Katrina Abuabara, MD: Patient-Reported Outcomes in Long Term Atopic Dermatitis Monitoring

Katrina Abuabara, MD, MA, MSCE

Credit: ucsfhealth.org

In this HCPLive interview, Katrina Abuabara, MD, MSCE, went into several major points from her presentation at the Revolutionizing Atopic Dermatitis (RAD) 2023 Annual Meeting in Washington, DC, including discussing the role of patient-reported outcomes on monitoring atopic dermatitis (AD).

Abuabara works as a researcher and dermatologist at the University of California, San Francisco and her research lab is known for its studies into the processes of aging and AD. She also is known for her research at the UC Berkeley School of Public Health.

For this Q&A with HCPLive, Abuabara described several more of the key takeaways from her RAD presentation regarding long-term AD control, describing patient-reported outcome measurements specifically.

“Patient-reported outcomes are incredibly important in atopic dermatitis or eczema,” she explained. “So, I alluded to the HOME initiative. HOME stands for harmonizing outcome measures and eczema, and you can't really talk about measuring eczema or atopic dermatitis—I'm using those terms interchangeably—in clinical trials without talking about HOME.”

She explained about the HOME initiative, which she added was started over a 10 years ago by Hywel Williams. Abuabara noted that the initiative involved clinicians, methodologists, patient advocates, foreign representatives, and patients themselves around the world.

“And they've had a series of meetings, and published dozens of papers, trying to standardize the outcomes for eczema, especially for clinical trials,” she said. “But also, they now have an initiative to standardize and provide recommendations for ways to measure eczema in clinical practice as well. So what they did was they identified 4 core domains that were really important to measure in any clinical trial, and those are signs, symptoms, quality of life, and long term control.”

Despite this list by the HOME initiative, Abuabara explained that only the ‘signs’ domain is measured by clinicians, typically. She added that they recommend using the Eczema Area Severity Index (EASI) score.

“But in terms of symptoms, they recommend using the patient-oriented outcome measure and an itch scale called the NRS 11,” she said. “In terms of quality of life, they recommend the DLQi or the Dermatology Life Quality Index, and there's also child and infant versions of that. And then in terms of long term control, they recommend using the Recap or the ADCT instrument.”

Abuabara also added that both Recap and the ADCT are quite similar instruments, noting that they are both available for free online and take only a few minutes to fill out. She also mentioned that the tools are patient reported and that a lot of work went into developing them.

“So it's part of this whole outcome measures process that was followed by HOME,” Abuabara explained. “First they looked into a systematic review to see how long term control was measured in research. And they published a systematic review back in 2016, that I was a part of…They looked at what kind of outcome measures people use to look at control and most using repeated measures of AD outcomes about a third use medication, and about a third quarter used at flares or remissions.”

Abuabara also noted that while flare assessment seems intuitive, it may actually be hard to measure what is defined as a flare, adding that in most trials her team had examined there were differences in how everyone did it.

“So they set out to try to define what long term control was by doing a big qualitative study with focus groups from patients from 6 different countries,” she noted. “And that qualitative study found that long term control really involves 3 major concepts. One is a reduction in disease activity. So you see that, that has to do with signs and symptoms, like the level of itch or pain or redness, or link to control.”

She added that the second area had to do with changes in treatment and AD management, with patients going from the highest-potency treatments to lower potency treatments or or no treatments, with the ability to just use one’s maintenance treatment regimen.

“And then finally, the third aspect of long term control is that it goes beyond the skin so it's not just the skin signs or symptoms or medication, but also the impacts on daily living,” Abuabara explained.

Abuabara stated that the final of these 3 aspects that came from their qualitative research showed that long term control varied quite a bit between individuals, which is why new patient-reported measures of Recap and ADCT were developed to understand it.

The quotes contained in this Q&A interview were edited for clarity.