Prescribing practices for adult atopic dermatitis in Europe: an update from EADV 2019
European Academy of Dermatology and Venereology Congress 2019
October 2019 is a notable month for atopic dermatitis (AD). While October is recognised as National Eczema Awareness Month in the United States (US), researchers from around the world gathered in Madrid, Spain to share their AD research at the 28th Annual Congress of the European Academy of Dermatology and Venereology (EADV), held 9–13 October.
This year’s EADV Congress, themed ‘The Modern Face of Dermatology’, represented more than 100 countries with over 12,000 participants and 750 lecturers. The AD research presented ranged from studies of treatment efficacy and safety to serological biomarkers of disease severity to refining the disease classification, as well as reports of other meetings held in Tokyo and Geneva.
While furthering our understanding of the various AD interventions is vital, it is also important to identify which treatments are routinely available and offered to patients in real-world clinical settings. The European TREatment of Atopic eczema Taskforce (TREAT) Survey, presented at EADV 2019 by Dr Mariëlle Vermeulen on behalf of the European TREAT Survey Taskforce, describes for the first time the photo- and systemic therapy prescribing practices in Europe for moderate-to-severe adult AD. In this week’s commentary, we report on the findings of TREAT Survey.
The TREAT Survey
Therapies available for moderate-to-severe AD have been limited, while robust long-term evidence for the efficacy of these therapies is lacking. Previous surveys have identified variations in prescribing practices and the variable factors influencing these prescribing practices. However, surveys conducted thus far have only addressed systemic therapy in paediatric AD patients in Europe1 and in the US and Canada2, and photo- and systemic therapy in adults with AD in the UK3. The TREAT Survey therefore aimed to provide insight into current prescribing practices of conventional photo- and systemic immunomodulatory therapies for adults with AD and the factors influencing these prescribing practices, before biologics and other novel therapeutics become routine clinical practice.
Using Snap Surveys software, the researchers developed an online, anonymous, multiple response survey that was live from 5 March 2018 to 28 September 2018. Participants were eligible for inclusion if they were a dermatologist or dermatology resident based in Europe (excluding the UK) and involved in the treatment of adult moderate-to-severe AD patients. The survey was distributed by invitation to a mailing list of EADV members, 41 national societies in Europe and through personal contacts. The survey included questions regarding the prescription practices for photo- and systemic therapy and systemic therapy only (Figure 1)
Figure 1. TREAT Survey questionnaire.
Prescribing practices in Europe
Of the 361 dermatologists who registered to participate, 229 surveys from 30 countries were included in the analysis (Table 1). The researchers found prescribing practices for adult moderate-to-severe AD patients varied among physicians in Europe.
Table 1. Survey participant characteristics.
AD, atopic dermatitis.
For phototherapy, narrow-band UVB was prescribed as first line phototherapy treatment by over 80% of participants. PUVA was the most common second line phototherapy treatment, while over half of those surveyed never prescribed broad-brand UVB, UVAB, UVA1 or UVA (broad-band-TL09). For systemic therapy, ciclosporin was most frequently prescribed as first line treatment (>50%), followed by oral corticosteroids and methotrexate (30-40%), and rarely azathioprine or mycophenoiate acid. Methotrexate was the most popular choice for second line treatment, while mycophenoiate acid was the least popular drug with nearly 40% of respondents never prescribing it. Clinical expertise was reported as the most important reason for prescription choice (Table 2).
The TREAT Survey represented a large number of countries in Europe and is the first to study adult moderate-to-severe AD patients in European populations. The study found photo- and systemic therapy are being prescribed on a regular basis and prescribing practices are inconsistent. The authors concluded that many evidence gaps still remain, and high-quality, long-term evidence is needed.
Conventional therapies have more well-known profiles, lower costs and wider availability relative to new promising therapies; however, prescribing practices will need to be continuously re-evaluated following the uptake of dupilumab treatment.
Table 2. Reasons for prescribing photo- and systemic therapy.
NA, not applicable; RCTs, randomised controlled trials.
Whilst new data on prescribing practices is welcome, one treatment consideration that was notably absent was ‘patient preference’. Whether this question was not asked by the researchers or no physicians prescribed on this basis, patient satisfaction is essential for optimal disease management.
To improve your knowledge of eczema treatment as part of patient-centred care, visit our online CME course ‘Atopic dermatitis treatment in adults: applying guidelines and new data’. To find out more about how therapies work for the treatment and management of AD, explore our online CME courses on the mechanisms of action:
Interested in reading more about the AD research presented at EADV this year? Sign up to Action Eczema and be notified when our EADV 2019 Congress Report is available online for viewing and CME credit.
1. Proudfoot L, Powell A, Ayis S, Barbarot S, Baselga Torres E, Deleuran M, et al. The European treatment of severe atopic eczema in children taskforce (TREAT) survey. Br J Dermatol. 2013;169:901-909.
2. Totri CR, Eichenfield LF, Logan K, Proudfoot L, Schmitt J, Lara-Corrales I. Prescribing practices for systemic agents in the treatment of severe pediatric atopic dermatitis in the US and Canada: The PeDRA TREAT survey. J Am Acad Dermatol. 2017;76(2):281-285.
3. Taylor K, Swan DJ, Affleck A, Flohr C, Reynolds NJ. Treatment of moderate‐to‐severe atopic eczema in adults within the U.K.: results of a national survey of dermatologists. Br J Dermatol. 2017;176:1617-1623.