical Rating Scale (WP-NRS), and Dermatology Life Quality Index (DLQI).

Additionally, researchers assessed economic burden, work productivity, and activity impairment. They also evaluated total monthly AD-related healthcare expenses and costs. Results described patients receiving any systemic therapy by the time of the office visit, including a subset of patients receiving dupilumab.

Of the 813 patients (mean age, 39.9 years) receiving systemic treatment, 227 (27.9%) were with monotherapy and 538 (66.2%) were with topical therapy. In the subset, 468 patients were taking dupilumab, with 163 (20.0%) as monotherapy and 276 (59.0%) as topical therapy. Smaller proportions of patients were taking systemic corticosteroids (18.0%), methotrexate (15.3%), cyclosporine (15.0%), azathioprine (1.6%), and mycophenolate (0.6%).

Results found that patients receiving systemic therapy experienced substantial clinical burden. The EASI, WP-NRS, and DLQI mean scores indicated moderate disease/effect on quality of life and a mean of 5.2 flares in the last 6 months. These patients also experienced considerable socioeconomic burden, with 28.3% reporting work productivity impairment consisting of 3 hours missed from work in past 7 days and about $160 per month in AD-related healthcare expenses and costs. Those in the dupilumab subgroup had lower mean scores on most clinical and economic burden outcomes; however, flares were the exception in the last 6 months and AD-related healthcare expenses and costs. These results showed that many patients still experience flares with substantial AD-related clinical and economic burden despite taking systemic therapy, including dupilumab.

“These findings suggest a remaining unmet medical need among patients receiving systemic therapies,” concluded the authors.

References

1. Jackson-Cowan L, Silverberg J. Longitudinal course of cognitive impairment in patients with atopic dermatitis. Poster presented at: Revolutionizing Atopic Dermatitis Conference; April 9–11, 2022. Baltimore, MD.

2. Prajapati VH, Eichenfield LF, Schuttelaar, ML, et al. Preference for oral versus injectable treatment in adults with moderate-to-severe atopic dermatitis: results from the phase 3b heads up clinical trial. Poster presented at: Revolutionizing Atopic Dermatitis Conference; April 9–11, 2022. Baltimore, MD.

3. Eyerich K, Argenziano G, Borlu M, et al. Real-world clinical and economic burden of patients with atopic dermatitis receiving systemic treatment: results from a multicountry study. Poster presented at: Revolutionizing Atopic Dermatitis Conference; April 9–11, 2022. Baltimore, MD.

For more information, including when the next RAD conference will be held, visit the official site