Prevalence and Medications of Atopic Dermatitis in Germany: Claims Data Analysis

Figures & data

Table 1 Relevant Drugs in Atopic Dermatitis Care

	Group	ATC	Moderate to Severe Form
Topical	Antibiotics	D06A
	Antihistamines	D04AA
	Crisaborol	D11AH06
	Cromoglicic acid	D11AH03
	Urea	D02AE
	Glucocorticosteroids*	D07
	Class I	D07AA
	Class II	D07AB
	Class III	D07AC
	Class IV	D07AD
	Combinations with  antiseptics	D07B
	Combinations with  antibiotics	D07C
	Other combinations	D07X
	Pimecrolimus	D11AH02
	Psoralene	D05AD
	Tacrolimus	D11AH01
	Tars	D05AA
Systemic, non-anti-inflammatory	Antibiotics	J01
	Antihistamines	R06A
Systemic, anti-inflammatory, biologics	Dupilumab	D11AH05	X
Systemic, anti-inflammatory, nonbiologicals	Azathioprine	L04AX01	X
	Ciclosporin	L04AD01	X
	Alitretinoin	D11AH04	X
	Glucocorticosteroids	H02AB	X
	Methotrexat	L01BA01	X
		L04AX03	X
		M01CX01	X
	Mycophenolic acid	L04AA06	X
	Psoralene	D05BA02	X

Notes: *The classes of topical glucocorticosteroids based on the national classification:²² Class I = weakly effective, Class II = moderately effective, Class III = strongly effective and Class IV = very strongly effective. In practical use, the potency is not necessarily associated with more frequent adverse effects.

Abbreviation: ATC, Anatomical Therapeutic Chemical Classification System.

Table 2 Relevant Comorbidities/Conditions of Atopic Dermatitis Comorbidity

	ICD-10-GM Code
Obesity	E66
Pruritus	L29
Allergic rhinitis	J30
Cataract	H25, H26
Uveitis	H44.1
Alopecia areata	L63
Ulcerative colitis	K51
Crohn’s disease	K50
Periodontitis	K05.2, K05.3, K05.4, K05.5, K05.6
Vitiligo	L80
Lymphoma	C81−C85, C88, C90, C96
Herpes virus infection	B00
Infections of the skin	L01
ADHD	F90.0, F90.1, F90.8, F90.9, F98.8
Chronic fatigue syndrome	G93.3
Migraine	G43
Sleep apnea	G47.3
Depression	F32, F33
Disease of the metabolic form circle	E11, E13, E14
	E78.0
	E78
	I10−I13
	E79
	E66

Abbreviation: ADHD, attention deficit hyperactivity disorder.

Table 3 Age Standardized Prevalence of Atopic Dermatitis by Five-Year Age Groups (Insured Persons in SHI in 2019; N = 73,007,114)

Age Group	Male			Female			Total
	n	%	CI	n	%	CI	n	%	CI
<15 years	471,410	9.62	9.60−9.65	428,653	924	9.21−9.27	900,062	9.44	9.42−9.46
15−19 years	84,536	4.77	4.74−4.81	104,314	6.29	6.25−6.33	188,850	5.51	5.48−5.53
20−24 years	65,604	3.13	3.10−3.15	100,734	5.22	5.19−5.25	166,338	4.13	4.11−4.15
24−29 years	64,905	2.76	2.74−2.78	102,453	4.67	4.64−4.69	167,358	3.68	3.67−3.70
30−34 years	68,066	2.68	2.66−2.70	112,416	4.64	4.61−4.66	180,482	3.64	3.62−3.65
35−39 years	60,990	2.55	2.53−2.57	102,622	4.33	4.30−4.36	163,612	3.44	3.42−3.45
40−44 years	51,597	2.40	2.38−2.42	94,105	4.25	4.23−4.28	145,702	3.34	3.32−3.36
45−49 years	52,663	2.36	2.34−2.38	96,584	4.09	4.07−4.12	149,247	3.25	3.24−3.27
50−54 years	67,900	2.40	2.38−2.42	126,181	4.17	4.14−4.19	194,081	3.31	3.30−3.33
55−59 years	67,314	2.38	2.36−2.39	123,169	4.01	3.99−4.04	190,483	3.23	3.21−3.24
60−64 years	54,896	2.40	2.38−2.42	99,083	3.84	3.82−3.87	153,979	3.16	3.15−3.18
65−69 years	45,509	2.40	2.37−2.42	82,909	3.64	3.62−3.67	128,419	3.08	3.06−3.09
70−74 years	33,335	2.38	2.35−2.40	59,664	3.38	3.36−3.41	92,999	2.94	2.92−2.96
75−79 years	37,561	2.57	2.54−2.59	61,822	3.13	3.11−3.16	99,383	2.89	2.87−2.91
80−84 years	33,328	2.73	2.70−2.76	57,185	3.13	3.11−3.16	90,513	2.97	2.95−2.99
85−89 years	14,528	2.71	2.67−2.76	27,126	2.78	2.75−2.81	41,654	2.76	2.73−2.78
≥90 years	5,540	2.58	2.51−2.65	15,393	2.51	2.47−2.55	20,934	2.53	2.49−2.56
Total	1,279,682	3.64	3.64−3.65	1,794,414	4.74	4.73−4.74	3,074,095	4.21	4.21−4.22

Figure 1 Most frequent comorbidities in 2018 in relation: prevalence among insured people with atopic dermatitis/prevalence among insured people without atopic dermatitis.

Abbreviation: ADHD, attention deficit hyperactivity disorder.

Table 4 Prescriptions of Relevant Drugs in Atopic Dermatitis Care (Insured Persons with AD in 2019; N = 3,074,095)

Drug Substance		n	%	mo	DDD
Total topical		1,278,832	41.60	2,421,505	82,888,415
	Glucocorticosteroids*	1,132,908	88.59	1,962,611	75,007,526
	Class I	58,933	4.60	74,125	1,808,408
	Class II	148,178	11.59	198,530	4,494,494
	Class III	842,555	65.88	1,328,779	60,003,876
	Class IV	83,885	6.56	126,024	4,404,052
	Combinations with antiseptics	114,517	8.59	146,114	2,145,606
	Combinations with antibiotics	27,340	2.13	35,132	646,916
	Other combinations	37,431	2.93	53,907	1,504,174
	Tacrolimus	80,715	6.31	111,408	2,008,820
	Pimecrolimus	123,567	9.66	171,022	3,099,646
	Urea	13,634	1.07	20,543	1,346,989
	Antibiotics	128,593	10.06	152,964	1,063,297
	Tars	2,151	0.17	2,957	362,137
Total systemic		1,263,857	41.11	2,803,926	63,023,747
Non-anti-inflammatory	Antibiotics	937,824	74.20	1,602,249	13,732,287
	Antihistamines	296,855	23.48	514,423	20,890,776
Anti-inflammatory, biologics	Dupilumab	8,151	0.64	30,801	2,116,818
Anti-inflammatory, non-biologicals	Glucocorticosteroids	315,835	24.99	549,323	21,291,204
	Methotrexat	14,123	1.12	42,841	2,928,436
	Azathioprine	4,639	0.37	25,696	966,059
	Ciclosporin	3,370	0.27	19,628	402,420
	Alitretinoin	2,258	0.18	10,263	380,638
	Mycophenolic acid	1,491	0.12	8,701	315,109

Notes: *The classes of topical glucocorticosteroids based on the national classification:²² Class I = weakly effective, Class II = moderately effective, Class III = strongly effective and Class IV = very strongly effective. In practical use, the potency is not necessarily associated with more frequent adverse effects.

Abbreviations: n, number of patients; mo, medication order; DDD, defined daily dose.

Figure 2 Prescriptions of relevant drugs (DDD in %) in atopic dermatitis care by medical specialist designation.

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