Treatment Patterns among Patients with Atopic Dermatitis in Secondary Care: A National, Observational, Non-interventional, Retrospective Study in Sweden
Keywords:atopic dermatitis, atopic eczema, registry, epidemiology, dispensed prescription, treatment patterns
This non-interventional, observational, longitudinal study describes treatment patterns of atopic dermatitis (AD) in Sweden. Data from 3 Swedish registries were merged, and included 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 was increasingly used as first- or second-line 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.
Langan SM, Irvine AD, Weidinger S. Atopic dermatitis. Lancet 2020; 396: 345-360.
https://doi.org/10.1016/S0140-6736(20)31286-1 DOI: https://doi.org/10.1016/S0140-6736(20)31286-1
Bylund S, Kobyletzki LB, Svalstedt M, Svensson A. Prevalence and incidence of atopic dermatitis: a systematic review. Acta Derm Venereol 2020; 100: adv00160.
https://doi.org/10.2340/00015555-3510 DOI: https://doi.org/10.2340/00015555-3510
Chan LN, Magyari A, Ye M, Al-Alusi NA, Langan SM, Margolis D, et al. The epidemiology of atopic dermatitis in older adults: a population-based study in the United Kingdom. PLoS One 2021; 16: e0258219.
https://doi.org/10.1371/journal.pone.0258219 DOI: https://doi.org/10.1371/journal.pone.0258219
Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol 2014; 70: 338-351.
https://doi.org/10.1016/j.jaad.2013.10.010 DOI: https://doi.org/10.1016/j.jaad.2013.10.010
Nutten S. Atopic dermatitis: global epidemiology and risk factors. Ann Nutr Metab 2015; 66: 8-16.
https://doi.org/10.1159/000370220 DOI: https://doi.org/10.1159/000370220
Wollenberg A, Christen-Zach S, Taieb A, Paul C, Thyssen JP, de Bruin-Weller M, et al. ETFAD/EADV eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children. J Eur Acad Dermatol Venereol 2020; 34: 2717-2744.
https://doi.org/10.1111/jdv.16892 DOI: https://doi.org/10.1111/jdv.16892
Food and Drug Administration (FDA). FDA approves new eczema drug dupixent. 2017. [cited 10 November 2021]. Available from: https://www.fda.gov/news-events/press-announcements/fda-approves-new-eczema-drug-dupixent.
Committee for Medicinal Products for Human Use (CHMP). Assessment report: dupixent. 2017. [cited 10 November 2021]. Available from: https://www.ema.europa.eu/en/documents/assessment-report/dupixent-epar-public-assessment-report_en.pdf.
The Dental and Pharmaceutical Benefits Agency (TLV). Dupixent is included in the drug benefits with limitation. 2018. [cited 10 November 2021]. Available from: https://www.tlv.se/download/18.2ec090df16367c5c52cd5e37/1527144790875/bes180517_dupixent.pdf.
Thyssen JP, Berents T, Bradley M, Deleuran M, Grimstad O, Korhonen L, et al. Clinical management of atopic dermatitis in adults: mapping of expert opinion in 4 Nordic countries using a modified Delphi process. Acta Derm Venereol 2020; 100: adv00015.
https://doi.org/10.2340/00015555-3369 DOI: https://doi.org/10.2340/00015555-3369
Jappe U, Beckert H, Bergmann KC, Gulsen A, Klimek L, Philipp S, et al. Biologics for atopic diseases: indication, side effect management, and new developments. Allergol Select 2021; 5: 1-25.
https://doi.org/10.5414/ALX02197E DOI: https://doi.org/10.5414/ALX02197E
Tsai HR, Lu JW, Chen LY, Chen TL. Application of Janus kinase inhibitors in atopic dermatitis: an updated systematic review and meta-analysis of clinical trials. J Pers Med 2021; 11: 279.
https://doi.org/10.3390/jpm11040279 DOI: https://doi.org/10.3390/jpm11040279
The National Board of Health and Welfare. National guidelines for psoriasis care. Support for control and management. 2019. [cited 10 November 2021]. Available from: https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/nationella-riktlinjer/2019-3-11.pdf.
Egeberg A, Thyssen JP, Wu JJ, Pierce E, Terres JAR. Treatment patterns in Danish patients with atopic dermatitis before and after hospital referral. Dermatol Ther (Heidelb) 2021; 11: 499-512.
https://doi.org/10.1007/s13555-021-00491-2 DOI: https://doi.org/10.1007/s13555-021-00491-2
Eckert L, Amand C, Gadkari A, Rout R, Hudson R, Ardern-Jones M. Treatment patterns in UK adult patients with atopic dermatitis treated with systemic immunosuppressants: data from The Health Improvement Network (THIN). J Dermatolog Treat 2020; 31: 815-820.
https://doi.org/10.1080/09546634.2019.1639604 DOI: https://doi.org/10.1080/09546634.2019.1639604
Armstrong AW, Huang A, Wang L, Miao R, Patel MY, Gadkari A, et al. Real-world utilization patterns of systemic immunosuppressants among US adult patients with atopic dermatitis. PLoS One 2019; 14: e0210517.
https://doi.org/10.1371/journal.pone.0210517 DOI: https://doi.org/10.1371/journal.pone.0210517
Wei W, Anderson P, Gadkari A, Blackburn S, Moon R, Piercy J, et al. Discordance between physician- and patient-reported disease severity in adults with atopic dermatitis: a US cross-sectional survey. Am J Clin Dermatol 2017; 18: 825-835.
https://doi.org/10.1007/s40257-017-0284-y DOI: https://doi.org/10.1007/s40257-017-0284-y
Lundin S, Jonsson M, Wahlgren CF, Johansson E, Bergstrom A, Kull I. Young adults' perceptions of living with atopic dermatitis in relation to the concept of self-management: a qualitative study. BMJ Open 2021; 11: e044777.
https://doi.org/10.1136/bmjopen-2020-044777 DOI: https://doi.org/10.1136/bmjopen-2020-044777
Epstein M, International Society of Pharmacoepidemiology. Guidelines for good pharmacoepidemiology practices (GPP). Pharmacoepidemiol Drug Saf 2005; 14: 589-595.
https://doi.org/10.1002/pds.1082 DOI: https://doi.org/10.1002/pds.1082
Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Ann Intern Med 2007; 147: W163-194.
https://doi.org/10.7326/0003-4819-147-8-200710160-00010-w1 DOI: https://doi.org/10.7326/0003-4819-147-8-200710160-00010-w1
World Medical Association. WMA Declaration of Helsinki - ethical principles for medical research involving human subjects. 2013. [cited 10 November 2021]. Available from: https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/.
Swedish MeSH. Age groups (Age groups). 2021. [cited 10 November 2021]. Available from: https://mesh.kib.ki.se/term/D009273/age-groups.
Gorritz M, Boytsov NN, Goldblum OM, Malatestinic WN, Wang X, Wade RL. Inadequate response and treatment patterns in adults diagnosed with atopic dermatitis and treated with topical therapy. J Dermatolog Treat 2022; 33: 2510-2517.
https://doi.org/10.1080/09546634.2021.1981813 DOI: https://doi.org/10.1080/09546634.2021.1981813
Pino Lopez J, Kromer C, Herr R, Schmieder A, Bayerl C, Schaarschmidt ML. Drug survival rates and reasons for drug discontinuation in patients with atopic dermatitis: a retrospective study of adult outpatients. Eur J Dermatol 2021; 31: 233-238.
https://doi.org/10.1684/ejd.2021.4020 DOI: https://doi.org/10.1684/ejd.2021.4020
Silverberg JI, Guttman-Yassky E, Gadkari A, Kuznik A, Mallya UG, Mastey V, et al. Real-world persistence with dupilumab among adults with atopic dermatitis. Ann Allergy Asthma Immunol 2021; 126: 40-45.
https://doi.org/10.1016/j.anai.2020.07.026 DOI: https://doi.org/10.1016/j.anai.2020.07.026
Eichenfield LF, DiBonaventura M, Xenakis J, Lafeuille MH, Duh MS, Fakih I, et al. Costs and treatment patterns among patients with atopic dermatitis using advanced therapies in the United States: analysis of a retrospective claims database. Dermatol Ther (Heidelb) 2020; 10: 791-806.
https://doi.org/10.1007/s13555-020-00413-8 DOI: https://doi.org/10.1007/s13555-020-00413-8
Region Stockholm. The caregiver guide. Specialized skin care. 2020. [cited 10 November 2021]. Available from: https://vardgivarguiden.se/avtal/vardavtal/avtal-vardval-lov/lov-vardval-stockholm/specialiserad-hudsjukvard-i-oppenvard/.
Smolen JS, Landewe RBM, Bijlsma JWJ, Burmester GR, Dougados M, Kerschbaumer A, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis 2020; 79: 685-699.
https://doi.org/10.1136/annrheumdis-2019-216655 DOI: https://doi.org/10.1136/annrheumdis-2019-216655
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