Expert dermatologists discuss treatment discontinuation as a barrier to achieving desired outcomes in atopic dermatitis.
Linda Stein Gold, MD: Aaron, I’m going to come back to you. We have all these wonderful tools, but we know if the patient doesn’t do what we’re hoping they’re going to do, that turns out to be a problem. What do you find, how do you assess that, how do you keep them on track?
Aaron S. Farberg, MD: Patient adherence is critical in this disease, and there are good data already out there, most recently one paper looking at insurance claim data as well as diagnosis between 2017 and 2019. We recognized that topicals are still the most commonly used treatment. They didn’t dive in exactly into which topicals, but we know that when you get to greater levels of efficacy and you move into the biologics as well as the JAK inhibitors, you’re going to have improved adherence because you’re also going to have better efficacy. It is difficult with these patients with the overall mindset of “I’m better.” As Peter was saying, when do we stop these treatments and these therapies? It almost doesn’t matter what we have to say, it’s what the patients are going to do.
As we get new treatments that work really quickly, I’ve seen some patients adjusting the way they are utilizing these therapies. It’s our job to educate our colleagues, as well as our patients, that this is a lifelong disease, although hopefully not. There is some question about disease modification that’s getting even more exciting, but we don’t have time to discuss that today. Adherence is of course of the utmost importance and making sure this fits into the patient’s daily life.
Linda Stein Gold, MD: Ali, do you have any special tricks or tips you use to make sure the patient stays on task?
Alexandra Golant, MD: I find my [patient] visits in atopic dermatitis sometimes are opposite to those in psoriasis because a lot of the patients with atopic dermatitis are less familiar with the chronic and systemic nature of their disease. Atopic dermatitis is a chronic, and for most patients, a lifelong systemic, inflammatory disease. The conversation about long-term control, and in some cases the need for systemic control-long term, becomes easier when they understand their disease as inflammation that’s going on underneath the surface even when they feel better. When they can accept it as a systemic condition, just like we understand many ailments in medicine, that conversation about systemics—like if you stop insulin in a diabetic, your diabetes would still be there–it becomes easier to understand.
I always say, “Let’s get you clear and then we’ll reassess.” That needle might move, and that’s due to some of the exciting things coming through the pipeline. But for now, setting them up to say, “This is a great time to have atopic dermatitis. For the first time, I can offer you something safe for you to stay on long term that is going to get you to a better level of control.” It was not something we could say before. It’s made that conversation much easier.
Aaron S. Farberg, MD: That’s an important point. Patients present to us in a variety of different ways. I’m finding now some obviously are presenting de novo, new with disease, and so we’re able to get these better treatments to them earlier. Sometimes the discussion is easier with a patient who has had atopic dermatitis for 10 years, and for whatever reason they weren’t offered or maybe they didn’t consider some of these other more advanced treatments. It’s sort of a different discussion with each of these patients.
Alexandra Golant, MD: It’s a disease state re-education. A point that Matt brought up, which I completely agree with, is that flare anticipation. It’s not only the parents feeling desperate that they can’t manage their child’s atopic dermatitis, it’s that adult patient saying, “Why can’t I get this under control? Why can’t I just be clear for a while?” It’s saying, “because it’s out of your control. This is completely not dictated by that allergy you’re trying to find, but because it’s a systemic disease.” Once that acceptance happens, I feel like the conversation becomes easier. That dominates a lot of my initial visit time and is why I run behind all the time.
Transcript edited for clarity