Patient Experience and Preferences for Treatments in Atopic Dermatitis: Results from a US Patient Survey

Abstract

Background: Recent advances in understanding the molecular mechanisms underlying atopic dermatitis (AD) have led to the development and FDA approval of multiple targeted therapies. Molecular heterogeneity of AD contributes to inconsistent clinical presentation and therapeutic response, which can lead to delays in diagnosis and initiation of appropriate treatment for patients. Adding complexity to the decision-making process, newer targeted systemic treatments are also associated with varied efficacy, safety profiles, and monitoring requirements. More information is needed on patient perspectives of current systemic treatment options to support joint treatment decision-making.

Objectives: To 1) better understand patient attitudes about contemporary AD treatments and experiences and 2) evaluate patient perception of a molecular test to predict treatment response. 

Methods: A 31-question survey (IRB-exempt) made available to attendees of the 2024 National Eczema Association Eczema Expo was designed to assess patient perspectives on their treatment for AD, including treatment attributes and experiences. Participation was voluntary and not associated with data presentation.

Results: Of 43 eligible respondents, 74% were 18 to 64 years old and 21% were <18 years of age, with the remaining participants ≥65 years (5%). Approximately 40% (16) of participants reported their AD was previously misdiagnosed and 28% (12) of the participants were biopsied to confirm their AD diagnosis. The top three factors most important to respondents using topical-only or systemic (±topical) medications were itch control (70%), skin clearance (58%), and safety/side effects (50%). For the 22 respondents who used targeted systemics, 23% switched or added another systemic and 32% added topicals. The top two reasons for switching or modifying systemic treatment were insufficient skin clearance and itch control. Patient ratings of how well current therapy met their treatment goals varied extensively. Scaled from 1% (goals not met) to 100% (goals met), patient rankings ranged from 26% - 100% with a median of 68% progress toward goals for those using systemic therapies (± skin-directed therapies). Over 80% of respondents would want, or may consider, taking a test informing them of which targeted systemic would work best for them, thus highlighting a clinical need for personalized therapeutic guidance in AD.

Conclusion: A substantial number of AD patients experience delayed diagnosis. Itch was the most important symptom that respondents desired their medication to address. While topicals and systemic therapies can be effective, AD patients had a wide variety of treatment responses regardless of treatment modality, suggesting a need for a more personalized approach to treatment selection. The majority (80%) of patients would want, or would consider, a test that would direct them towards a more effective therapy for their AD.