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Mariel Metcalfe (firstname.lastname@example.org) is Head of Living With at Research Partnership.
There is a real opportunity for pharma to support the under-served population of atopic dermatitis patients, writes Mariel Metcalfe.
Atopic dermatitis (AD) or eczema is a chronic inflammatory skin disease, which, although not as debilitating as other chronic conditions, can have a significant psychological impact on patients, or parents caring for children with the disease. It also puts a considerable burden on healthcare resources. AD affects up to 20% of children and around 3% of adults worldwide and its prevalence is still increasing, especially in some lower income countries in Asia and Latin America.
The majority of patients start to experience symptoms before they reach five years of age and often suffer from asthma or other allergies. Severity varies widely – some people might just suffer from a light rash on a few areas of the body and might get better as they get older, whilst others can suffer from very dry, bleeding and sore skin all over, with regular painful flare-ups, which continue into adulthood. In the US, physicians typically use the Body Surface Index to assess severity of the disease. Around 65% of patients in the US are recognised as suffering from moderate-severe eczema. Severe patients can suffer from more than 15 flare-ups per year, lasting two weeks or more.
In terms of treatment, not that much has changed in the last 20 years. Patients are usually prescribed topical corticosteroids by their primary care physician or dermatologist. Patients may be prescribed different strengths depending on the severity of their symptoms. They will often use steroids in combination with bath emollients and skin moisturisers to alleviate dry skin and itching. Some people, especially those who suffer from other allergies, believe that changes to diet, such as removing gluten or dairy, can be effective in reducing symptoms. Others believe that reducing stress and anxiety can limit flare-ups and may use yoga or meditative practices to help them relax.
However, there are two new treatments available in the US which are opening up new options for those living with AD, particularly those with moderate to severe symptoms. Crisaborole (trade name Eucrisa) is a PDE-4 inhibitor for mild-to-moderate eczema that reduces inflammation and can be used topically on the skin. It is marketed by Pfizer and was approved by FDA in the treatment of AD in late 2016. Sanofi and Regeneron's Dupilumab (trade name Dupixent), is the first biologic to be approved in the US and is used for patients with severe eczema. We have seen from our data that there is a higher level of satisfaction with these new products, which offer good efficacy in terms of reducing symptoms and flare-ups. However, there are other patient drivers impacting on treatment selection. Method of administration is one example. Dupiliumab is delivered via injection, which can make it unpopular for some patients. Other factors such as whether a patient demands the treatment, tolerance with eczema symptoms and acceptance of their condition, are all drivers to take-up.
Our report also tells us that there is a real opportunity for pharma to support an under-served population of patients who have very low expectations of the relief they can get from treatments. We found a large segment of patients, partially consisting of parents of children who have been recently diagnosed, and also adults themselves, who suffer from considerable stress and distress from living with AD. This segment is especially keen to find new ways of treating the condition, and although they typically have a good relationship with their doctor, is looking for additional support in coping with the disease.
This is probably not surprising, given that suffering from eczema can be very upsetting to babies and small children. Parents can feel extremely anxious about how eczema affects their children, both physically and psychologically, particularly as they get older. Being a teenager with AD can be particularly distressing - 47% of children reported concern that they would be bullied or teased because of their AD. One parent in our study commented, “The worst thing is people noticing and saying something to him. He feels so embarrassed.”
According to our research, the largest unmet need is for products that alleviate itching. Patients are also looking for treatments that will work more quickly (a third stated they think current treatments take too long to work) and for oral rather than topical solutions. As one male patient put it, “A large part of the eczema covers my hands, and the creams to treat are messy, and I get cat fur stuck all over my hands at night, and I don't like to use it during the day because I'll get cream all over my desk.”
Beyond this, pharma can also help with more beyond-the-pill patient care - websites where they can go for support and information and educational pamphlets or brochures would be appreciated. 70% of patients or caregivers said they had sought information online. Children in particular said they would like Youtube videos showing them how best to apply treatment. It would seem that, in the absence of pharmacological solutions, emotional and psychological support, perhaps delivered through digital and social channels, as well as via healthcare professionals and nurses, could be of considerable benefit. The younger generations would probably be much more natural adopters of digital channels such as websites, apps and social tools, which could educate them and help them feel less isolated. A combination of these strategies would all help move patients with AD out of the shadows so that they feel they can live a normal, comfortable and itch-free life.