Development of the alopecia areata scale for clinical use: Results of an academic-industry collaborative effort.

BACKGROUND: The current classification for alopecia areata (AA) does not provide a consistent assessment of disease severity. OBJECTIVE: To develop an AA severity scale based on expert experience. METHODS: A modified Delphi process was utilized. An advisory group of 22 AA clinical experts from the United States was formed to develop this AA scale. Representatives from the pharmaceutical industry provided feedback during its development. RESULTS: Survey responses were used to draft severity criteria, aspiring to develop a simple scale that may be easily applied in clinical practice. A consensus vote was held to determine the final AA severity statement, with all AA experts agreeing to adopt the proposed scale. LIMITATIONS: The scale is a static assessment intended to be used in clinical practice and not clinical trials. CONCLUSION: The final AA disease severity scale, anchored in the extent of hair loss, captures key features commonly used by AA experts in clinical practice. This scale will better aid clinicians in appropriately assessing severity in patients with this common disease.

The Use of Real-World Data to Evaluate the Association Between Atopic Dermatitis and Cardiovascular Disease: A Retrospective Claims Analysis.

INTRODUCTION: Atopic dermatitis (AD) is a systemic inflammatory condition that may increase the risk of cardiovascular disease (CVD); however, ongoing debate exists surrounding its direct association. We aimed to elucidate whether AD contributes to a higher incidence of CVD and major adverse cardiovascular events (MACE) in adult patients with AD, independent of metabolic disorders. METHODS: We retrospectively analyzed a large US-based population of patients with AD (≥ 18 years of age). Logistic regression estimated the risk of CVD and MACE in adult patients with AD, independent of metabolic disorders (including diabetes, hypertension, and obesity). RESULTS: The odds ratio (OR; 95% confidence interval [CI]) for patients without metabolic disorders was 1.25 (1.13, 1.39) for CVD and 1.22 (1.01, 1.47) for MACE. The OR (95% CI) for AD patients with metabolic disorders was 1.09 (1.07, 1.12) for CVD and 1.14 (1.09, 1.18) for MACE. This trend was even more pronounced after long-term follow-up (≥ 3 years). Lifestyle and health behavioral factors of the subjects were not available in the dataset. The lack of control for these factors could potentially confound our results. CONCLUSIONS: Atopic dermatitis may contribute to the risk of developing CVD and MACE in adults, independent of metabolic disorders.

A real-world study evaluating adeQUacy of Existing Systemic Treatments for patients with moderate-to-severe Atopic Dermatitis (QUEST-AD): Baseline treatment patterns and unmet needs assessment.

BACKGROUND: Systemic therapies are commonly used for patients with uncontrolled moderate-to-severe atopic dermatitis (AD) and impaired quality of life (QoL). However, real-world treatment patterns and unmet needs of adults with moderate-to-severe AD receiving systemic therapies are poorly quantified. OBJECTIVE: To evaluate unmet needs in patients with moderate-to-severe AD treated with systemic therapies. METHODS: Adults with AD diagnosis in past 5 years and a prescription for systemic treatment or phototherapy in past 6 months were identified from the Optum Research Database. Patients completed a survey about symptoms, treatment, and QoL. Chi-squared and t tests analyzed bivariable comparisons of demographics and outcomes. Spearman's rank-order correlation analyses examined the relationship between frequency of flares and outcomes. RESULTS: Eight hundred and one participants were included (mean age, 45.2 years; 71.8% female). In the 12 months before baseline survey, 38.3% reported no remission from AD. In the month before baseline survey, 63.6% used topical corticosteroids, and 81.3% of patients experienced 1 or more flares. Patients experiencing flares reported worse Patient-Orientated Eczema Measure (POEM), Peak Pruritus Numeric Rating Scale (NRS), and Dermatology Life Quality Index scores (DLQI), lower treatment satisfaction, and greater work productivity loss than patients without flares (all P < .001). Patients with severe atopic dermatitis reported worse POEM, Peak Pruritus NRS, and DLQI, lower treatment satisfaction, and greater work productivity loss than patients with moderate AD (all P < .001). CONCLUSION: Despite receiving systemic therapies, adults with moderate-to-severe AD reported disease symptoms, recurrent flares, and impaired QoL, suggesting unmet therapeutic needs.

Extent and consequences of inadequate disease control among adults with a history of moderate to severe atopic dermatitis.

Since control of atopic dermatitis (AD) remains challenging but has not been adequately characterized, the objective of this study was to characterize disease control among patients with a history of moderate to severe AD. Data were from the 2014 Adelphi US AD Disease Specific Programme, a cross-sectional survey of physicians (n = 202) and their patients with history of moderate to severe AD (n = 1064, 54% female, 75% white, mean age 40 years). Inadequately controlled AD as rated by the physician was defined as currently flaring; deteriorating/changeable AD; or physician dissatisfaction with current control. The overall inadequate control rate was 58.7% (n = 625), which increased with current AD severity and was observed in 53.4% and 83.4% of patients receiving immunosuppressants and systemic corticosteroids, respectively. Relative to controls, inadequately controlled patients had poorer disease-specific quality of life, higher level of work impairment, greater itch and sleep interference with daily living (all P < 0.05). Multivariate analysis showed factors significantly associated with inadequate control (all P < 0.05), including Hispanic race, symptoms on the head/neck or lower limbs, itch and sleep interference with daily living. A limitation of the study was reliance on accuracy of reporting, potential selection bias and cross-sectional study design. In summary, there was a high rate and substantial impact of physician-rated inadequately controlled disease among patients with a history of moderate to severe AD, suggesting the need for more effective therapies.

Discordance Between Physician- and Patient-Reported Disease Severity in Adults with Atopic Dermatitis: A US Cross-Sectional Survey.

BACKGROUND: There is limited understanding of severity rating of atopic dermatitis in clinical practice. OBJECTIVES: To evaluate the agreement between physician- and patient-rated severity of atopic dermatitis. METHODS: Data were collected from the 2014 Adelphi US Atopic Dermatitis Disease Specific Programme, a cross-sectional survey of physicians and their patients with a history of moderate-to-severe atopic dermatitis; patients voluntarily completed a questionnaire. Current disease severity (mild/moderate/severe), based on personal judgment, was rated independently by patients and their physicians. The weighted kappa statistic identified level of agreement between physicians and patients. Bivariate analyses characterized agreement; multi-nomial logistic regression identified factors associated with discordance. RESULTS: Overall, 678 patients were included (369 [54.4%] were women, 525 [77.4%] were White, mean age was 39.3 years). Agreement was moderate (weighted kappa = 0.52): compared with physician ratings, patient-rated severity was higher in 76 patients (11.2%), lower in 137 patients (20.2%), and matched in 465 patients (68.6%). There were no differences in the rates of agreement between physician and patient ratings based on physician specialty (p = 0.6781), objective severity measures [Eczema Area and Severity Index score (p = 0.5308), percent body surface area affected (p = 0.9872), and current systemic immunosuppressant use (p = 0.9197)]. Multivariate analysis showed patients with a worse quality of life (Dermatology Life Quality Index) were more likely to rate a higher severity (relative risk ratio 1.04, 95% confidence interval 1.00-1.08; p = 0.0460). Physicians were more likely to rate a higher severity with a greater physician-reported sleep disturbance (relative risk ratio 1.71, 95% confidence interval 1.01-2.89; p = 0.0440). CONCLUSIONS: Almost one-third of patients rated atopic dermatitis severity differently from their physicians, supporting the importance of the patient perspective in the severity assessment of atopic dermatitis and the need for greater communication between patients and physicians.