Cross-sectional burden-of-illness study in atopic dermatitis (MEASURE-AD) in Australia and New Zealand reveals impacts on well-being.

OBJECTIVES: To describe disease burden in individuals with moderate-to-severe atopic dermatitis (AD) in Australia and New Zealand (ANZ) and compare it with other geographic regions. METHODS: This multicentre, cross-sectional, observational study (MEASURE-AD) recruited consecutive adolescent and adult patients attending dermatology clinics in 28 countries. Data collected included scores of pruritus, disease severity, sleep, pain, disease control, work and quality of life. RESULTS: This study included 112 ANZ participants (Australia n = 72; New Zealand n = 40) from December 2019 to December 2020. Treatments included topicals (85.7% of patients), non-biologic systemic therapy (28.6%), phototherapy (9.8%) and dupilumab (4.5%). Mean Eczema Area and Severity Index (EASI) score was 22.3 (95% CI 19.6-25.0) and Patient-Oriented Eczema Measurement (POEM) score was 18.4 (95% CI 16.8-20.0). Pruritus Numerical Rating Scale (NRS) was 6.0 (95% CI 5.5-6.6) (50% had severe pruritus) and Dermatology Life Quality Index (DLQI) 14.3 (95% CI 12.8-15.8). ADerm-Impact sleep domain score was 15.1 (95% CI 13.2-16.9). ADerm-Symptom Scale worst skin pain domain score was 5.0 (95% CI 4.3-5.6). Work Productivity and Activity Impairment (WPAI) percentages indicated work and productivity impairment. Inadequately controlled AD was self-reported by 41%, with 9.7 flares in the past 6 months. Scores of pruritus, disease severity, sleep, pain, disease control and quality of life in ANZ were often the highest of all the geographic regions studied. CONCLUSION: ANZ patients with AD have a high disease burden, which extends across multiple facets of daily life. Many are inadequately controlled with existing therapies.

VITALITY: impact of adalimumab on health and disability outcomes in patients with Crohn's disease, rheumatoid arthritis, or psoriasis treated in clinical practice in New Zealand.

Objective: VITALITY, a 6-month, multicenter, prospective, observational study, assessed the effects of originator adalimumab (HUMIRA) on health and disability outcomes in patients with Crohn's disease (CD), rheumatoid arthritis (RA), or psoriasis treated in routine clinical practice in New Zealand (NZ). Methods: Biologic-naïve adults initiating adalimumab in accordance with NZ funding requirements were recruited. The primary endpoint was 6-month change from baseline in World Health Organization Disability Assessment Schedule (WHODAS) 2.0 score in all participants completing the study (full analysis set). Secondary endpoints included 6-month change in other patient-reported outcomes (PROs) of work activity and wellbeing (Work Productivity and Activity Impairment Questionnaire: General Health, Kessler Psychological Distress Scale, Flourishing Scale, and Subject Vitality Scale) and in disease-specific PRO measures. Results: In total, 164 participants with severe disease initiating adalimumab completed the WHODAS 2.0 at baseline, of whom 114 (69.5%) completed the study at 6 months. Mean WHODAS 2.0 score halved from 15.2 points (SD = ±9.1) at baseline to 7.3 points (SD = ±7.2) after 6 months' adalimumab treatment (mean difference = 7.9 points; 95% CI = 6.4-9.4; p < .001), with statistically significant improvements seen as early as 2 months after adalimumab initiation (p < .001). The proportion of participants with a WHODAS 2.0 score ≥ 10 more than halved, from 68.3% to 28.9%, between baseline and 6 months. Other PROs also improved significantly at 6 months, as did disease-specific measures. No new adalimumab safety signals were observed. Conclusions: Health and disability outcomes improved significantly after 6 months of adalimumab use in NZ patients with severe CD, RA, or psoriasis. Clinicaltrials.gov: NCT02451839.

Visual performance requirements for post-PRK police recruits.

BACKGROUND: New Zealand Police regulations (1996) allow the unaided visual acuity requirement of 6/12 to be achieved following refractive surgery (except radial keratotomy or keratoplasty) provided applicants also achieve normal (95 per cent confidence limit data from the literature): glare disability, contrast sensitivity, and low luminance visual acuity, one year or more after treatment. METHODS: To confirm the limits adopted, 80 young normal adults were subjected to the tests in the regulations. To examine the operation of the current standards, the results of 34 post-photorefractive keratectomy (post-PRK) police applicants are reported. Glare disability was the loss of high contrast visual acuity (VA) with the Mentor Brightness Acuity Tester at medium intensity. Contrast sensitivity (CS) was examined using both Melbourne Edge Test thresholds and the VA difference between high and low contrast Bailey-Lovie charts. Low luminance VA was measured using high contrast Bailey-Lovie charts viewed through a one per cent transmittance filter. RESULTS: The 95 per cent confidence limits found for normal performance were as follows. Glare disability: no more than 10 letters worse than VA without glare. Contrast sensitivity: no more than 12 letters difference between high contrast and low contrast letter acuity together with an edge contrast threshold of not less than 20 dB (CS = 100). These results were close to the values adopted for the current standard. The 95 per cent confidence limit for low luminance VA was a loss of 24 letters (almost five lines) and not the three lines of loss estimated from the literature. Two of the 34 post-PRK applicants failed. One was unable to achieve 6/6 acuity with best refraction. The second could not meet the low luminance VA limit (loss no more than three lines). No failures have been due to glare disability or poor contrast sensitivity even though one applicant had obvious corneal haze.