Care pathways in atopic dermatitis: a retrospective population‐based cohort study

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Abstract

Background

Atopic dermatitis (AD) is a complex disease with variations in severity and healthcare utilization. Examining patient pathways through analyses of longitudinal patient data provides an opportunity to describe real‐world clinical patient care and evaluate healthcare access and treatment.

Objective

To describe longitudinal care pathways including health care management, treatment patterns and disease progression (by proxy measures) in patients with AD.

Materials and methods

This was a longitudinal observational study, which used linked data from national and regional healthcare registers in Sweden. Patients with AD were identified through diagnosis in primary or secondary care or by dispensed medications. Descriptive statistics for number of healthcare visits, type of dispensed drug class, rate of ‐ and time to ‐ referral to secondary care and treatment escalation were calculated.

Results

A total of 341 866 patients with AD distributed as 197 959 paediatric (age < 12), 36 133 adolescent (age ≥ 12‐ < 18) and 107 774 adult (age ≥ 18) patients were included in this study. Healthcare visits to primary and secondary care and dispensation of AD‐indicated treatments were more common during the year in which managed AD care was initiated. Topical corticosteroids (TCSs) and emollients were the most frequently used treatments across all age cohorts while systemic treatment was uncommon in all age cohorts. Among patients who initiated treatment with TCSs, 18.2% escalated to TCSs with higher potency following the start of managed AD care.

Conclusions

We found that healthcare contacts and use of AD‐indicated treatments were concentrated in the year during which managed AD care was initiated and decreased significantly thereafter. Since a significant proportion of patients with AD have flares and persistent AD, our results suggest that patients with AD may be monitored infrequently and are undertreated. There is a need to inform practitioners about adequate treatment options to provide individualized care, in particular for patients with persistent severe AD.

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Most cited references 26

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Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I

J.C. Szepietowski, T Bieber, S. Christen-Zaech … (2018)

This guideline was developed as a joint interdisciplinary European project, including physicians from all relevant disciplines as well as patients. It is a consensus-based guideline, taking available evidence from other guidelines, systematic reviews and published studies into account. This first part of the guideline covers methods, patient perspective, general measures and avoidance strategies, basic emollient treatment and bathing, dietary intervention, topical anti-inflammatory therapy, phototherapy and antipruritic therapy, whereas the second part covers antimicrobial therapy, systemic treatment, allergen-specific immunotherapy, complementary medicine, psychosomatic counselling and educational interventions. Management of AE must consider the individual clinical variability of the disease; highly standardized treatment rules are not recommended. Basic therapy is focused on treatment of disturbed barrier function by hydrating and lubricating topical treatment, besides further avoidance of specific and unspecific provocation factors. Topical anti-inflammatory treatment based on glucocorticosteroids and calcineurin inhibitors is used for flare management and for proactive therapy for long-term control. Topical corticosteroids remain the mainstay of therapy, whereas tacrolimus and pimecrolimus are preferred in sensitive skin areas and for long-term use. Topical phosphodiesterase inhibitors may be a treatment alternative when available. Adjuvant therapy includes UV irradiation, preferably with UVB 311 nm or UVA1. Pruritus is targeted with the majority of the recommended therapies, but some patients may need additional antipruritic therapy. Antimicrobial therapy, systemic anti-inflammatory treatment, immunotherapy, complementary medicine and educational intervention will be addressed in part II of the guideline.

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Prevalence and Incidence of Atopic Dermatitis: A Systematic Review

Simon B. A. Bylund, Laura von Kobyletzki, Marika Svalstedt … (2020)

The primary objective of this study was to systematically review and analyse epidemiological studies of the prevalence and incidence of atopic dermatitis (AD) during childhood and adulthood, focusing on data from the 21 st century. A systematic search of PubMed, EMBASE and Google (manual search) was performed in June 2019, followed by data abstraction and study quality assessment (Newcastle–Ottawa Scale). Cross-sectional and longitudinal epidemiological studies of individuals with AD (doctor-diagnosed or standardized definition) were included. Of 7,207 references reviewed, 378 moderate/good-quality studies were included: 352 on prevalence of AD and 26 on incidence of AD. In the 21 st century, the 1-year prevalence of doctor-diagnosed AD ranged from 1.2% in Asia to 17.1% in Europe in adults, and 0.96% to 22.6% in children in Asia. The 1-year incidence ranged from 10.2 (95% confidence interval (95% CI) 9.9– 10.6) in Italy to 95.6 (95% CI 93.4–97.9) per 1,000 person-years in children in Scotland. There were few recent studies on incidence of AD in the 21 st century and no studies on adults only; most studies were conducted in Europe and the USA. Epidemiological studies on childhood and adulthood AD in different continents are still needed, especially on the incidence of AD during adulthood.

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The Atopic March: Progression from Atopic Dermatitis to Allergic Rhinitis and Asthma

Selene K. Bantz, Zhou Zhu, Tao Zheng (2014)

The development of atopic dermatitis (AD) in infancy and subsequent allergic rhinitis and asthma in later childhood is known as the atopic march. This progressive atopy is dependent on various underlying factors such as the presence of filaggrin mutations as well as the time of onset and severity of AD. Clinical manifestations vary among individuals. Previously it was thought that atopic disorders may be unrelated with sequential development. Recent studies support the idea of a causal link between AD and later onset atopic disorders. These studies suggest that a dysfunctional skin barrier serves as a site for allergic sensitization to antigens and colonization of bacterial super antigens. This induces systemic Th2 immunity that predisposes patients to allergic nasal responses and promotes airway hyper reactivity. While AD often starts early in life and is a chronic condition, new research signifies that there may be an optimal window of time in which targeting the skin barrier with therapeutic interventions may prevent subsequent atopic disorders. In this review we highlight recent studies describing factors important in the development of atopic disorders and new insights in our understanding of the pathogenesis of the atopic march.

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Author and article information

Contributors

L. von Kobyletzki:

ORCID: https://orcid.org/0000-0002-3094-9685

laura.von_kobyletzki@med.lu.se

G. Ortsäter:

ORCID: https://orcid.org/0000-0001-5102-3358

gustaf.ortsater@quantifyresearch.com

Journal

Journal ID (nlm-ta): J Eur Acad Dermatol Venereol

Journal ID (iso-abbrev): J Eur Acad Dermatol Venereol

Journal ID (doi): 10.1111/(ISSN)1468-3083

Journal ID (publisher-id): JDV

Title: Journal of the European Academy of Dermatology and Venereology

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Print): 0926-9959

ISSN (Electronic): 1468-3083

Publication date (Electronic): 18 May 2022

Publication date (Print): September 2022

Volume: 36

Issue: 9 ( doiID: 10.1111/jdv.v36.9 )

Pages: 1456-1466

Affiliations

[ ¹ ] Department of Occupational and Environmental Dermatology Skåne University Hospital, Lund University Lund Sweden

[ ² ] Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden

[ ³ ] Department of Dermatology and Sexual Health Södersjukhuset Stockholm Sweden

[ ⁴ ] Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet Stockholm Sweden

[ ⁵ ] Pfizer AB Sollentuna Sweden

[ ⁶ ] Department of Medical Sciences Uppsala University Uppsala Sweden

[ ⁷ ] Pfizer Inc. New York NY USA

[ ⁸ ] Quantify Research Stockholm Sweden

[ ⁹ ] Dermatology and Venereology, Department of Public Health and Clinical Medicine Umeå University Umeå Sweden

[ ¹⁰ ] Inflammation & Immunology Pfizer Ltd Surrey UK

[ ¹¹ ] Department of Dermatology and Venereology Bispebjerg Hospital, University of Copenhagen Copenhagen Denmark

Author notes

[*] [* ]Correspondence: L. von Kobyletzki. E-mail: laura.von_kobyletzki@ 123456med.lu.se ; G. Ortsäter. E-mail: gustaf.ortsater@ 123456quantifyresearch.com

Author information

L. von Kobyletzki https://orcid.org/0000-0002-3094-9685

N. Ballardini https://orcid.org/0000-0001-6759-346X

D. Henrohn https://orcid.org/0000-0001-9514-1153

M.P. Neary https://orcid.org/0000-0002-8584-3677

G. Ortsäter https://orcid.org/0000-0001-5102-3358

K. Geale https://orcid.org/0000-0001-7241-8471

A. Rieem Dun https://orcid.org/0000-0002-8182-5682

I. Lindberg https://orcid.org/0000-0002-6549-6065

A. De Geer https://orcid.org/0000-0002-5327-3198

P. Neregård https://orcid.org/0000-0001-9115-3878

J.C. Cappelleri https://orcid.org/0000-0001-9586-0748

W. Romero https://orcid.org/0000-0002-5573-0110

J.P. Thyssen https://orcid.org/0000-0003-3770-1743

Article

Publisher ID: JDV18185 Other ID: JEADV-2021-3857.R1

DOI: 10.1111/jdv.18185

PMC ID: 9542393

PubMed ID: 35470924

SO-VID: 9d620233-04b9-4871-b5bf-57d16bfaa1e0

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

History

Date received : 30 December 2021

Date accepted : 31 March 2022

Page count

Figures: 5, Tables: 3, Pages: 1466, Words: 7914

Funding

Funded by: Pfizer , doi 10.13039/100004319;

Award ID: GPP3

Custom metadata

source-schema-version-number 2.0

cover-date September 2022

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.2.0 mode:remove_FC converted:07.10.2022

ScienceOpen disciplines: Dermatology

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ScienceOpen disciplines: Dermatology

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Care pathways in atopic dermatitis: a retrospective population‐based cohort study

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Abstract

Background

Objective

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Results

Conclusions

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Karger: Dermatology

Most cited references 26

Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I

Prevalence and Incidence of Atopic Dermatitis: A Systematic Review

The Atopic March: Progression from Atopic Dermatitis to Allergic Rhinitis and Asthma

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