Article: Living with Atopic Dermatitis - Effects beyond the skin’s surface

Earlier this year, we published the report “Living with Atopic Dermatitis (AD) EU”, based on primary market research, which reveals key insights and unmet needs from the AD adult and paediatric patient perspective and treatment journey. In December 2017, we published a US report, which is also available to purchase.

Impact on daily life

Atopic dermatitis (AD) or eczema is a chronic inflammatory skin disease causing rashes, which can result in intense itching and extremely dry, red, rough skin. The physical effect is clear, however, AD has an impact that goes much deeper than the skin’s surface. The rashes can make people feel self-conscious and frustrated about the constant need to scratch their skin. Furthermore, it can make sufferers feel isolated or embarrassed and want to avoid others particularly during a bad flare. Our Living With AD study conducted in the EU found that about one third of patients are highly embarrassed about their AD. 

The impact of AD on patients’ lives varies across a severity spectrum and can be incredibly debilitating for patients with moderate to severe symptoms, often highly affecting their psychological, emotional and practical lives. Depending on the severity, patients can undergo extreme stress during a flare cycle, which in turn triggers more flares and further stress.

The emotional impact of AD is certainly a common theme in both the EU and US. In the EU, patients reported that the condition mostly affects their ability to go to communal facilities, having to wear certain clothes to cover their condition, sleeping habits and general well-being. One adult patient reported; “The lack of sleep affects me a lot because sometimes I’m so tired, especially with looking after two children.” In the US too, AD causes a considerable emotional burden; with over half of patients reporting they suffer from stress and anxiety more than once a week. A third of patients believe AD influences their general and emotional sense of wellbeing. 

Anxiety and mental health are more commonly discussed today. Anxiety occurring as a direct result of AD is significant. One patient from our EU study stated: “AD causes me anxiety because I am always thinking about it. It is a vicious circle and is difficult to escape from it.” Anxiety affects children more than adults in both the EU and the US. Caregivers indicate that children are particularly concerned about the reaction of others and can feel embarrassed by the topical treatments.

To gain deeper insights into the AD patient journey, we conducted segmentation analysis in both the EU and the US. The results from our EU research revealed that we can split patients into 4 key segments: trusting treatment, severely burdened, mild and positive, impacted and dissatisfied. The segment which are most affected by their AD in daily life is the severely burdened group, with the highest number of comorbidities and severe flares on a yearly basis and greater body coverage affecting visible areas such as the hands and face. Our US segmentation research revealed that three core attitudinal segments exist; AD not prioritised, distressed and demanding, concerned but supported. As expected, patients in the distressed and demanding segment had been diagnosed most recently (many are children), meaning they had the least amount of time to come to terms with their disease, therefore experienced more concern and worry about their diagnosis.

Satisfaction with treatment

Treatments for AD can help to ease the symptoms for sufferers, although currently there is no complete cure. The main treatments for the condition are emollients or moisturisers to help prevent the skin becoming dry and itchy and topical corticosteroids (creams and ointments) to reduce swelling and redness on the skin. Patients are typically prescribed topical corticosteroids by their primary care physician or dermatologist at different strengths depending on where they are on the severity spectrum, with 5 out of 7 patients being generally satisfied with their treatment. Mild patients are most highly satisfied with treatment whilst severe patients are least satisfied.

Satisfaction with treatment in general varies depending on whether the patient falls into the mild, moderate or severe group. Moderate to severe patients seem to experience a much greater impact from AD, both on daily life and on work or studies. They are more likely to be on systemic treatment and are actively searching for information on AD. Contrastingly, the mild AD patient is least affected by their AD practically and emotionally. They are less engaged in AD management and are least adherent to treatment where they take mainly topical-only medications. The main difference between mild, moderate and severe AD patients is how compliant and reliant they are upon the treatment; severe patients are more reliant and thus constantly search for new and better treatment to help manage their condition.

Until a few years ago, AD treatments were mainly limited to topical corticosteroids and systemic immunosuppressants; however, greater understanding of how AD develops has led to the launch of new treatments (PDE-4 inhibitor, dupilumab) as well as a more robust pipeline.

In the EU, dupilumab (trade name Dupixent®), an injectable treatment, is prescribed to treat adults with moderate to severe AD. In comparison to other treatments, (namely, topical, oral immunosuppressants, oral steroids and other injectables) of the small number of patients interviewed in our EU study currently on dupilumab, the majority were highly satisfied. On 6th August 2019, it was announced that the marketing authorisation has been extended for dupilumab, and can be targeted to help a younger demographic (age 12 and under), suffering with moderate-to-severe Atopic Dermatitis.

Outside of the EU, dupilumab is given to specific patients with moderate to severe AD and in some countries such as Japan, it is prescribed to also help control asthma. In general, dupilumab as a treatment for AD has received mainly positive feedback of good efficacy in terms of reducing symptoms and flare-ups according to our research.  

Another available treatment in the US is crisaborole (trade name Eucrisa). Crisaborole is prescribed to help moderate eczema and is applied topically on the skin. In general, according to our US research, adult patients seem to have a good satisfaction level with the drug with the main benefit perceived to be a reduction in itching.

Unmet needs still remain

While patients are moderately satisfied with available AD treatments, there is room for improvement and still many unmet needs that need to be addressed. Similarly, to our US study, we found that patients across the EU are seeking more support from pharma companies, as only 10% of patients claim to currently be receiving any support.  

There is also a great desire to receive information on specific websites, educational materials and apps about how to manage AD. Across the EU the key requirement from patients is to have longer lasting relief of itchy skin with treatments that act more quickly with less frequent administration. Greater support is required for specific groups, especially moderate to severe patients and all patients who are less satisfied with treatments.

Living with Atopic Dermatitis EU

Our new Living with AD EU report offers cost effective, high-value quantitative insight into patient attitudes and behaviour. The study was conducted amongst 403 adults living with the disease and 141 caregivers of children with AD in France, Germany, Italy, Spain and UK. The methodology consisted of 30-minute quantitative online and 30-minute qualitative telephone interviews with patients.

The report enables pharmaceutical companies developing products in AD to gain a deeper understanding of how patients come to be diagnosed with AD and how it affects their day-to-day lives physically, emotionally and socially. It also explores patient attitudes and perceptions towards treatment and the healthcare professionals managing their condition as well as identifying the types of support patients seek at key stages of their journey.

Head of Living with, Mariel Metcalfe commented, “Atopic Dermatitis can exert a major physical and emotional burden not only on the patient but also their caregivers. This report provides comprehensive, quantitative insights into patient behaviours and perceptions, as well as their feelings and unmet needs at key stages of their journey living with AD.”