Improved Treatment Adherence, Clinical Outcomes Associated With Digital Intervention in Atopic Dermatitis

A digitally delivered targeted intervention demonstrated significant improvements in treatment adherence and related clinical outcomes among patients with atopic dermatitis (AD), according to study findings published in Dermatology and Therapy.

Current management of AD is focused on avoiding triggers, improving skin hydration, and reducing skin inflammation, noted researchers, with success largely dependent on disease severity and patients’ adherence. Poor treatment adherence is a significant issue in AD, in part due to inconvenience of treatments and fear of adverse effects.

“Exploring new ways to improve patients’ self-efficacy and treatment adherence is important, as it may improve the patient’s overall treatment outcome and quality of life and reduce the economic burden of AD,” the study authors wrote.

For other chronic conditions, such as diabetes, digital therapeutics, which are evidence-based, software-driven therapeutic interventions that are delivered to patients online and can be used as a supplement to—or replacement for—existing treatments, have demonstrated utility to address several gaps in disease management.

“Few studies have explored the benefits of digital interventions in the context of AD, and these focused on a single aspect of disease management such as psychological support, remote patient monitoring, or medication reminders,” said researchers. “However, management of AD requires an integrative approach, and no holistic digital program targeted at AD was previously tested that incorporates all the above components.”

They developed a digital program, delivered via a mobile app, consisting of symptom and trigger education, treatment reminders, lifestyle coaching, and healthy lifestyle support to assess its clinical efficacy among people with AD.

The novel AD digital program was applied across a 6-week, single-arm feasibility trial at the Hudlaeknastodin Dermatology Clinic in Iceland between November 2021 and January 2022. A total of 21 adults with mild-to-severe AD were assessed pre- and postclinically on several secondary outcomes of intervention efficacy:

• Clinical symptoms: Scoring Atopic Dermatitis (SCORAD) and Patient-Oriented Eczema Measure (POEM)
• Health-related quality of life (HRQOL): Dermatology Life Quality Index (DLQI)
• Changes in behaviors related to disease management: 6-item questionnaire focusing on regular skincare, avoiding triggers such as drying and irritating substances, avoiding smoking at home, learning relaxation techniques, seeking advice on self-help, and using AD-related educational materials

Among the study cohort, 20 of the 21 recruited patients (95.2%) completed the program (mean age, 31.4 years; mean time from diagnosis, 26.8 years; 81% female). Approximately half of patients at baseline reported severe AD symptoms as measured by SCORAD, and at postassessment, most of these patients had only moderate or mild symptoms and a few participants were completely cleared of symptoms.

“Strikingly, all patients who reported severe or very severe symptoms on the POEM questionnaire pre-program reported only moderate or mild symptoms, or being clear from symptoms, by program end.”

Compared with preassessment, postassessment clinical symptoms (SCORAD) and patient-reported global severity (POEM) improved by 44% (mean [SD], 56.1 [16.7] to 31.2 [18.4]; 44% change; P < .001) and 46% (mean [SD], 15.7 [6.7] to 8.5 [4.9]; 46% change, P < .001), respectively. Moreover, DLQI assessment showed that the participants’ HRQOL was affected significantly less by their skin disease after the program vs before (mean [SD], 7.9 [4.5] vs 4.6 [4.0]; 41% change; P < .001).

Adherence to treatments and preventive measures improved from pre- to post intervention, including skincare, avoidance of triggers, and disease-related knowledge. A significant interaction was also observed between increased treatment adherence and clinical improvement, in which larger clinical improvements were observed in patients with higher treatment adherence.

Due to the study’s single-arm design, findings may not be generalizable across different populations with AD.

“Nonetheless, even with power limitations, we found significant improvements in objective and subjective AD severity and patient HRQOL. The results of this study suggest that digital support programs can improve the efficiency of existing treatments through improved adherence and education,” concluded researchers.

Reference

Gudmundsdottir SL, Ballarini T, Amundadottir ML, et al. Clinical efficacy of a digital intervention for patients with atopic dermatitis: a prospective single-center study. Dermatol Ther (Heidelb). Published online October 14, 2022. doi:10.1007/s13555-022-00821-y