Patients with moderate to severe atopic dermatitis using immunosuppressant treatment experience unsatisfactory outcomes, frequently need systemic steroid rescue therapy, and report many associated adverse events, according to a study published in PLoS One.

Researchers in this retrospective cohort study used data from the Truven Health MarketScan database to analyze the impact immunosuppressant treatment has on patients with atopic dermatitis. All patients included in this study had a pre-index baseline period that lasted 6 months and a post-index follow-up period that lasted 12 months. All patients were categorized into either the immunosuppressant arm that included treatments of cyclosporine, azathioprine, methotrexate, and mycophenolate mofetil or a control arm that excluded treatments of systemic immunosuppressants, systemic corticosteroids, or phototherapy. Data collection included socio-demographic variables, comorbidities, treatment-related clinical events, immunosuppressant usage, concomitant treatment, and adjustments in dose or type of immunosuppressant.

The study included 4204 patients using an immunosuppressant to treat atopic dermatitis who were matched with 4201 controls using another form of treatment. During the post-index follow-up period for patients in the immunosuppressant arm, 68.5% were non-persistent, 84.6% received concomitant treatment, 36.3% required dose escalation, 7.6% required additional immunosuppressants, and 2.8% switched immunosuppressants. Significantly more patients in the immunosuppressant arm had immunosuppressant-related clinical events, required hospitalization (<.0001), required immunosuppressant-related monitoring tests (<.001), and had higher levels of healthcare resource utilization and associated costs.

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Limitations of this study include using medical claim codes as a basis for diagnosis, which could lead to misclassification of patients. Also, using retrospective data means a direct causal relationship cannot be proven.

The researchers concluded that their study “highlights the unmet need for more effective long-term therapies for atopic dermatitis with improved safety profiles and reduced monitoring requirements.”

Disclosures: This study was supported by Sanofi and Regeneron Pharmaceuticals, Inc. Please refer to the reference for a complete list of authors’ disclosures.

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Armstrong AW, Huang A, Wang L, et al. Real-world utilization patterns of systemic immunosuppressants among US adult patients with atopic dermatitisPLoS One. 2019; 14(1):e0210517.