Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section IV: Consensus Statements on the Assessment and Management of Pediatric Atopic Dermatitis

Lansang, Perla; Lara‐Corrales, Irene; Bergman, James N.; Hong, Chih-ho; Joseph, Marissa; Kim, Vy H. D.; Lam, Joseph M.; Landells, Ian; Marcoux, Danielle; Prajapati, Vimal H.; Ramien, Michele; Spring, Shanna

doi:10.1177/1203475419882654

Cited by 15 publications

(28 citation statements)

References 4 publications

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“…Three CPGs had no red flags: from Malaysia, 49 South Korea 60 and the UK (antimicrobials) 66 . The CPGs assigned the most red flags were from Canada, each with seven out of eight 17–27 . Looking at the domains assessed, most red flags were for ‘no external review’, with 32 of the CPGs flagged, in line with the score of that IOM criterion.…”

Section: Resultsmentioning

confidence: 99%

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Global Guidelines in Dermatology Mapping Project (GUIDEMAP), a systematic review of atopic dermatitis clinical practice guidelines: are they clear, unbiased, trustworthy and evidence based (CUTE)?*

Arents¹,

Zuuren

Vermeulen

et al. 2022

Br J Dermatol

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Background Clinical practice guidelines (CPGs) are essential in delivering optimum healthcare, such as for atopic dermatitis (AD), a highly prevalent skin disease. Although many CPGs are available for AD, their quality has not been critically appraised. Objectives To identify CPGs on AD worldwide and to assess with validated instruments whether those CPGs are clear, unbiased, trustworthy and evidence based (CUTE). Methods We searched MEDLINE, Embase, PubMed, Web of Science, Cochrane Library, Emcare, Epistemonikos, PsycINFO and Academic Search Premier for CPGs on AD published between 1 April 2016 and 1 April 2021. Additionally we hand searched prespecified guideline resources. Screening, data extraction and quality assessment of eligible guidelines were independently carried out by two authors. Instruments used for quality assessment were the AGREE II Reporting Checklist, the US Institute of Medicine (IOM) criteria of trustworthiness and Lenzer’s Red Flags. Results Forty CPGs were included, mostly from countries with a high sociodemographic index. The reporting quality varied enormously. Three CPGs scored ‘excellent’ on all AGREE II domains and three scored ‘poor’ on all domains. We found no association between AGREE II scores and a country’s gross domestic product. One CPG fully met all nine IOM criteria and two fully met eight. Three CPGs had no red flags. ‘Applicability’ and ‘rigour of development’ were the lowest scoring AGREE II domains; ‘external review’, ‘updating procedures’ and ‘rating strength of recommendations’ were the IOM criteria least met; and most red flags were for ‘limited or no involvement of methodological expertise’ and ‘no external review’. Management of conflicts of interest (COIs) appeared challenging. When constructs of the instruments overlapped, they showed high concordance, strengthening our conclusions. Conclusions Overall, many CPGs are not sufficiently clear, unbiased, trustworthy or evidence based (CUTE) and lack applicability. Therefore improvement is warranted, for which using the AGREE II instrument is recommended. Some improvements can be easily accomplished through robust reporting. Others, such as transparency, applicability, evidence foundation and managing COIs, might require more effort.

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Section: Resultsmentioning

confidence: 99%

“…Second to that was 'sponsor (s) is a professional society that receives substantial industry funding', which was also difficult to assess, with six of the 40 CPGs still being red flagged. [12][13][14][16][17][18][19][20][21][22][23][24][25][26][27] The data are summarized in Table 3 and Table S5 (see Supporting Information).…”

Section: Red Flags Scoringmentioning

confidence: 99%

Global Guidelines in Dermatology Mapping Project (GUIDEMAP), a systematic review of atopic dermatitis clinical practice guidelines: are they clear, unbiased, trustworthy and evidence based (CUTE)?*

Arents¹,

Zuuren

Vermeulen

et al. 2022

Br J Dermatol

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“…The costs substantially increased when considering AD-related comorbidities, particularly asthma, bacterial skin infections, depression and sleep disorder; the impact of these comorbidities on the burden of AD has been recognised in previous studies [ 14 , 52 – 54 ]. Despite its low frequency in THIN (1.38%), sleep disorder is estimated to account for substantial costs (€14,667,476.37 in 2020) at the UK population level.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Economic Burden of Mild-to-Moderate Atopic Dermatitis in the UK: A Propensity-Score-Matched Case–Control Study

Toron

Neary

Smith

et al. 2021

Dermatol Ther (Heidelb)

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Introduction The burden of mild-to-moderate atopic dermatitis (AD) in the United Kingdom (UK) is not well understood. Long-lasting AD flares may lead to systemic inflammation resulting in reversible progression from mild to more severe AD. This study aimed to assess the clinical and economic burden of mild-to-moderate AD in the UK. Methods AD patients were identified in the Health Improvement Network (THIN) from 2013 to 2017 and propensity score matched to non-AD controls by demographics. Patients were identified based on continuous disease activity using validated algorithms and sufficient patient status to fully validate data integrity for the entire period. Mild-to-moderate AD patients were identified by using treatment as a surrogate. Demographics, clinical characteristics and healthcare resource use (HCRU) were obtained from THIN. Literature reviews were conducted to obtain additional outcomes. A cost-of-illness model was developed to extrapolate the burden in 2017 to the UK population and in subsequent years (2018–2022). Results In 2017, the prevalence of mild-to-moderate AD in THIN was 1.28%. These patients reported higher comorbidity rates and significantly higher ( p < 0.0001) HCRU, encompassing mean general practitioner visits (5.57 versus 3.59), AD-related prescriptions (5.85 versus 0.68) and total referrals (0.97 versus 0.82) versus matched non-AD controls. The model projected total HCRU and drug excess costs of €462.99M over the 5 years. The excess cost decreased to €417.35M after excluding patients on very potent topical corticosteroids, who most likely had at least moderate disease. The excess costs increased to €1.21B and €7.06B when considering comorbidity burden and productivity losses, respectively. Conclusion Mild-to-moderate AD patients had higher comorbidity burden, HCRU and cost compared with matched non-AD controls. Overall, UK country-based economic burden was high given partly the high prevalence of this disease. Moreover, productivity burden and comorbidities had considerable impact on the economic burden, which further suggests the importance of optimal disease management. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00519-7.

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“…However, they remain one of the most employed assessment tools because of the usability in clinical practice and requirements by authorities for drug labeling. Although initiatives to validate global assessments are underway, variability and lack of standardization in these assessments do not produce sufficiently reliable data to inform decision-making and therefore are not optimal for this purpose [60][61][62][63][64][65][66][67].…”

Section: Global Assessment Scalesmentioning

confidence: 99%

“…Key symptoms of AD such as pruritus, sleep disturbance, and interference with daily activities can be challenging to assess [64]. PROMs are useful in clinical practice because of their ease of use and potential correlations with established objective scales [65].…”

Section: Promsmentioning

confidence: 99%

The Unmet Needs in Atopic Dermatitis Control in Latin America: A Multidisciplinary Expert Perspective

Sánchez

Chérrez-Ojeda

Galván

et al. 2021

Dermatol Ther (Heidelb)

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Introduction: Adoption of control tools for atopic dermatitis (AD) in Latin America (LA) is currently very limited. Clinical assessment tools represent a practical method to measure the impact of treatment on disease activity and on the quality of life of patients. However, the use of these tools in the LA clinical practice setting is limited. Methods: A selected panel of Latin American experts in fields related to atopic dermatitis were provided with a series of relevant questions to address prior to the multi-day conference. Within this conference, each narrative was discussed and edited by the entire group, through numerous drafts and rounds of discussion, until a consensus was achieved. Results: The panel proposes specific and realistic recommendations for implementing control tools for AD care in LA. In creating these recommendations, the authors strove to address all barriers to the widespread use of these tools. Conclusion: This article includes a narrative analysis of barriers to AD control in LA and

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Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section IV: Consensus Statements on the Assessment and Management of Pediatric Atopic Dermatitis

Cited by 15 publications

References 4 publications

Global Guidelines in Dermatology Mapping Project (GUIDEMAP), a systematic review of atopic dermatitis clinical practice guidelines: are they clear, unbiased, trustworthy and evidence based (CUTE)?*

Global Guidelines in Dermatology Mapping Project (GUIDEMAP), a systematic review of atopic dermatitis clinical practice guidelines: are they clear, unbiased, trustworthy and evidence based (CUTE)?*

Clinical and Economic Burden of Mild-to-Moderate Atopic Dermatitis in the UK: A Propensity-Score-Matched Case–Control Study

The Unmet Needs in Atopic Dermatitis Control in Latin America: A Multidisciplinary Expert Perspective

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