Patients who Achieve Rapid Onset Itch Relief, Skin Clearance more Satisfied with Eczema Therapy

Melinda Gooderham, MSc, MD

Patient satisfaction with atopic dermatitis treatment is closely correlated with significant response to both onset to and overall itch improvement, as well as greater skin clearance.¹

An analysis from a recent patient survey—presented during the late-breaking abstract sessions at the Revolutionizing Atopic Dermatitis (RAD) 2023 Spring Conference in Washington, DC—provided a clearer glimpse into the priorities and interests of patients receiving treatment for atopic dermatitis. More specifically, the outcomes elucidate means by which clinicians can strategize care to improve patient quality of life.

Presented by study author Melinda Gooderham, MSc, MD, medical director of the SKiN Centre for Dermatology and assistant professor at Queens University, the multinational team of investigators sought to investigate patient satisfaction with treatment for their moderate to severe atopic dermatitis based on the degree of skin clearance and itch improvement, as well as the speed of itch improvement.

Prior survey research also presented at RAD 2023 showed that among the key components of treatment efficacy most prioritized by patients were improvement in skin appearance and itch, and speed of treatment onset.² Another trial presented at RAD 2023 showed the major prevalence and burden of itch, or pruritus, on atopic dermatitis: an estimated 95.3% of all patients with atopic dermatitis reported itch at a Brazil university hospital; mean Pruritus Numerical Rating Scale (NRS) score among impacted patients was 7.28.³

“Numerous systemic therapies are currently available to treat moderate-to-severe atopic dermatitis,” Gooderham and colleagues noted. “However, more data evaluating patient satisfaction with various characteristics of these treatments are needed to inform shared decision-making between physicians and their patients.”

The team conducted a cross-sectional online survey of adult patients in the US with physician-diagnosed moderate to severe atopic dermatitis. Patients were queried on baseline demographics, dermatitis history, symptom status, and their history with atopic dermatitis therapies. They were additionally asked to rate 4 components of treatment preference:

• Itch based on the worst symptom experienced in the past 24 hours (Worst Pruritus NRS)
• Itch based on number of days with itchy skin (0 – 7 days)
• Speed of improvement in itch based on time to notable reduction following initiated or current treatment (1 - ≥14 days)
• Skin clearance per body surface area (BSA) still affected by atopic dermatitis (≤2% - >10%)

The participants were additionally asked to grade their treatment satisfaction on a 7-item scale ranging from “extremely satisfied” to “extremely dissatisfied.” Their satisfaction scores were based on itch improvement, speed of itch improvement, and degree of skin clearance.

The final assessment included 200 survey respondents; 186 were receiving current atopic dermatitis treatment. Prescription topical therapy was the most prevalent treatment (72.0%), followed by dupilumab (11.3%). Median patient age was 44.0 years old; 59.5% of patients were female and 49.5% were White. Patients had primarily been diagnosed with atopic dermatitis ≥20 years ago (30.5%) and suffered from moderate disease (38.5%).

Gooderham and colleagues reported just 14.5% of patients taking therapy reported Worst Pruritus NRS scores of 0 or 1; 9.1% reported 0 days of itchy skin in the past week. Skin clearance appeared more successful among patients; 45.3% reported a notable reduction in itch after 1-6 days and 41.0% reported a BSA of ≤2%.

Patients with a Worst Pruritus NRS score of 0-1 were significantly more likely to express satisfaction with their therapy (85.2%) then patients with scores of 2-3 (54.7%), 4-7 (19.6%), or 8-10 (7.1%; P <.001).

Investigators noted their trial was limited by no consideration given to treatment safety outcomes, as well as the results coming from a convenience sample that may not be generalized to the US atopic dermatitis patient population.

However, they concluded their findings show patients with moderate to severe atopic dermatitis who were able to achieving the greatest improvement in daily itch and skin clearance reported the greatest rates of treatment satisfaction.

“Choosing a treatment that has a rapid onset of improvement will be more beneficial for treatment satisfaction,” Gooderham said. “As they say: happy patient, happy doctor.”

References

1. ^{Silverberg JI, Gooderham M, Pink AE, Mansfield C. Patient Satisfaction With Treatments for Moderate-to-Severe Atopic Dermatitis According to Degree and Speed of Skin and Itch Improvements: Results From a Patient Survey in the United States. Paper presented at: Revolutionizing Atopic Dermatitis 2023 Spring Conference; April 29 – May 1, 2023; Washington, DC. Accessed April 30, 2023.}
2. ^{Kunzmann K. What Do Atopic Dermatitis Patients Want From Their Therapy? HCPLive. Published April 30, 2023. https://www.hcplive.com/view/what-do-atopic-dermatitis-patients-want-therapy}
3. ^{Kunzmann K. More Than 95% of Atopic Dermatitis Patients Experience Chronic Itch. HCPLive. Published April 30, 2023. https://www.hcplive.com/view/more-than-95-atopic-dermatitis-patients-chronic-itch}