gms | German Medical Science

Introduction: Atopic dermatitis (AD) is a chronic inflammatory skin disorder with significant quality-of-life impairment. Depending on the disease course and the effectiveness of topical therapies, some patients with AD are eligible for systemic drug therapy. While conventional systemic therapy options such as oral glucocorticoids are not recommended for prolonged use, various targeted treatments are now available for continuous use [1]. However, only dupilumab, baricitinib, tralokinumab and upadacitinib are authorized for treatment of adolescents, while only dupilumab and baricitinib are authorized for treatment of children. The aim of this study was to identify and quantify patients with AD and insufficient disease control under conventional systemic treatment using a set of proxies in German health claims data in children, adolescent, and adult age groups.

Methods: A descriptive, retrospective analysis was conducted using the InGef research database, with health claims from German Statutory Health Insurances (SHI) from October 01, 2019 to December 31, 2022. Patients with AD (ICD-10-GM: L20.8, L20.9) were identified based on a documented main or secondary hospital diagnosis or two confirmed outpatient diagnoses within two different quarters. Prevalence and incidence of AD were estimated for October 01, 2021 to September 30, 2022 (i.e., index period). Patients were considered eligible for systemic drug therapy if they had a dispensation of AD-related systemic drug therapy within the index period or two years prior. Insufficient disease control operationalized by six predefined criteria was analyzed during the index period and a follow up period ranging from October 01, 2021 until December 31, 2021, the latter being only applicable to the criteria “High use of topical treatment” and “Prolonged use of topical treatment”. Population sizes were quantified and extrapolated for the German population.

Results: The administrative prevalence and incidence of AD was 2.4% and 0.3%, respectively; they were highest in the youngest age group of 0-4 years (7.0% and 1.5%, respectively), and consistently decreased with advancing age. In the study period, 3,400 patients with AD received a systemic drug therapy, corresponding to 69,490 patients (18.5% aged 2-17 years old), extrapolated to the German population. 1,846 (77.5%) adult patients and 535 (22.5%) children and adolescents were treated with conventional systemic treatment only (i.e., oral corticosteroids or cyclosporin for patients 16 years or older). Of those, 1,372 adults (79.8%) and 347 (20.2%) children and adolescents fulfilled at least one criterion of insufficient disease control. The criteria most frequently met across all age groups were AD-related infections (58.4%), prolonged use of topical treatment (44.2%), and high number of active flares (36.9%). In children and adolescents, hospitalizations due to AD were more frequent (27.6% and 28.3%, respectively) than in adults (7.9%), whereas high use of topical treatment was less frequent in children compared to the other age groups.

Conclusion: Our findings reveal a need in Germany for advanced systemic therapy options to treat moderate to severe AD among children and adolescents and provide a better understanding of insufficient disease control patterns that can help identify eligibility for targeted systemic therapy.

Competing interests: This study was funded by Pfizer. Leonie Berger, Carolina Schwedhelm, Astrid Genet, Jessica Herrath, Anja Plenske, Olaf Behmer, and Agnes Kisser are employed by Pfizer Pharma GmbH in Germany. Valeria Weber and Anja Mocek are employees of the IGES Institut GmbH, which is a paid consultant of Pfizer Pharma GmbH for designing the study, carrying out the analyses, and interpreting the results. Dorota Pawlowska-Phelan is an employee of the InGef Institute for Applied Health Research Berlin GmbH, which was contracted and reimbursed by IGES Institut GmbH for providing the data and carrying out the analyses.

The authors declare that an ethics committee vote is not required.