APP Insights Into AD Therapy: Systemics May Improve Patient Compliance

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At the 5th Annual Elevate-Derm West Conference in Scottsdale, Arizona, a poster titled, “Systemic Therapy Improves Patient-Reported Treatment Satisfaction, Adherence, and Reduces Therapy Burden in Patients with Atopic Dermatitis (AD): Advanced Practice Provider (APP) and Patient Perspectives” was presented. Researchers behind the study found the addition of systemic therapy to topical treatment resulted in a higher proportion of patients being satisfied with their therapy.¹

Study Background and Design

The study stated that, despite therapeutic advances, patients with AD often face challenges with treatment adherence and satisfaction.² Alongside this, they recognized that although APPs are often involved in patient care, their perception of patients’ treatment challenges has not been explored.

With this in mind, a cross-sectional, real-world survey was conducted including retrospective data collection from APP-reported medical records and patient surveys. Patients involved in the study were grouped into 2 categories based on their current treatment: Systemics ± topicals or topicals-only. Systemic treatments included injectable biologics, oral and injected corticosteroids, and conventional immunosuppressants. Topical treatments included corticosteroids, calcineurin inhibitors, and crisaborole.

APPs included in the study were nurse practitioners (NPs) and physician assistants (PAs) affiliated with dermatologists or allergists who treat ≥ patients with moderate to severe AD in a month. In total, 34 NPs and 53 PAs completed 914 patient record forms, of which 171 patients reported their current treatment satisfaction and completed the Adelphi Adherence Questionnaire.

Results

Through the study, researchers found that proportion of patients “extremely” or “very satisfied” with their current prescribed treatment was statistically higher in the systemics ± topicals group. Among this group, 38% were “extremely satisfied,” 25% were “very satisfied,” and 22% were “satisfied.” Among those in the topicals-only group, 9% were “extremely satisfied,” 33% were “very satisfied,” and 43% were “satisfied.”

For those patients dissatisfied with their current treatment (Systemics ± topicals n=17, topicals-only n=8), most patients within both groups cited “AD not improving as expected” as their reason for dissatisfaction. Other reasons for dissatisfaction included “side effects with medication,” inconvenience with the mode of administration,” and “medication is expensive.”

From an APP-reporting perspective, NPs and PAs stated that 27% of patients in the systemics ± topicals group were experiencing issues with their current treatments compared to 38% of those in the topicals-only group.The primary issue APPs reported patients experiencing with their current treatments was “loss of response” in both groups, with the second most common being “failure to resolve all symptoms.” APPs reported that patients in the topicals-only group had experienced more inconvenience with their therapy, struggled more with mode of administration, and had a higher lack of compliance than patients receiving systemics ± topicals.

While patients receiving topical-only reported being slightly less adherent than those in the systemics ± topicals group, APPs reported that full compliance was “numerically higher” in those on systemics ± topicals and on systemics alone. Of the participants, 58% on systemics ± topicals were reported by APPs to be compliant, 49% on systemics alone, and 37% on topicals alone.

Conclusion

Overall, the study found that the addition of systemic therapy to topicals resulted in a high proportion of patients being “extremely” or “very satisfied” with their therapy, with the primary reason for patients being dissatisfied being that their AD was not improving as expected. Although they found that systemics ± topicals may increase compliance or adherence compared to topicals-only, they noted that overall compliance could be improved.

Researchers stated that it is crucial for APPs to set appropriate therapy expectations at the initial stages of treatment, and continually reassess them to ensure patients understanding aligns with treatment progress. Considering the potential benefits of adding systemic therapy to topical treatment, they suggested that newer advanced systemics with strong efficacy and flexible dosing may further help to improve compliance or adherence and reduce treatment challenges.

References

1. Cheever E, Panch LA, DiRuggiero D, et al. Systemic Therapy Improves Patient-Reported Treatment Satisfaction, Adherence, and Reduces Therapy Burden in Patients with Atopic Dermatitis: Advanced Practice Provider and Patient Perspectives. Presented at Elevate-Derm West in Scottsdale, Arizona. November 7-10, 2024.
2. Augustin M, Costanzo A, Pink A, et al. Real-World Treatment Patterns and Treatment Benefits among Adult Patients with Atopic Dermatitis: Results from the Atopic Dermatitis Patient Satisfaction and Unmet Need Survey. Acta Derm Venereol. 2022;102:adv00830. Published 2022 Dec 7.doi:10.2340/actadv.v102.3932