Atopic Dermatitis Patients Prefer Skin Clearance Outcomes, Topical Therapy

Kelley Myers, PhD

Patient treatment preferences for atopic dermatitis generally pertain to the opportunity to quickly achieve skin clearance, and more often favor topical agents, according to a new study.

In results from a cross-sectional online survey of patients with atopic dermatitis, a team of US investigators observed that treatment decision-making is most prominently driven by the desire to improve the probability of clear or almost clear skin within 3-4 months of care.

The findings come amid an era of burgeoning targeted biologics and different administrations of care for the common skin condition—and perhaps more importantly highlight the priorities of patients as they are offered a more diverse armamentarium and improved capability of clinical outcomes.

Led by Kelley Myers, PhD, a research economist in the Health Preference Assessment group at RTI Health Solutions, the investigators conducted a treatment preference analysis of adults in the US with self-reported physician diagnoses of mild to moderate atopic dermatitis through a discrete choice experiment-based cross-sectional survey.

“As the AD treatment landscape continues to evolve, it is important to understand how patients evaluate tradeoffs among treatment benefits, treatment risks, and process factors such as the mode and frequency of administration,” Myers and colleagues wrote.

Survey respondents were required to evaluate and select from pairs of hypothetical treatment profiles regarding their atopic dermatitis. The profiles were based on 3 attributes:

• Efficacy (I.e, chance of clear or almost clear skin within 3-4 months of treatment; time until onset of action)
• Risk (increased risk of serious infection; risk of pain, burning and/or stinging after application)
• Mode and frequency of administration

The team analyzed the survey data through a random parameters logistical model, and subgroup analysis interpreted the heterogeneity of results.

An 11-point scale gauging atopic dermatitis disease burden (with 0 indicating eczema did not bother a patient daily and 10 indicating it significantly bothered them) was included in the patient analysis.

Among the 300 survey respondents, mean age was 40 years, and nearly two-thirds (65%) were female. Another three-quarters (72%) had a body surface area of less than 10% covered with eczema lesions. Nine in 10 patients (91%) had a prior or current topical treatment prescription.

Investigators observed that achieving clear or almost clear skin within 3-4 months of treatment was considered the “most important” study attribute. Patients additionally reported a preference for twice-daily topical cream therapy over a once-daily oral pill (P = .05) or self-administered subcutaneous injection once every other week (P <.001). Patients also indicated they were willing to accept therapies that took longer to provide benefit in order to administer it topically.

Myers and colleagues’ subgroup analysis showed patients with lower scores for self-assessed disease burden were more likely to choose a topical therapy over a systemic one, and were also less averse to risks of harm including pain, burning, and/or stinging than patients with greater disease burden.

Indeed, the team concluded that patients with mild to moderate atopic dermatitis were most driven to receive care topically, and that 3-4-month skin clearance was the key outcome in care.

“The results of this study can help better inform shared decision making when selecting therapies to manage mild to moderate atopic dermatitis,” they wrote.

The study, “Treatment Preferences Among Patients with Mild-to-Moderate Atopic Dermatitis,” was published in JDPA.