Costs and Treatment Patterns Among Patients with Atopic Dermatitis Using Advanced Therapies in the United States: Analysis of a Retrospective Claims Database

Eichenfield, Lawrence F.; DiBonaventura, Marco; Xenakis, Jason; Lafeuille, Marie-Hélène; Duh, Mei Sheng; Fakih, Iman; Levenberg, Mark; Cappelleri, Joseph C.; Sikirica, Vanja

doi:10.1007/s13555-020-00413-8

Cited by 30 publications

(35 citation statements)

References 23 publications

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“… 1 , 2 Affecting up to 20% of children and 10% of adults globally, 3 , 4 AD is significantly associated with decreased levels of health‐related quality of life (QoL), 5 , 6 increased work‐related impairment 5 , 7 and high healthcare costs. 8 , 9 , 10 …”

Section: Introductionmentioning

confidence: 99%

Comparative efficacy and safety of systemic therapies used in moderate‐to‐severe atopic dermatitis: a systematic literature review and network meta‐analysis

Silverberg

Thyssen

Fahrbach

et al. 2021

Acad Dermatol Venereol

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Given the lack of head-to-head studies of systemic therapies in moderate-to-severe atopic dermatitis (AD), network meta-analyses (NMAs) can provide comparative efficacy and safety data to inform clinical decision-making. In this NMA, eligible randomized controlled trials (RCTs) published before 24 October 2019 were identified by a systematic literature review. Short-term (12-16 weeks) efficacy (Investigator's Global Assessment [IGA] and Eczema Area and Severity Index [EASI] responses), patient-reported outcomes (PROs) and safety data from each trial were abstracted and analysed separately for monotherapy and combination therapy (systemic plus topical anti-inflammatory therapy). RCTs were analysed in fixed-effects and random-effects Bayesian NMA models. Overall, 19 phase 2 and phase 3 RCTs of abrocitinib, baricitinib, dupilumab, lebrikizumab, nemolizumab, tralokinumab and upadacitinib were included. In monotherapy RCTs, upadacitinib 30 mg once daily (QD) had the numerically highest efficacy (83.6% achieved ≥50% improvement in EASI [EASI-50 response]), followed by abrocitinib 200 mg QD (74.6%), upadacitinib 15 mg QD (70.5%), dupilumab 300 mg every 2 weeks (Q2W) (63.4%) and abrocitinib 100 mg QD (56.7%). Similar trends in EASI-75 and EASI-90 response were observed. In combination therapy RCTs, abrocitinib 200 mg QD had the highest EASI-50 (86.6%), followed by dupilumab 300 mg Q2W (82.4%) and abrocitinib 100 mg QD (79.7%). Similar findings were observed for IGA response and PROs. In monotherapy and combination therapy RCTs, the probability of treatment-emergent adverse events (TEAEs) was higher among all active treatments than with placebo (except for dupilumab 300 mg Q2W [odds ratio (OR), 0.96; 95% credible interval (CrI), 0.45-2.18] and abrocitinib 100 mg QD [OR, 0.95; 95% CrI, 0.35-2.66] in combination therapy RCTs), although active treatments did not significantly differ from one another. Abrocitinib, dupilumab and upadacitinib were consistently the most effective systemic therapies in adult and adolescent patients with AD, with no significant TEAE differences in short-term RCTs.

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Section: Introductionmentioning

confidence: 99%

Comparative efficacy and safety of systemic therapies used in moderate‐to‐severe atopic dermatitis: a systematic literature review and network meta‐analysis

Silverberg

Thyssen

Fahrbach

et al. 2021

Acad Dermatol Venereol

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“…Importantly, the Japanese and international AD guidelines discourage the long‐term use of systemic corticosteroids because of severe side effects, 16 especially in children, 17 but the results of the current study showed that oral corticosteroid use is approximately 8% in Japan. A recent analysis of a US claims database showed similar results, with 73.4% of patients who initiated treatments associated with moderate‐to‐severe AD beginning treatment with a systemic corticosteroid 18 . For short‐term management (≤1 week) of AD, clinicians might use oral corticosteroids in patients with severe AD because of the low cost and lack of better treatment options, 16 highlighting the need for alternative treatments.…”

Section: Discussionmentioning

confidence: 87%

Real‐world treatment patterns of patients with atopic dermatitis in Japan: Analysis of the JMDC Claims Database

Kamei

Saeki

Tsuchiya

et al. 2021

J Cutaneous Imm & Allergy

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Objectives This study was conducted to assess changes in the real‐world treatment of atopic dermatitis (AD) in Japan. Methods Patients from the JMDC Claims Database with ≥1 confirmed diagnosis of AD, an identifiable medical care start date for AD, and ≥2 AD–related treatments on separate dates between January 1, 2005, and May 31, 2019, were included; data were analyzed on a yearly basis. Results In total, 411,102 patients were included. The average age of patients increased from 12.0 to 18.8 years between 2005 and 2017. In any given year, the prevalence of AD was highest in patients aged <2 years and lowest in patients aged ≥50 years. Dermatology (65.1%‐69.5% from 2005 to 2017) and clinics (92.3%‐93.4%) were the main department and medical facility, respectively, providing daily medical care for AD. The proportion of patients who were given the thymus and activation‐regulated chemokine test increased from 2008 to 2017 (0.03%‐3.5%). From 2005 to 2017, the proportion of patients who received moisturizer (68.8%‐79.1%), topical calcineurin inhibitors (8.2%‐17.8%), very strong topical corticosteroids (26.0%‐40.6%), strongest topical corticosteroids (3.5%‐7.8%), cyclosporine (0.01%‐0.3%), or phototherapy (0.06%‐1.8%) increased, and the proportion of patients who received topical non‐steroidal anti‐inflammatory drugs (12.0%‐3.1%) decreased. Annual costs for medication associated with AD per person/visit increased between 2005 and 2017; however, the ratio of medication to total cost did not. Conclusions The results of this analysis show that Japanese patients used increasingly potent treatments for AD, and overall AD‐related medication costs increased between 2005 and 2017.

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“…As severity of the disease is not coded in administrative registers, this study defined severity based on concurrent treatment employed in a previously published study [ 31 ]. Patients with systemic treatments (corticosteroids and non-corticosteroid immunosuppressants) were considered to have a severe form of AD and are presented separately in this publication for reference [ 31 ].…”

Section: Methodsmentioning

confidence: 99%

Clinical and Economic Burden of Pediatric Mild-to-Moderate Atopic Dermatitis: A Population-Based Nested Case–Control Study in Sweden

Ortsäter

Geale

Dun

et al. 2020

Dermatol Ther (Heidelb)

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Introduction Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin condition characterized by pruritic, eczematous lesions. Recent evidence suggests that AD may be a systemic disorder, implying that management of this disease extends beyond merely controlling symptoms associated with AD. Even though this disease is highly prevalent in children and patients typically present with mild-to-moderate symptoms, the disease burden is not well established. Methods A large, retrospective cohort study of Swedish population data was conducted to compare the clinical burden in terms of healthcare resource use and direct medical costs for pediatric mild-to-moderate (pM2M) AD patients (≤ 14 years of age, N = 87,721) with matched controls. The burden of a severe AD cohort was also evaluated. Severity of AD was defined by treatment usage and systemic treatment was used as a proxy for severe AD. A robust approach was used by including any type of secondary care visits known to be more common in AD patients than in the general population; however, data for primary care visits were not available. Results For healthcare resource use, the incidence rate ratio (pM2M AD versus reference cohort) of secondary care visits ranged from 1.56 to 2.35 during each of 5 years after AD onset (all p < 0.001), with largest differences seen in years 1–2. The average direct medical cost (SD) was €1111 (3416) and €524 (2446) in the pM2M AD and reference cohorts, respectively. The corresponding estimate in the severe AD cohort was €1906 (7067). Including all secondary care visits and pharmacy-dispensed medications, the pM2M AD cohort was shown to have an additional €118.9 million in direct medical costs over 5 years compared with the reference cohort. Conclusions This study shows significant clinical and economic burden of pM2M AD with important secondary care resource utilization, suggesting a need for further research to increase treatment options and improve the management of these patients. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-020-00470-z.

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Costs and Treatment Patterns Among Patients with Atopic Dermatitis Using Advanced Therapies in the United States: Analysis of a Retrospective Claims Database

Cited by 30 publications

References 23 publications

Comparative efficacy and safety of systemic therapies used in moderate‐to‐severe atopic dermatitis: a systematic literature review and network meta‐analysis

Comparative efficacy and safety of systemic therapies used in moderate‐to‐severe atopic dermatitis: a systematic literature review and network meta‐analysis

Real‐world treatment patterns of patients with atopic dermatitis in Japan: Analysis of the JMDC Claims Database

Clinical and Economic Burden of Pediatric Mild-to-Moderate Atopic Dermatitis: A Population-Based Nested Case–Control Study in Sweden

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