Real-world treatment patterns of Finnish adult patients with atopic dermatitis: From topicals to systemic therapy

BackgroundAtopic dermatitis (AD) is a chronic skin condition with varying persistence and intensity. In mild cases, topical therapies usually suffice to prevent flares. However, systemic treatment options may be required in the moderate to severe forms of AD. In the lack of comprehensive real-world data, exhaustive descriptions of the overall treatment practice of AD are still missing.ObjectivesThe objective of this study was to describe the real-world treatment patterns of AD in Finland. Further, the study aimed to provide an in-depth understanding of the treatment of severe AD.MethodsThis retrospective registry study utilized nationwide data from both primary and secondary healthcare electronic health records. All patients (128,428) with AD diagnosis code or reimbursement for AD medication from 2005 to 2019 were collected. Treatments, switches, persistence and time to next treatment (TTNT) were investigated. Severity of AD was assessed based on registry data.ResultsThe majority of patients (83%) had used at least one treatment for AD during the study time. Irrespective of AD severity, the amounts of reimbursed topicals appeared low (topical calcineurin inhibitors 66 g, topical corticosteroids 110 g and emollients 1 kg per year) when compared to the care recommendations. Most patients with severe AD managed their condition with topical treatment options. Only 7.2% of patients with severe AD purchased systemic medication, of which methotrexate and cyclosporine were the most common options. The TTNT for systemic treatment ranged from several years up to decades, and the median treatment persistence ranged from 4 to 9 months depending on the selected therapy.ConclusionsThe use of systemic medication was rare in the AD population, and the detected treatment persistence among patients receiving systemic medication was low. The amount of topical treatment use detected in this study suggests potentially suboptimal levels of basic treatment of AD.