The Burden of Atopic Dermatitis: from Population to Bedside

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1 The Burden of Atopic Dermatitis: from Population to Bedside S028 AAD Annual Meeting March 2, 2019 Research and institutional funding Sanofi Regeneron Disclosures Consultant Honoraria Sanofi Astellas Canada RTI Health Solutions Prime Inc CADTH (Canadian Spire Learning Agency for Drugs CME Outfitters and Technology in Eczema Society of Canada Health) Aaron Drucker, MD, ScM, FRCPC Assistant Professor, University of Toronto Scientist, Women s College Research Institute My family has relationships with: AbbVie, Eli Lilly and Company, GlaxoSmithKline, Intarcia Therapeutics, Janssen Pharmaceuticals, Kallyope, Merck & Co., Novartis, Novo Nordisk, Pfizer, Shire, Zafgen Objectives Review the clinical epidemiology of atopic dermatitis List the many impacts atopic dermatitis has on individuals and society Integrate understanding of patient level burden into clinical practice Prevalence of atopic dermatitis Prevalence of atopic dermatitis in the US International prevalence adults Children: 11% Adults: 7% Shaw TE et al. The Journal of investigative dermatology. 2011;131(1): Silverberg JI et al. The Journal of investigative dermatology. 2015;135(1): Barbarot S et al. Allergy Jun;73(6):

2 Global age standardized Prevalence Severity spectrum of childhood AD GBD Study. compare/ Silverberg and Simpson. Pediatr Allergy Immunol Aug;24(5): Severity spectrum of adult AD Barbarot S et al. Allergy Jun;73(6): USA PO SCORAD POEM PGA Mild 27% 35% 39% Moderate 52% 48% 53% Severe 21% 17% 8% Persistence of childhood atopic dermatitis into adulthood Meta analysis of prevalence over time in birth cohorts Proportion of enrollees by age with no medication use and no symptoms Past 20 years old, there are still fewer than 20% of participants symptom-free! Abuabara K et al. Allergy Mar;73(3): Margolis JS et al. JAMA Dermatol Jun;150(6):

3 Atopic comorbidities Family history of atopy Non white race Low socioeconomic status Predictors of persistence Adult onset atopic dermatitis Abuabara K et al. J Allergy Clin Immunol Feb;141(2): Paternoster L et al. J Allergy Clin Immunol Mar;141(3): Roduit C et al. JAMA Pediatr Jul 1;171(7): Lee HH et al. J Am Acad Dermatol. [Epub ahead of print] Years lived with disability (US) Impacts of atopic dermatitis Global Burden of Disease Study compare/ Effect on daily life Impacts on sleep Impacts on social life Impacts on choice of clothing, makeup, shaving Embarrassment Decreased work productivity 15% miss 1 day of work from atopic dermatitis 2% miss 3 days of work from atopic dermatitis Sleep 11% of children with AD experience impaired sleep 4 nights/week 22% of children with severe AD Adults with AD have 3x rates of insomnia vs general population Disordered sleep initiation and maintenance Increased parasomnias Increased daytime sleepiness/fatigue Drucker AM et al. J Invest Dermatol Jan;137(1): Silverberg JI. JAMA Dermatol Jul;151(7): Silverberg JI and Simpson El. Pediatric allergy and immunology. Aug 2013;24(5): Camfferman D et al. Journal of clinical sleep medicine. Dec ;6(6): Shani Adir A et al. Pediatric dermatology. Mar Apr 2009;26(2): Chamlin SL et al. Pediatrics. Sep 2004;114(3): Silverberg JI et al. The Journal of investigative dermatology. Jan 2015;135(1):

4 Consequences of poor sleep Emotional and conduct problems Headaches Short stature Injuries Increased rates of ADHD Poor rating of overall health Depression: >200% increased risk Romanos M et al. Journal of epidemiology and community health. Mar 2010;64(3): Schmitt J et al. Allergy. Mar 2011;66(3): Silverberg JI. The Journal of allergy and clinical immunology. Aug Silverberg JI, Paller AS. JAMA dermatology. Apr 2015;151(4): Garg N, Silverberg JI. JAMA dermatology. Jan 2015;151(1): Silverberg JI et al. The Journal of investigative dermatology. Jan 2015;135(1): Rønnstad ATM et al. J Am Acad Dermatol Sep;79(3): Suicide 22% increased risk of suicide 66% of AD patients who died from suicide saw a physician within 1 month before their death Clinical Implications 13% saw a physician FOR ECZEMA in the month before their death Drucker et al. BMJ Open Nov 25;8(11):e Assessing patient level burden Ask patients about: Mood Sleep Effects on school/work/other aspects of life Patient s symptoms: POEM Quality of life: DLQI Itch Sleep Bleeding Weeping/oozing Cracked skin Flaking skin Dry/rough skin Mild 0 7 Moderate 8 16 Severe Charman CR et al. Arch Dermatol Dec;140(12): Vakharia PP et al. Br J Dermatol Apr;178(4):

5 Addressing sleep and mental health Treating atopic dermatitis improves sleep Coordinate mental health assessment and treatment with primary care Do they need to see a sleep specialist? Even if sleep disrupted, usually not Reserve for when not improved by treating the skin disease Successfully treating the skin disease should alleviate the associated burden Azathioprine Dupilumab Baricitinib Berth Jones J et al. Br J Dermatol Aug;147(2): Simpson EL et al. J Am Acad Dermatol Sep;75(3): Guttman Yassky E et al. J Am Acad Dermatol. [Epub ahead of print]. Summary Atopic dermatitis is common, even in adults Childhood disease is likely more persistent than previously thought Most patients do not have severe disease but those that do have substantially impaired quality of life Assessing patient level burden in clinic is important Shared decision making Demonstrates empathy We can improve patient and population health 5