Associations of self-reported atopic dermatitis with comorbid conditions in adults: a population-based cross-sectional study

PCV86 - Inertia Or Actual Switching On Medicaton Adherence And Economic Well-Being Of Medicare Beneficiaries Enrolled In Part D Plans

Risk of myocardial infarction, ischemic stroke, and cardiovascular death in patients with atopic dermatitis

Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report

Asthma is one of the most common chronic health conditions that affect children and adults. It is associated with many comorbid conditions, particularly those along the allergic spectrum, such as atopic dermatitis, allergic rhinitis, and food allergy. The relationship between asthma and food allergies involves prognosis, management, and understanding of risk for severe reactions. Both conditions are heterogeneous and can change over time, which necessitates an individualized approach toward counseling and management. Long-standing associations of an increased risk for food allergy fatality in individuals who have asthma is not as straightforward or concrete as previously believed. It is important for clinicians to have a current understanding of the evidence about the relationship between asthma and food allergy to participate in shared decision-making and counseling with patients. This review will offer background and new perspective surrounding the nuanced relationship of asthma and food allergy.

Association of sleep disturbances with geriatric age in atopic dermatitis patients

CBP-201 is a next-generation monoclonal antibody targeting the IL-4Rα subunit. Rapid efficacy with CBP-201 was demonstrated in global phase 2 (WW001) and China-only pivotal trials (CN002) in patients with moderate-to-severe atopic dermatitis (AD). Previous studies of AD therapy demonstrated similar efficacy between moderate and severe disease, with a trend toward greater improvement in moderate patients. It is unknown whether there are differences in clinical response to CBP-201 with moderate vs.severe AD. We report post hoc efficacy analyses at Week 16 with CBP-201 300 mg from WW001 in baseline severity subgroups, based on validated Investigator Global Assessment (vIGA™) scores of 3 (moderate) and 4 (severe). In WW001 (NCT04444752), adults with moderate-to-severe AD were enrolled in a RDBPC 16-week trial of subcutaneous CBP-201 or placebo. For post hoc analysis, data for 300 mg every 2- and 4-week dose regimens were pooled. Investigators assessed AD severity using Eczema Area and Severity Index (EASI), SCORing AD (SCORAD), percent Body Surface Area (BSA) of AD involvement and vIGA. Patient-reported outcomes were assessed with the Dermatology Life Quality Index (DLQI) and Patient Oriented Eczema Measure (POEM). Least squares mean (LSM) score changes were analysed using ANCOVA modeling (including treatment, baseline score and baseline vIGA), with missing data interpolated by last observation carried forward. Responder endpoints were analysed using Clopper–Pearson methodology and, for missing values, nonresponder imputation. P-values are for CBP-201 vs. placebo, per baseline severity subgroup, at Week 16. At baseline, 113 patients had moderate AD (n = 74 CBP-201, n = 39 placebo) and 56 patients had severe AD (n = 39 CBP-201, n = 17 placebo). Baseline EASI scores were lower in the moderate subgroup [mean (SD): CBP-201, 21.5 (7.0); placebo, 22.2 (6.3)] vs. the severe subgroup [CBP-201, 33.6 (11.9); placebo, 31.9 (10.8)]. In both the moderate and severe AD subgroups, significant improvements with CBP-201 vs. placebo were observed. Except for the proportion of patients achieving vIGA 0/1, numerically greater CBP-201 responses were observed in patients with severe vs. moderate AD at Week 16; placebo responses were comparable per subgroup. In the severe and moderate subgroups, LSM SCORAD scores decreased by −42.8% (severe) and −29.8% (moderate), and LSM percent BSA decreased by −29.8% and −17.3%, respectively. Clinically meaningful 2-point improvement in vIGA was reported for 48.7% and 27.0% of patients with severe and moderate AD, respectively. The proportions of patients achieving vIGA 0/1, with 2-point improvement, were 20.5% and 27.0% with severe and moderate AD, respectively. Numerically greater proportions of patients with severe vs. moderate AD experienced EASI responses with CBP-201: EASI-50, 66.7% vs. 54.1%; EASI-75, 53.8% vs. 39.2%; EASI-90, 28.2% vs. 23.0%. Patients with severe vs. moderate AD reported greater improvements in patient reported outcomes with CBP-201: DLQI, −8.7 vs. −7.0; POEM, −12.5 vs. −8.7. Clinically meaningful improvements were observed in patients with AD with either moderate or severe AD after 16 weeks of treatment with CBP-201 300 mg at either 2- or 4-week dosing. There were no differences noted between moderate and severe patients in the placebo treatment group. In most severity readouts, greater proportions of patients with AD with severe disease on study entry experienced clinically meaningful improvements with CBP-201. In future CBP-201 trials, a more severe AD population needs to be examined to determine if this same observation is also noted. Collectively, the WW001 findings support further investigation of CBP-201, at both the 2- and 4-week dosing schedules enrolling larger numbers of moderate and severe patients with AD and with prespecified analyses by baseline AD severity.

The burden of atopic dermatitis (AD) was assessed. A population-based, cross-sectional questionnaire study was performed among 34,313 Swedish adults in 2017. The prevalence of AD was 14%. Adults with mild AD had an increased relative risk ratio (RRR) of severe depression (aRRR 1.78, 95% confidence interval (95% CI) 1.50-2.12) and anxiety (aRRR 1.97, 95% CI 1.69-2.30), which was higher for severe AD (aRRR 6.22 95% CI 4.60- 8.42, aRRR 5.62 95% CI 4.10-7.71, respectively). Persons with severe AD were less likely to have a university degree (aRRR 0.55, 95% CI 0.34-0.90) and more likely to have a lower annual income (238,000-324,000 SEK: aRRR 0.51, 95% CI 0.39-0.77; 325,000 SEK or more 0.36; 0.25-0.58) compared with individuals without AD. These results suggest that AD implies an increased prevalence of comorbid mental conditions and an adverse impact on academic achievement and work. These adverse associations increase substantially for patients with severe AD and comorbid asthma.

Atopic Dermatitis in Latin America: A Roadmap to Address Data Collection, Knowledge Gaps, and Challenges.

MP19-11 ERECTILE DYSFUNCTION AND TREATMENT: AN ANALYSIS OF ASSOCIATED CHRONIC HEALTH CONDITIONS

SummaryBackgroundBetter understanding of the relationship between atopic dermatitis (AD) severity and health‐related quality of life (HRQoL) could help improve knowledge of a more effective treatment for people with AD.ObjectivesTo assess the relationship between AD severity and HRQoL and perception of AD symptoms in adults with moderate‐to‐severe AD in Europe and the U.S.A.MethodsParticipants for this cross‐sectional, internet‐based survey were recruited from the larger population‐based National Health and Wellness Survey. AD severity was measured by Patient‐Oriented SCORing of AD. HRQoL was measured by the five‐level EuroQol‐5D, Dermatology Life Quality Index (DLQI) and Patient‐Oriented Eczema Measure (POEM).ResultsAltogether, 1232 respondents were included: 1098 (89·1%) with moderate‐to‐severe AD [221 (20·1%) from France, 209 (19·0%) from Germany, 118 (10·7%) from the U.K. and 550 (50·1%) from the U.S.A.]. An additional 134 (10·9%) respondents with mild AD were included. Sociodemographic and clinical AD characteristics were similar between countries. In adults with moderate‐to‐severe AD, higher AD severity correlated with poorer HRQoL (Spearman's r = –0·38 and 0·61 for EQ‐5D and DLQI, respectively; both P < 0·001). AD severity was positively correlated with POEM (Spearman's r = 0·51; P < 0·001). People with moderate‐to‐severe vs. those with mild AD had poorer health outcomes (EQ‐5D, DLQI and POEM, P < 0·001 for all). These results were similar and consistent for the European and the U.S. populations separately.ConclusionsHigher AD severity is associated with poorer HRQoL across Europe and the U.S.A. This is a burden for patients and may provide encouragement for more effective management of AD.What's already known about this topic?Atopic dermatitis (AD) is associated with a detrimental effect on health‐related quality of life (HRQoL), including sleep disturbance, anxiety and depression.Limited data describing the relationship between different levels of AD severity and self‐reported HRQoL have been published.What does this study add?There is a positive association between increasing AD severity (Patient‐Oriented SCORing of AD) and decreasing HRQoL (EQ‐5D and Dermatology Life Quality Index) and the perception of AD symptoms (Patient‐Oriented Eczema Measure) from the patient's perspective.AD severity according to geographic locations was explored (France, Germany, the U.K., and the U.S.A.), showing that the decreasing HRQoL associated with increasing AD severity was quite consistent between the geographic locations.What are the clinical implications of this work?The results of this study showed that higher AD severity is associated with poorer HRQoL from the subject’s perspective in both Europe and the US. This fact confirms that there is a burden for these patients and may provide encouragement for a more effective management of AD, especially among those with greater AD severity.

With increasing age, the risk of developing chronic health conditions also increases, and many older people suffer from multiple co-existing health conditions, i.e., multimorbidity. One common health condition at older age is hearing loss (HL). The current article reflects on the implications for audiological care, when HL is one of several health conditions in a multimorbidity. An overview of health conditions often co-existing with HL, so called comorbidities, is provided, including indications for the strength of the associations. The overview is based on a literature study examining cohort studies that were published in the years 2010–2018 and examined associations of hearing loss with other health conditions, namely Visual impairment, Mobility restrictions, Cognitive impairment, Psychosocial health problems, Diabetes, Cardiovascular diseases, Stroke, Arthritis, and Cancer. This selection was based on previous publications on common chronic health conditions at older age and comorbidities of hearing loss. For all of these health conditions, it was found that prevalence is larger in people with a HL and several longitudinal studies also found increased incident rates in people with a HL. The examined publications provide little information on how hearing loss should be managed in the clinical care of its comorbidities and vice versa. The current article discusses several options for adaptations of current care. Nonetheless, solutions for an integrated audiology care model targeting HL in a multimorbidity are still lacking and should be subject to future research.

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease and is driven by a complex pathophysiology underlying highly heterogeneous phenotypes. Current advances in precision medicine emphasize the need for stratification. To perform deep phenotyping and identification of severity-associated factors in adolescent and adult patients with AD. Cross-sectional data from the baseline visit of a prospective longitudinal study investigating the phenotype among inpatients and outpatients with AD from the Department of Dermatology and Allergy of the University Hospital Bonn enrolled between November 2016 and February 2020. Patients were stratified by severity groups using the Eczema Area and Severity Index (EASI). The associations of 130 factors with AD severity were analyzed applying a machine learning-gradient boosting approach with cross-validation-based tuning as well as multinomial logistic regression. A total of 367 patients (157 male [42.8%]; mean [SD] age, 39 [17] years; 94% adults) were analyzed. Among the participants, 177 (48.2%) had mild disease (EASI ≤7), 120 (32.7%) had moderate disease (EASI >7 and ≤ 21), and 70 (19.1%) had severe disease (EASI >21). Atopic stigmata (cheilitis: odds ratio [OR], 8.10; 95% CI, 3.35-10.59; white dermographism: OR, 4.42; 95% CI, 1.68-11.64; Hertoghe sign: OR, 2.75; 95% CI, 1.27-5.93; nipple eczema: OR, 4.97; 95% CI, 1.56-15.78) was associated with increased probability of severe AD, while female sex was associated with reduced probability (OR, 0.30; 95% CI, 0.13-0.66). The probability of severe AD was associated with total serum immunoglobulin E levels greater than 1708 IU/mL and eosinophil values greater than 6.8%. Patients aged 12 to 21 years or older than 52 years had an elevated probability of severe AD; patients aged 22 to 51 years had an elevated probability of mild AD. Age at AD onset older than 12 years was associated with increased probability of severe AD up to a peak at 30 years; age at onset older than 33 years was associated with moderate to severe AD; and childhood onset was associated with mild AD (peak, 7 years). Lifestyle factors associated with severe AD were physical activity less than once per week and (former) smoking. Alopecia areata was associated with moderate (OR, 5.23; 95% CI, 1.53-17.88) and severe (OR, 4.67; 95% CI, 1.01-21.56) AD. Predictive performance of machine learning-gradient boosting vs multinomial logistic regression differed only slightly (mean multiclass area under the curve value: 0.71 [95% CI, 0.69-0.72] vs 0.68 [0.66-0.70], respectively). The associations found in this cross-sectional study among patients with AD might contribute to a deeper disease understanding, closer monitoring of predisposed patients, and personalized prevention and therapy.

Atopic dermatitis (AD) is a chronically recurrent inflammatory skin disorder characterized by pruritus, a specific distribution, and a family history. It has recently been reported that the incidence of AD has increased in Korea.1,2 Pruritus, sleep loss, dietary restrictions, and psychosocial factors significantly decrease the quality of life for AD patients.3,4 Recently, the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma, and Immunology published the PRACTALL consensus report for the diagnosis and treatment of AD in children and adults.5 The report suggests a stepwise management that includes the addition of multiple therapeutic agents on the basis of the disease severity. The PRACTALL consensus report defines severe or recalcitrant AD as AD that cannot be controlled with topical treatment.6 In the 2009 Korean Work Group Report on the treatment of severe/recalcitrant AD, severe AD is defined as AD with a SCORAD index higher than 50 and that cannot be controlled with conventional treatment,7 while the 2008 Guideline of Atopic Dermatitis in Korean Children defines severe AD by a SCORAD index higher than 40.8 Specific criteria for the definition of recalcitrant and severe AD are necessary. For the management of severe AD, the PRACTALL consensus report recommends systemic therapy such as antimicrobial treatment, systemic corticosteroids, cyclosporin A, azathioprine, anti-histamines, phototherapy, and immunotherapy. Several reports, including the 2009 Korean Work Group Report, have described intravenous immunoglobulin (IVIg) treatment as one of various immunoregulatory treatments. Nevertheless, this treatment was not included in the PRACTALL report.7,9,10 IVIg treatment displays immunomodulatory and anti-inflammatory properties, and its effectiveness in several immune-mediated conditions such as Kawasaki disease and idiopathic thrombocytopenic purpura has been demonstrated.11 IVIg is considered a candidate for the treatment of AD because of its ability to downregulate T-cell function, particularly interleukin-4 production.12,13 A small number of observations on the efficiency of IVIg in AD have been reported, but prospective and randomized studies for its clinical efficiency in childhood AD are sparse. A randomized, placebo-controlled prospective study in childhood AD patients is therefore required.14 Jee et al.14 recently reported therapeutic effects of IVIg in childhood AD; however, this study involved moderate to severe AD patients, and it did not include severe AD patients because the disease severity might have affected the treatment results. Further randomized studies with strict criteria for recalcitrant/severe AD are warranted. In addition, the IVIg effective dose, the dosing interval for initiation and maintenance, the identification of biomarkers (e.g., ECP, ICAM-1, and IL-5/INF-gamma) to determine efficiency, and clear criteria for IVIg indications all require consideration. Currently, we lack evidence-based data supporting the use of IVIg and other immunomodulators in childhood AD. Before IVIg can be recommended, its cost-benefit ratio, course, duration, and adverse reactions compared with alternative therapeutic options must be determined. The effects of novel therapies such as IVIg for recalcitrant/severe AD patients should be verified through repeated research and numerous research discussions.

The prevalence of atopic dermatitis (AD) has been steadily increasing in recent decades, reaching a steady plateau at the end of the 20th century. However, most of them were surveys of children, and the current prevalence and severity of AD in adults are unknown. A longitudinal survey including 40 649 freshmen attending Hiroshima University between 2002 and 2019 was conducted, with the aim to determine changes in AD prevalence in young adults over the age of 18years. All data were longitudinally collected at a fixed time of the year. The AD diagnosis and severity assessment were made by dermatologists based on the diagnostic criteria in the Japanese Guidelines for AD. History or comorbidities of asthma and allergic rhinitis/conjunctivitis, current AD management, and use of topical corticosteroids (TCS) were also surveyed using a questionnaire. The prevalence of AD in university freshmen is slightly increasing from 9.1% in 2002 to 12.0% in 2010, remaining steady at around 10-11% until 2019, with poorly controlled AD present in nearly 10%. History or comorbidities of asthma and allergic rhinitis/conjunctivitis slightly increased from 2006 to 2019 in both the students with and without AD. Facial eczema was common among those with severe and most severe AD, whereas approximately 50% of the students with moderate AD and approximately 20% of those with mild AD exhibited facial eczema. The percentage of students treating AD at medical institutions and those self-managing was almost the same. This survey also revealed the presence of substantial anxiety regarding TCS use for AD and the necessity of promoting more effective explanation and education on AD by medical professionals.

Severity in psoriasis and atopic dermatitis (AD) is commonly assessed with the Psoriasis Area and Severity Index (PASI) and the SCORing Atopic Dermatitis (SCORAD), respectively. Until today no serum marker is available to reflect the clinical scoring in both diseases. As mast cells play an important role in the pathogenesis of early psoriasis and AD, tryptase, a major compound of mast cell granules that is released upon activation, could in principle serve as such a marker. To assess the correlation between serum tryptase and severity of psoriasis and AD as well as the correlation between total IgE levels and severity of AD. Serum samples from patients hospitalized for psoriasis and AD were collected at time of admission and time of discharge from hospital. PASI and SCORAD assessments were performed at the same time points. Outpatients presenting with naevi and other benign noninflammatory skin lesions served as control group. Serum tryptase values and total IgE levels of patients with AD were measured using a fluoroenzyme immunoassay technique. No correlation of serum tryptase level with either the severity of psoriasis or the severity of AD was seen. Total IgE levels in patients with AD at time of admission and discharge from hospital remained the same. Serum total tryptase did not prove to be a useful tool in assessing severity of psoriasis or AD. Total IgE levels did not correlate with severity of AD.