Australian patients with atopic dermatitis have a high disease burden extending across multiple facets of daily life and many are inadequately controlled on existing therapy, global research has found.

The cross-sectional study across 28 countries pointed to ‘under-treatment’ as a likely contributing factor to Australia’s low quality of life scores compared with comparable countries, according to the authors.

Funded by AbbVie, the study team examined medical records of 112 patients from seven centres in Australia and New Zealand over 12 months in 2019-20.

Greater than 85% were receiving topical treatment, 29% were on non-biologic systemic therapy, and 10% phototherapy, while just 4.5% were receiving dupilumab.

But perhaps the most interesting results were those related to disease burden, which showed patients were “suffering considerably from AD … which has a very large effect on their quality of life,” the team reported in Australasian Journal of Dermatology (link here).

Results showed a mean Eczema Area and Severity Index (EASI) score of 22.3 (95% CI 19.6–25.0) and Patient-Oriented Eczema Measurement (POEM) score of 18.4 (95% CI 16.8–20.0).

Some 50% of participants had severe pruritus, while there were also high scores in sleep impact and skin pain. Mean Dermatology Life Quality Index (DLQI) was a high 14.3 indicating a “very large negative effect on their lives”, the authors reported.

“The negative impact of AD extends across multiple facets of daily life including pruritus, skin pain, mental health, sleep and work,” they wrote.

“The impact of these factors was reflected in sleep disturbance; a mean average number of 6.4hours slept per night was reported; 63% of patients reported disturbed sleep ≥3days in the past week.”

“A substantial proportion of patients suffered from measurable depression or anxiety, thereby further impacting the effects of AD on their quality of life. One-third of patients (33.6%) reported that their skin prevented them from working or studying over the past week.”

The study also highlighted that patients’ AD was poorly controlled with existing therapies, according to the team who noted over 41% of participants did not feel their current treatments were effectively controlling their AD.

At 4.5%, the proportion of participants receiving dupilumab in Australia was far lower than elsewhere in the study, which was 31% across the global dataset, the authors added.

“These findings, in addition to the higher disease burden in the ANZ subpopulation of the global dataset, suggest that more effective management of AD is required in Australia and New Zealand,” they wrote.

“Under-treatment with suboptimal topical and systemic therapies is likely a contributing factor to the lower quality of life scores in Australian/New Zealand patients.”

Particular issues in Australia included steroid phobia, which had been previously documented as a factor behind the reluctance of local patients to use potent topical steroids, according to the team.

In addition, UV therapies had been difficult to access, and there was reluctance to start patients on systemic immunomodulatory treatments, the authors said.

“Steps have been made in Australia to address this with the recent availability and funding of dupilumab and Upadacitinib,” they added.