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Original Investigation
August 2018

Association of Inadequately Controlled Disease and Disease Severity With Patient-Reported Disease Burden in Adults With Atopic Dermatitis

Author Affiliations
  • 1Department of Dermatology, Oregon Health & Science University, Portland
  • 2Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York
  • 3Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 4Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
  • 5Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
  • 6Department of Dermatology, University of California at San Diego, San Diego
  • 7Regeneron, Tarrytown, New York
  • 8Sanofi, Bridgewater, New Jersey
  • 9Sanofi, Chilly-Mazarin, France
  • 10Quorum Consulting Inc, San Francisco, California
  • 11Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
  • 12Analysis Group Inc, Montreal, Canada
  • 13Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, New York
JAMA Dermatol. 2018;154(8):903-912. doi:10.1001/jamadermatol.2018.1572
Key Points

Question  What is the association of atopic dermatitis severity and disease control with the patient-reported disease burden in clinical practice?

Findings  Among 1519 adults in this cross-sectional study, patients reported a multidimensional burden that is higher with greater disease severity and inadequate disease control.

Meaning  For patients with moderate to severe dermatitis, there is a need for more effective therapies and for greater incorporation of the patient’s perspective into clinical assessment.


Importance  Real-world data are limited on the patient-reported burden of adult atopic dermatitis (AD).

Objective  To characterize the patient-reported burden of AD with regard to impact of disease severity and inadequate control in adults from clinical settings.

Design, Setting, and Participants  In this cross-sectional study using data from 6 academic medical centers in the United States collected by a self-administered internet-based questionnaire, 1519 adult patients with AD were stratified by AD severity as mild or moderate/severe using the Patient-Oriented Scoring Atopic Dermatitis (PO-SCORAD). Patients with moderate/severe disease using systemic immunomodulators/phototherapy were further stratified as having adequate or inadequate disease control. Strata were compared for all outcomes.

Main Outcomes and Measures  Outcomes included validated measures and stand-alone questions assessing itch (pruritus numerical rating scale; PO-SCORAD itch visual analog scale), pain (numerical rating scale), sleep (PO-SCORAD sleep visual analog scale; sleep interference with function), anxiety and depression (Hospital Anxiety and Depression Scale), and health-related quality of life (Dermatology Life Quality Index).

Results  Among the 1519 adult patients with AD, relative to mild AD (n = 689, 64% women; mean [SD] age, 46.5 [18.0] years), patients with moderate/severe AD (n = 830, 66.8% women; mean [SD] age, 45.1 [16.9] years) reported more severe itching and pain, greater adverse effects on sleep, higher prevalence of anxiety and depression (417 [50.2%] vs 188 [27.3%]), and greater health-related quality-of-life impairment. The 103 patients with moderate/severe AD with inadequate disease control despite treatment with systemic immunomodulators or phototherapy (55.7%) reported higher burdens of itch and sleeping symptoms vs patients with controlled disease including more days per week with itchy skin (5.7 vs 2.7) and higher proportions with itch duration greater than half a day (190 [22.8%] vs 20 [2.9%]). Sleep symptoms included trouble sleeping (3.9 vs 1.1 on the PO-SCORAD VAS), longer sleep latency (38.8 vs 21.6 minutes), more frequent sleep disturbances (2.6 vs 0.4 nights in past week), and greater need for over-the-counter sleep medications (324 [39%] vs 145 [21%]).

Conclusions and Relevance  Inadequate disease control was common among patients with moderate/severe AD, and was associated with a higher patient-reported burden than patients with controlled disease. Regardless of disease control, the burden of moderate/severe AD was higher than mild AD, suggesting a need for more effective therapies for moderate/severe disease.