Atopic dermatitis severity and time spent managing symptoms showed the strongest link with disease burden in patients with the disease.
Studies have shown that atopic dermatitis (AD) has a significant disease burden. The complexities of this burden, however, have not been fully explored. Evidence shows that approximately 7% to 11% of adults have prevalent or new presentation of disease. Given this frequency, detailed knowledge of disease burden may improve care.
For a study published in JAMA Dermatology, Aaron M. Drucker, MD, ScM, and colleagues sought to expand the knowledge base on the burden of AD including how the different facets of disease burden interact. “We know a lot about how eczema [AD] affects different people, but there are still knowledge gaps that remain,” Dr. Drucker explained. “If we can better understand what drives the burden of eczema [AD] for individuals, we can better help them manage their skin condition.”
32-Item Electronic Survey Designed to Help Understand Disease Impact
Dr. Drucker and colleagues analyzed data collected from a 32-item electronic survey that was developed as part of a patient-focused drug development meeting with the US FDA. The online survey reached its intended target through patient advocacy groups, social media, and clinicians.
To begin the survey, participants had to identify themselves with the response, “I have eczema.” Demographic and clinical variables were collected as well as the patient’s rating of the impact of the disease. The study team used univariable and multivariable ordinal regression to assess associations between demographic and clinical characteristics with each of the overall AD impact scores, mood alternations at the time of the survey, and mood alterations when AD was at its worst. Univariable and multivariable models assessed the study variables listed.
They also determined Spearman correlation coefficients (ρ) and 95% confidence intervals. Coefficients were classified as very weak (0-0.19), weak (0.20-0.39), moderate (0.40-0.59), strong (0.60-0.79), or very strong (0.80-1.00).
The age range of the 1,065 survey respondents was 18 through older than 65; 83% were women. Forty-five percent of participants reported having current moderate AD and 28% reported having current severe AD. A total of 80% of participants reported having severe AD when their skin condition was most pronounced.
In terms of characterizing disease impact in the past few months, 32 survey participants reported no impact, 194 reported a low impact score, 295 reported a moderate impact score, 228 reported a high impact score, and 316 reported a significant impact on life.
AD severity was strongly correlated with greater overall impact scores; moderate AD (OR, 4.13; 95% CI, 2.94-5.79) and severe AD (OR, 13.63; 95% CI, 8.65-21.5) both showed correlations with greater disease burden compared with mild AD (Table).
Spending More Time Managing AD Linked With Higher Disease Burden
Alteration in mood was another facet explored in the survey. Most survey respondents reported current mood changes. Mild mood changes were reported by 424 respondents, 316 respondents reported moderate mood changes, and 95 respondents reported severe mood changes. Current AD severity was strongly associated with current mood alterations (severe AD: OR, 5.29; 95% CI, 3.41-8.20).
“An interesting association that we found is that spending more time managing eczema was associated with a higher burden of disease,” Dr. Drucker notes. “This could go two ways: either that time spent leads to increased burden, or higher burden leads to people needing to spend more time on their condition. In either case, treatments that are effective and decrease the time spent managing the condition may help to decrease the burden of atopic dermatitis.”
