PS11 Dupilumab for moderate-to-severe atopic dermatitis: transformative changes in quality of life and low burden of treatment — a mixed-methods study

Abstract

Abstract Moderate-to-severe atopic dermatitis (AD) has a significant impact on quality of life (QoL). The emergence of biologic agents has changed the treatment landscape for those with severe disease. Adult patients on biologic treatment for moderate-to-severe AD were invited to complete written questionnaires during scheduled clinical care. Questionnaires prompted reflection on QoL before and after treatment with dupilumab. Dermatology Life Quality Index (DLQI) and Burden of Treatment (BoT) scores were simultaneously assessed. Charts were retrospectively reviewed with respect to prior treatments, duration of biologic treatment, adverse events and clinical severity scoring. Statements were assessed qualitatively to identify common themes. Twenty-one patients participated in the study. The median age of participants was 38 years. Most (n = 14; 67%) were men. All patients were on subcutaneous dupilumab 300 mg, for a median duration of 10 months (range 3–61). Thirteen patients had trialled one immunosuppressant agent prior to commencing dupilumab, and five had failed two or more agents. Three had contraindications to immunosuppression. Median DLQI prior to commencing biologic treatment was 22 (range 9–30, SD 5.5), improving to 2 (range 0–11, SD 3.1) at the time of study participation. Median Eczema Area and Severity Index scores were 30.2 before dupilumab and 6.4 at the time of participation. Median BoT scores on dupilumab were low (range 0–3/10) across all domains, including burden related to emollients, topical steroids, injections, cost and scheduling of appointments. Themes identified in patients’ descriptions of prebiologics QoL included embarrassment, low self-esteem, anxiety, poor quality of social relationships, sleep disturbance, perceived loss of autonomy, loss of time, frustration with health services, high financial costs, negative childhood memories and hopelessness about the future. All patients described dramatic improvements on dupilumab. Themes included the disappearance of itch, confidence reacquisition, improved relationships, the ability to sleep, enjoyment of activities, freedom of clothing choice, greater free time, improved daily functioning, liberation from topical steroids and reclaiming control. Three patients (14%) reported disappointment with incomplete clearance, all relating to persisting facial dermatitis. Six patients (29%) reported side-effects on dupilumab, all described as mild eye symptoms, which did not affect QoL. This study highlights the profound impact of dupilumab therapy for moderate-to-severe AD on physical, psychological and social functioning. The transformative life changes described by patients on biologic treatment are compelling. Side-effects described were minor and more tolerable than with conventional immunomodulatory treatments, with a low burden of treatment in all patients.