Identification and Quantification of Atopic Dermatitis Patients With Insufficient Disease Control Under Conventional Systemic Treatments in Germany: A Feasibility Study

OBJECTIVES: Besides systemic therapy options such as cyclosporine, off-label immunomodulators or systemic corticosteroids, targeted therapies suitable for continuous treatment of Atopic Dermatitis (AD) are available. The aim of this study was to identify and quantify AD patients with insufficient disease control under conventional systemic treatment using a set of proxies in claims data.

METHODS: We analyzed German claims data from the InGef Research database covering the period from Jan 01, 2017 to Mar 31, 2020. Patients with a confirmed AD diagnosis (ICD-10-GM L20.-, L20.8, L20.9) and a dispensation of an AD-related systemic therapy between 2017 and 2019 were included. AD-related dispensations required a documented AD diagnosis in the same quarter. Patients treated with conventional systemic therapy (corticosteroids or cyclosporine), but not with dupilumab or off-label immunomodulators, were analyzed for insufficient disease control based on the predefined criteria. Proxies for insufficient disease control were: high number of active flares, long-term use of topical treatment, high use of topical treatment, variation in outpatient specialist consultations, hospitalization due to AD, AD-related infections.

RESULTS: In 2019, 3,348 AD patients were currently receiving or had recently received AD-related systemic drug therapy, corresponding to 76,511 patients extrapolated to the German population. 472 patients (14.1%) had received at least one dispensation of dupilumab or off-label drugs between 2017 and 2019. 2,158 patients (64.5%) had dispensations of cyclosporine or systemic corticosteroids between 2017 and 2019 and fulfilled at least one criterion for insufficient disease control in 2019: the criteria most frequently met were AD-related infections (63.9%), long-term use of topical treatment (42.1%) and high number of active flares (35.5%).

CONCLUSIONS: In sum, 2,630 patients (78.6%) in the study population were treated with targeted or off-label systemic therapy in 2019 or had insufficient disease control under conventional therapy. This corresponds to 59,679 patients extrapolated to the German population.