Severe Atopic Dermatitis In Spain: A Real-Life Observational Study

Figures & data

Table 1 Prevalence Of Atopic Dermatitis According To Age Group

Age Groups	6–12 Years	13–18 Years	> 18 Years	p
Patients with severe AD	600	244	1479
Patients with AD	17,533	6841	38,475
General population	151,910	106,346	1,973,278
Estimated prevalence of AD, %	11.5%	6.4%	1.9%	<0.001
95% CI	11.0–12.0%	5.8–7.0%	1.8–2.0%
Estimated prevalence of severe AD, %	0.39%	0.23%	0.07%	<0.001
95% CI	0.23–0.54%	0.04–0.41%	0.06–0.08%

Note: p: statistical significance.

Abbreviation: AD, atopic dermatitis.

Table 2 Baseline Characteristics And Comorbidities Of The Study Population And The General Population By Age Group

Age Groups	6–12 Years		13–18 Years		> 18 Years
Comparison By PS	Severe AD	Population	Severe AD	Population	Severe AD	Population
Number of patients, PS	600	1200	244	488	1479	2958
Demographic characteristics
Mean age, years	9.1 (2.0)	9.0 (2.0)	14.8 (1.6)	14.9 (1.7)	51.4 (14.7)	50.9 (14.8)
Sex (male)	58%	57.7%	48.6%	48.1%	39.0%	39.8%
Time since diagnosis, years	8.6 (3.1)	–	10.9 (3.9)	–	27.6 (4.3)	–
General comorbidity
Mean Charlson Index	0.1 (0.2)	0.1 (0.2)	0.2 (0.2)	0.2 (0.2)	0.9 (0.3)	0.8 (0.3)
Mean comorbidities	1.1 (0.9)	1.0 (0.8)	1.5 (0.9)	1.2 (0.8)	3.2 (2.2)	2.8 (2.2)
Specific comorbidity
Hypertension	0.5%	0.4%	0.4%	0.3%	38.9%	36.1%*
Mellitus diabetes	0.3%	0.4%	1.2%	1.0%	14.9%	11.5%^‡
Dyslipidaemia	2.5%	2.0%	2.1%	2.9%	46.0%	44%^‡
Obesity	19.5%	17.5%	19.8%	18.8%	27.7%	24.1%^†
Ischemic heart disease	0.5%	0.4%	0.8%	0.6%	5.7%	4.0%
Cerebrovascular accident	0.2%	0.3%	1.2%	0.7%	7.4%	5.5%
Heart/kidney failure	0.0%	0.0%	0.0%	0.0%	7.4%	6.2%
COPD	0.0%	0.0%	0.0%	0.0%	10.9%	9.3%
Bronchial asthma	49.0%	18.6%^‡	44.9%	11.9%^†	20.8%	6.5%^‡
Allergic rhinitis	25.0%	19.4%*	22.2%	17.2%	22.9%	10.2%^‡
Depressive syndrome	0.3%	0.3%	0.8%	0.5%	12.6%	10.3%*
Anxiety or agitation	79.7%	32.4%^‡	65.8%	20.8%^†	67.3%	35.3%^‡
Celiac disease	0.5%	0.2%	1.3%	0.7%	2.2%	1.1%^†
Body mass index, Kg/m^2	15.2 (2.3)	14.1 (2.5)	19.5 (3.1)	17.8 (3.2)	28.6 (3.2)	27.5 (3.2)^†

Notes: Values expressed in percentages or mean (standard deviation). Statistical significance: ^‡p <0.001, ^†p <0.01, *p <0.05 in the pairwise comparison. PS, pairing by age and sex.

Abbreviations: AD, atopic dermatitis; PS, Propensity Score Matching; COPD, chronic obstructive pulmonary disease.

Table 3 Medication Administered For Severe Atopic Dermatitis According To Age Group

Age Groups	6–12 Years	13–18 Years	> 18 Years	p
Immunosuppressants
Cyclosporine	38.5%	45.5%	48.1%	<0.001
Azathioprine	25.0%	20.9%	11.4%	0.001
Methotrexate	1.2%	0.8%	13.5%	<0.001
Mycophenolate mofetil	0.5%	6.2%	9.6%	<0.001
Cyclophosphamide	0.2%	2.5%	2.2%	0.003
Other medications*
Hydroxychloroquine	0.0%	1.2%	4.2%	<0.001
Interferon	0.0%	0.0%	1.4%	0.002
Immunoglobulins	34.3%	18.0%	1.5%	<0.001
Apremilast	0.0%	0.4%	1.3%	0.001
Biological agents
Omalizumab	0.3%	3.7%	3.0%	<0.001
Rituximab	0.0%	0.0%	0.6%	0.001
Secukinumab	0.0%	0.4%	1.8%	0.001
Infliximab	0.0%	0.4%	1.4%	0.007
Treatment cycles
Mean cycles	1.9 (0.9)	1.4 (0.7)	1.4 (0.7)	<0.001
1	46.2%	73.3%	74.7%
2	19.7%	16.5%	15.3%
3+	34.2%	10.3%	10.0%	<0.001
Other variables
Systemic corticosteroids**	97.3%	90.9%	81.7%	<0.001
Hospitalization	0.8%	1.0%	1.8%	0.040

Notes: Values expressed in percentages or means (standard deviation). p: statistical significance. *Indication not approved. **Concomitant-medication.

Table 4 Medication Administered And Duration Of Cycles In Patients With Severe Atopic Dermatitis

Medication Administered	N	%	Mean age, Years	Sex (Male)	Time Since Diagnosis, Years	General Comorbidity	Systemic Corticosteroids	Mean Cycles Over 5 Years	Duration Cycle 1, Days	Cycle Duration 2, Days	Cycle Duration 3, Days	Second Line*
Immunosuppressants
Cyclosporine	1053	45.3%	45.4 (22.6)	40.1%	23.4 (8.7)	3.4 (2.4)	87.8%	1.4 (0.7)	60.7 (60.0)	71.7 (88.8)	66.3 (76.0)	Methotrexate
Azathioprine	370	15.9%	31.7 (21.0)	47.7%	20.1 (9.7)	1.7 (1.4)	84.7%	1.5 (0.7)	84.4 (72.0)	80.6 (82.8)	89.1 (68.0)	Methotrexate
Methotrexate	209	9.0%	48.7 (14.9)	41.7%	27.0 (6.0)	2.6 (2.0)	72.2%	1.4 (0.7)	54.0 (13.3)	52.9 (13.8)	53.5 (15.1)	Cyclosporine
Mycophenolate mofetil	160	6.9%	50.2 (16.7)	52.8%	26.6 (5.6)	2.6 (1.8)	90.7%	1.3 (0.5)	92.0 (70.0)	82.7 (87.6)	82.9 (47.4)	Cyclosporine
Cyclophosphamide	40	1.7%	52.2 (18.9)	54.3%	26.5 (5.8)	2.2 (1.1)	100.0%	1.4 (0.7)	53.6 (55.9)	28.3 (14.8)	20.8 (13.2)	Cyclosporine
Other medications**
Hydroxychloroquine	65	2.8%	47.5 (14.1)	42.4%	27.9 (4.6)	2.6 (2.0)	79.0%	1.3 (0.6)	90.3 (62.3)	97.2 (97.0)	81.1 (79.5)	Cyclosporine
Interferon	21	0.9%	49.8 (12.3)	46.7%	27.1 (3.1)	2.2 (1.7)	86.7%	1.2 (0.4)	53.6 (48.9)	71.7 (90.1)	–	Cyclosporine
Immunoglobulins	272	11.7%	10.9 (5.4)	55.8%	10.1 (6.0)	1.2 (0.9)	94.9%	2.2 (0.9)	34.1 (26.9)	32.0 (16.4)	33.1 (18.3)	Cyclosporine
Biological agents
Omalizumab	55	2.4%	38.0 (13.7)	44.2%	24.6 (7.1)	2.3 (1.8)	92.6%	–	51.3 (50.5)
Rituximab	9	0.4%	41.5 (7.6)	42.4%	27.0 (4.1)	2.3 (1.9)	100.0%	–	32.0 (17.6)
Apremilast	20	0.9%	42.3 (12.3)	45.0%	25.9 (4.4)	1.8 (1.2)	100.0%	–	40.5 (39.6)
Secukinumab	28	1.2%	45.9 (13.1)	48.5%	27.0 (7.2)	2.7 (1.6)	97.0%	–	47.2 (48.3)
Infliximab	21	0.9%	48.0 (15.2)	34.5%	26.5 (4.0)	2.1 (1.4)	100.0%	–	41.6 (45.6)

Notes: Values expressed in percentage or mean (standard deviation). *Drug used for second line treatment. **Indication not approved.