March 18, 2021
Immunosuppressants used off-label to treat moderate-to-severe atopic dermatitis are associated with unsatisfactory outcomes, including high rates of medication nonpersistence and systemic steroid rescue treatment among US patients, according to a real-world study published online in PLOS One.
“At the time of this study, prior to the introduction of biologics in the United States, systemic therapies used for the treatment of moderate-to-severe atopic dermatitis included off-label immunosuppressants and corticosteroids,” researchers wrote. “Immunosuppressant therapy is associated with a substantial risk of side-effects, therefore needing clinical monitoring, and is likely to incur a significant health care burden for patients and payers.”
To investigate the burden of immunosuppressant use among US adults with atopic dermatitis, researchers used data from the Truven Health MarketScan database for January 1, 2010, to September 30, 2015. The analysis included 4204 patients with atopic dermatitis treated with immunosuppressants who were matched for age, gender, region, and index year with 4201 control patients with atopic dermatitis but without immunosuppressant use.
The study revealed that 68.5% of patients using immunosuppressants were nonpersistent with treatment over 12 months of follow-up—and just 12% resumed immunosuppressant therapy after a treatment gap. The average time from index date to immunosuppressant treatment gap was 88.1 days.
Additionally, 72.3% of those using immunosuppressants required systemic steroid rescue treatment. The average number of claims for systemic steroids was 4.6, researchers reported.
Compared with control patients, those treated with immunosuppressants also had a higher incidence of immunosuppressant-related clinical events. Moreover, 0.28% of patients using immunosuppressants developed cancer, compared with 0.14% of control patients.
Annual health care costs associated with clinical events and monitoring totaled an average $9516 per patient taking immunosuppressants, compared with $1630 per control patient, the study found.
“The increase in immunosuppressant-related clinical events, including the need for increased monitoring with immunosuppressant treatment, compared with controls demonstrates a substantial treatment burden,” researchers wrote, “and highlights the unmet need for more effective long-term therapies for atopic dermatitis with improved safety profiles and reduced monitoring requirements.”
Armstrong AW, Huang A, Wang L, et al. Real-world utilization patterns of systemic immunosuppressants among US adult patients with atopic dermatitis. PLoS One. 2019;14(1):e0210517. Published 2019 Jan 25. doi:10.1371/journal.pone.0210517