Global Biologic Access: Trends in 50 Countries Among Patients with Atopic Dermatitis

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Disparities in use of biologic medications such as dupilumab and tralokinumab for atopic dermatitis have been identified in an analysis of 50 countries, with barriers shown to be related to sociodemographic status.¹

These findings resulted from an analysis of the association between burden of atopic dermatitis, also known as eczema, and sociodemographic index (SDI). The investigators were led in part by Arbie Sofia P. Merilleno, from the Research and Innovation Institute and the department of medicine at Women's College Hospital in Toronto, Canada.

“Biologics have transformed the treatment of moderate-to-severe atopic dermatitis, but new treatments are expensive and not universally accessible,” Merilleno and colleagues wrote. “The objective of this study was to describe global utilization patterns of dupilumab and tralokinumab from 2017 to 2022 and estimate the associations of country-level economic status and atopic dermatitis disease burden with biologic utilization.”^1,2

Trial Design Details

The research team implemented pharmaceutical sales data from IQVIA MIDAS for the period between 2017 - 2022, looking into international trends in biologic medications for eczema across countries by examining the volume and value of sales of such drugs at the country level. The team also incorporated the SDI of each of the countries they evaluated, as well as disability-adjusted life years (DALY) and prevalence rates for eczema.

The latter set of data was sourced by the investigative team from the Global Burden of Disease Study, and they also looked at population data drawn from the World Bank. Biologic implementation rates were calculated by the investigators for each year by dividing the total units sold by the country’s population. They placed the rates into categories which were according to the SDI groups (low-middle/middle, high-middle, and high) and charted the annual averages.

For the purposes of exploring how SDI and atopic dermatitis DALY rates were connected to use of biologics, the research team used both univariable and multivariable linear regression analyses. In their sensitivity analysis, the team looked at prevalence rates rather than DALY rates to assess any link with biologic utilization in a univariable linear regression.

Any possible impacts of the COVID-19 pandemic were accounted for by the investigators when they conducted additional analyses through the use of data only from 2017 - March 2020.

Findings on Global Trends

The research team concluded that, over time, the global biologic use for patients with atopic dermatitis climbed significantly, especially in countries found to have high SDI scores. They found that biologics were only purchased in 3 high-SDI countries in 2017, specifically the US, France, and Germany, and the United States.

The investigators added that in these countries, the average biologic use rate was shown to be 1.1 units per 100,000 individuals. They also noted that by 2022, use of biologics had expanded to 47 more countries, leading to an average increase in use of 175.4 times, growing from 1.1 units per 100,000 in 2017 to 192.9 units per 100,000 individuals in the year 2022.

In 2022, the investigative team also found that countries in the high-SDI category showed an average rate of biologic use that was 28.2 times greater (329.6 units per 100,000) than that of lower-middle/middle-SDI countries (11.7 units per 100,000).

SDI was reported by the team to be heavily correlated with use of biologics, the team’s multivariable linear regression suggested. In fact, they highlighted that nations with a high-middle SDI utilized 10.9 more medication units (95% CI; −87.6 to 109.5). Additionally, high-SDI countries were shown by the investigators to have used 118.0 more units (95% CI; 27.7–208.3) per 100,000 individuals versus those with low-middle/middle-SDIs.

Despite such findings, the research team noted a lack of clear link between biologic usage and atopic dermatitis burden assessed by DALY rates, adding that there had only been a 0.7-unit rise in biologic implementation per 100,000 patients for each 1 DALY increase per 100,000 (95% CI; −0.3 to 1.7). In a similar vein, the team highlighted a lack of connection identified between rates of eczema prevalence and biologic use.

These data were shown to have held steady even when data following March 2020 was excluded from the analysis.

“This study highlights disparities in biologic utilization for atopic dermatitis between countries related to their sociodemographic status,” they wrote. “This relationship is most likely driven by the high costs of biologics restricting access in low-middle and middle-SDI countries. While biologics are available in some Latin American countries, financial barriers often limit their use.”¹

References

1. ^{Merilleno, A.S.P., Tadrous, M., Ushcatz, I., Zhao, H.J. and Drucker, A.M. (2024), Association between atopic dermatitis burden and sociodemographic index with dupilumab and tralokinumab utilization across 50 countries. Int J Dermatol. https://doi.org/10.1111/ijd.17543.}
2. ^{Davis DMR, Drucker AM, Alikhan A, Bercovitch L, Cohen DE, Darr JM, et al. Guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies. J Am Acad Dermatol. 2024; 90: e43–e56.}