Patterns of pharmacological treatment in adult patients with atopic dermatitis
Background: Atopic dermatitis is a chronic inflammatory skin disease with an estimated prevalence ranging from 2-17% in adults. The current standards of pharmacological treatment in the real-world setting are unknown.
Objective: To determine drug prescription patterns in the treatment of adult Colombian patients diagnosed with atopic dermatitis.
Materials and methods: This observational study analyzed prescription records of patients aged >18 years who were diagnosed with atopic dermatitis between January and December 2017. Sociodemographic and pharmacological variables (topical and systemic corticosteroids, calcineurin inhibitors, immunomodulators and antihistamines) and concomitant medications were evaluated.
Results: In total, 15839 patients were identified with a mean age of 43.5±25.8 years, mainly women (63.7%). A prevalence of atopic dermatitis of 0.3% in adults was estimated, with an incidence of 361.0 new cases/100.000 individuals during the study period. Topical corticosteroids were the most frequently prescribed medications (84.4%), followed by antihistamines (59.3%), systemic corticosteroids (32.6%), immunomodulators (1.7%) and calcineurin inhibitors (1.2%); 56.8% of patients received combination therapy. Conclusions: Treatment of atopic dermatitis is infrequently reported in the country. It mainly affects adult women, and patients are treated predominantly with topical corticosteroids, either as a monotherapy or in combination with antihistamines and systemic corticosteroids for short periods of time.
2. Sacotte R, Silverberg JI. Epidemiology of adult atopic dermatitis. Clin Dermatol. 2018;36(5):595-605. https://doi.org/10.1016/j.clinder matol.2018.05.007
3. Ozkaya E. Adult-onset atopic dermatitis. J Am Acad Dermatol. 2005;52(4):579-82. https://doi.org/10.1016/j.jaad.2004.11.037
4. Deckers IA, McLean S, Linssen S, Mommers M, van Schayck C, Sheik A. Investigating international time trends in the incidence and prevalence of atopic eczema 1990-2010: a systematic review of epidemiological studies. PLoS One. 2012;7:e39803. https://doi.org/10.1371/journal.pone.0039803
5. Sidbury R, Kodama S. Atopic dermatitis guidelines: Diagnosis, systemic therapy, and adjunctive care. Clin Dermatol. 2018;36(5):648-52. https://doi.org/10.1016/j.clindermatol.2018.05.008
6. Williams HC. Atopic dermatitis. N Engl J Med. 2005;352:2314-24. https://doi.org/10.1056/NE JMcp042803
7. Leung DY. New insights into atopic dermatitis: role of skin barrier and immune dysregulation. Allergol Int. 2013;62(2):151-61. https://doi.org/10.2332/allergolint.13-RAI-0564
8. Harrop J, Chinn S, Verlato G, Oliveri M, Norbäck D, Janson C, et al. Eczema, atopy and allergen exposure in adults: a population-based study. Clin Exp Allergy. 2007;37(4):526-35. https://doi.org/10.1111/j.1365-2222.2007.02679.x
9. Eichenfield LF, Tom WL, Chamlin SL, Harrod C, Smith W, Sidbury R, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014;70(2):338-51. https://doi.org/10.1016/j.jaad.2013.10.010
10. Tollefson MM, Bruckner AL; Section On Dermatology. Atopic dermatitis: skin-directed anagement. Pediatrics. 2014;134(6):e1735-44. https://doi.org/10.1542/peds.2014-2812
11. Giavina-Bianchi M, Giavina-Bianchi P. Systemic Treatment for Severe Atopic Dermatitis. Arch Immunol Ther Exp (Warsz). 2019;67:69-78. https://doi.org/10.1007/s00005-018-0521-y
12. Zhong CS, Elmariah SB. Novel therapies in the treatment of atopic dermatitis. Semin Cutan Med Surg. 2018;37:190-197. https://doi.org/10.12788/j.sder.2018.044
13. Wollenberg A, Barbarot S, Bieber T, Christen-Zaech S, Deleuran M, Fink A. et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part II. JEADV. 2018;32(6):850-78. https://doi.org/10.1111/jdv.14888
14. Ariëns LFM, Bakker DS, van der Schaft J, Garritsen F, Thijs J, de Bruin-Weller M. Dupilumab in atopic dermatitis: rationale, latest evidence and place in therapy. Ther Adv Chronic Dis. 2018;9:159-170. https://doi.org/10.1177/2040622318773686
5. Fabbrocini G, Napolitano M, Megna M, Balato N, Patruno C. Treatment of Atopic Dermatitis with Biologic Drugs. Dermatol Ther (Heidelb). 2018;8:527-38. https://doi.org/10.1007/s13555-018-0258-x
16. Dennis RJ, Caraballo L, Garcia E, et al. Prevalence of asthma and other allergic conditions in Colombia 2009-2010: a cross-sectional study. BMC Pulm Med. 2012;12:17. https://doi.org/10.1186/1471-2466-12-17
17. Egeberg A, Andersen YMF, Gislason GH, Thyssen J, Skow L. Differential disease burden and treatment patterns among adults with psoriasis and atopic dermatitis seen in hospital vs. private clinics. J Eur Acad Dermatol Venereol. 2018;32(1):e23-e25. https://doi.org/10.1111/jdv.14441
18. Chiesa Fuxench ZC, Block JK, Boguniewicz M, Schwartz L. Atopic Dermatitis in America Study: A Cross-Sectional Study Examining the Prevalence and Disease Burden of Atopic Dermatitis in the US Adult Population. J Invest Dermatol. 2019;139(3):583-90. https://doi.org/10.1016/j.jid.2018.08.028
19. Abuabara K, Hoffstad O, Troxel A, Gelfand J, Margolis D. Atopic dermatitis disease control and age: A cohort study. J Allergy Clin Immunol. 2015;136(1):190-192.e3. https://doi.org/10.1016/j.jaci.2015.03.028
20. Hua T, Silverberg JI. Atopic dermatitis in US adults: Epidemiology, association with marital status, and atopy. Ann Allergy Asthma Immunol. 2018;121(5):622-4. https://doi.org/10.1016/j.anai.2018.07.019
21. Silverberg JI, Gelfand JM, Margolis DJ, Boguniewicz M, Fonacier L, Grayson M, et al. Atopic Dermatitis in US Adults: From Population to Health Care Utilization. J Allergy Clin Immunol Pract. 2019;7(5):1524-32.e2. https://doi.org/10.1016/j.jaip.2019.01.005
22. Goh YY, Keshavarzi F, Chew YL, Ling Y. Prevalence of Atopic Dermatitis and Pattern of Drug Therapy in Malaysian Children. Dermatitis. 2018;29(3):151-61. https://doi.org/10.1097/DER.0000000000000376
23. Wollenberg A, Oranje A, Deleuran M, Simon D, Szakai Z, Kunz B, et al. ETFAD/EADV Eczema task force 2015 position paper on diagnosis and treatment of atopic dermatitis in adult and paediatric patients. J Eur Acad Dermatol Venereol. 2016;30(5):729-47. https://doi.org/10.1111/jdv.13599
24. Roekevisch E, Spuls PI, Kuester D, Limpens J, Schmitt J. Efficacy and safety of systemic treatments for moderate-to-severe atopic dermatitis: a systematic review. J Allergy Clin Immunol. 2014;133(2):429-38. https://doi.org/10.1016/j.jaci.2013.07.049
25. Matterne U, Böhmer MM, Weisshaar E, Jupiter A, Carter B, Apfelbacher C. Oral H1 antihistamines as 'add-on' therapy to topical treatment for eczema. Cochrane Database Syst Rev. 2019;1:CD012167. https://doi.org/10.1002/14651858.CD012167.pub2
26. Diepgen TL. Long-term treatment with cetirizine of infants with atopic dermatitis: a multi-country, double-blind, randomized, placebo-controlled trial (the ETAC trial) over 18 months. Pediatr Allergy Immunol. 2002;13(4):278-86. https://doi.org/10.1034/j.1399-3038.2002.01047.x
27. Silverwood RJ, Forbes HJ, Abuabara K, Ascott A, Schmidt S, Smeeth L, et al. Severe and predominantly active atopic eczema in adulthood and long term risk of cardiovascular disease: population based cohort study. BMJ. 2018;361:k1786. https://doi.org/10.1136/bmj.k1786
28. Cheng CM, Hsu JW, Huang KL, Bai Y, Su T, Li C, et al. Risk of developing major depressive disorder and anxiety disorders among adolescents and adults with atopic dermatitis: a nationwide longitudinal study. J Affect Disord. 2015;178:60-5. https://doi.org/10.1071/PVv2015n178p60