Disease Severity, Time Managing Symptoms Contribute to High Disease Burden for Patients With AD

Patients with atopic dermatitis (AD) face significant disease burden including skin disease severity and time spent managing symptoms, according to a recent study published in JAMA Dermatology.

Disease burden was found to be multidimensional and heterogenous, with no single driving factor.

“Research has documented the disease burden of AD, including its visible nature and the effect on itch and sleep, but knowledge gaps remain,” wrote the authors.

To describe the multidimensional burden of AD among adults, the researchers collected data from the patient-focused drug development electronic survey conducted by the FDA. The survey collected responses from patients with AD on quality of life and treatment preference.

The researchers used data from adult participants with AD for their analysis of associations between demographic and clinical variables and patient-reported overall AD impact scores on an ordinal scale (1 = no impact, 5 = significant impact on a patient’s life).

Clinical variables included in the survey were time between symptom onset and diagnosis, current and worst AD severity, history of changes in severity, affected areas, and frequency of flares, comorbid conditions such as depression, current and historic use of AD treatments, time spent managing AD, and symptom control.

Of 1065 survey respondents, 83% were women and ages varied from 18 to 65 and older.

According to the survey, most adults with mostly moderate or severe AD rated the negative effect on their life as moderate-to-high. Only 3% of participants reported no association of AD with disease burden. Around half (51%) of respondents reported high-significant impact scores, and 46% reported low-moderate AD impact scores.

Severity of atopic dermatitis was found to be associated with overall impact scores (moderate: odds ratio [OR], 4.13; 95% CI, 2.94-5.79; severe: OR, 13.63; 95% CI, 8.65-21.50 vs mild).

Spending more time managing symptoms of AD was also found to be strongly associated with overall higher disease burden (11-20 hours: OR, 2.67; 95% CI, 1.77-4.03, 21 hours: OR, 5.34; 95% CI, 3.22-8.85, vs < 5 hours).

However, no single element of disease burden correlated particularly strongly with overall disease burden, which suggests that AD burden is multidimensional, driven by a combination of factors.

These findings are consistent with previous research indicating that respondents with moderate-to-severe AD had a higher disease burden than respondents with mild AD; although, it contrasts previous research emphasizing the effects of itch and disrupted sleep in the disease burden.

Time spent managing AD was strongly associated with mood changes in addition to AD disease burden. The authors suggest that there is a need for more efficient therapies that improve symptoms and reduce time spent managing AD for both patients and caregivers.

“Further work to address the complex burden of AD, including strategies to reduce time spent managing AD, and understanding the fullness of the patient experience is needed,” concluded the authors.

The study faced limitations due to the survey design, which may have contributed to selection bias for patients more willing to use technology. Additionally, patients with more severe AD burdens may have been more likely to participate.

Reference

Elsawi R, Dainty K, Begolka WS, et al. The multidimensional burden of atopic dermatitis among adults: results from a large national survey. JAMA Dermatol. Published online June 29, 2022. doi:10.1001/jamadermatol.2022.1906.