Identifying Candidates for Systemic Therapy in Atopic Dermatitis: A Practical Checklist

A novel checklist, known as the, “When to Start Systemic Therapy Checklist,” has been developed to assist dermatology providers in determining when to initiate systemic therapy (ST) for patients with atopic dermatitis (AD). This checklist, which addresses the complexities of deciding to start ST, comprises 3 key components: clinical severity, subjective burden, and lack of treatment response. Systemic therapy is recommended when at least 1 criterion in each component is met.

To validate the effectiveness of this checklist, researchers compared the checklist-based decisions against actual treatment data from the CorEvitas AD Registry, focusing on patients prescribed systemic therapy.

The study included adults with moderate-to-severe AD from the CorEvitas AD Registry, which spans from July 2020 to August 2023. Patients were categorized into 2 groups: those initiating ST at enrollment (ST group) and those not initiating ST but having a validated Investigator’s Global Assessment for Atopic Dermatitis (vIGA-AD) score of 3 or higher and an Eczema Area Severity Index (EASI) score of 12 or higher (non-ST group). The checklist criteria were then compared with registry outcome measures, using proxy measures when direct matches were unavailable.

The results showed that in the ST group (n=1488), 97.0% of patients met at least 1 criterion from the clinical severity section, 94.1% from the subjective burden section, and 92.1% from either section A or B. In the non-ST group (n=208), 100% of patients met at least 1 criterion from the clinical severity section, 92.3% from the subjective burden section, and 92.3% from either section A or B. For those in the ST group meeting at least 1 criterion from both sections A and B, the overall percentage agreement with the checklist was 81.7% (95% CI: 79.8%, 83.5%). However, the lack of treatment response section (section C) could not be evaluated due to insufficient data in the registry.

“Nearly all patients initiating ST met at least one criterion from both section A and B of the ‘When to Start Systemic Therapy Checklist’, demonstrating a strong alignment between the checklist sections A and B and disease burden of AD patients in the registry,” concluded the study authors. “Subsequent research is needed to assess section C due to registry limitations. Future analyses should examine why some patients with high disease burden and severity remain untreated with systemics.”

Reference:

Silverberg J, Augustin M, Eichenfield L, Lio P, et al. A checklist to aid in identifying patients with atopic dermatitis who are candidates for systemic therapy. SKIN The Journal of Cutaneous Medicine. 2024 8(2), s374. https://doi.org/10.25251/skin.8.supp.374