Kent A. Hanson

Vitiligo, a common and chronic depigmentation disorder, significantly impacts patients' quality of life and exerts a substantial economic burden. The deleterious impact of vitiligo can be exacerbated by comorbid conditions, including psychiatric and autoimmune conditions. Treatment may vary across geographic regions, and there is sparse evidence of treatment patterns for vitiligo in Japan. Evaluations of healthcare costs are also needed to help underline unmet needs, including data on the influence of comorbid conditions on costs. Here we report results of a retrospective cohort analysis using claims data from the Japan Medical Data Center database to evaluate the economic burden and treatment patterns among patients with vitiligo in Japan. Primary study outcomes were costs and healthcare resource utilization (HCRU) 12 months post‐index (diagnosis date) for patients with vitiligo versus matched controls, based on inpatient, outpatient, and pharmacy claims. In total, 28 800 patients were included (4800 in the vitiligo cohort; 24 000 matched controls). Patients with vitiligo had significantly greater all‐cause healthcare costs (¥84 766 vs. ¥55 011, p < 0.0001) and HCRU than matched controls, primarily driven by outpatient, dermatology‐, and vitiligo‐related procedure costs. In patients with vitiligo, comorbid psychiatric and autoimmune conditions significantly increased all‐cause healthcare costs versus no comorbid condition (¥193 468 vs. ¥78 313 and ¥185 179 vs. ¥77 184, respectively; both p < 0.0001). Most patients (67.5%) did not receive treatment for vitiligo in the 12 months following diagnosis. Of those who did, 76.0% received only phototherapy. Only 2.2% received second‐line treatment. Overall, Japanese patients with vitiligo face substantially higher healthcare costs and resource utilization than those without vitiligo, with burden further increased by psychiatric and autoimmune comorbidities; notably, most remained untreated in the year after diagnosis, and treated patients primarily received phototherapy.

Introduction Alopecia areata (AA) is an autoimmune disease characterized by nonscarring hair loss that may impact quality of life (QoL). After 2021, new therapies were approved to treat severe AA in Taiwan; however, there is no global definition of severe AA. Dermatologists may use other criteria in addition to scalp hair loss (SHL) when estimating severity. This study evaluates the impact of AA on patient QoL and how dermatologists assessed disease severity and managed AA in Taiwan prior to availability of new therapies. Methods Dermatologists completed the Adelphi Real World AA Disease Specific Programme™ cross-sectional survey. Each provided their perspective on assessing AA severity and available AA treatments, and information on patients consulting with AA. Results were analyzed descriptively and stratified by dermatologist-assessed AA severity. Results Fifty dermatologists reported median (interquartile range) SHL of 45% (31–51%) and 76% (51–90%) as typical of “severe” and “very severe” AA, respectively, based on 285 patients. Multiple factors were considered, including SHL, disease duration, and prior treatment responses. Mean (SD) time on current therapy was 8.3 (13.0) months. Patients with severe/very severe disease received varied first- and second-line treatments and had more severe QoL impacts, including anxiety/worry, depression, and impairments in daily life and activities. Most dermatologists felt confident in diagnosing AA; however, few were satisfied with treatment options for patients with severe AA. Conclusions Dermatologists in Taiwan did not define AA disease severity solely based on extent of SHL, and many felt there was an unmet need for effective treatments for severe disease.

Background: Patients with alopecia areata (AA) in ALLEGRO‐2b/3 (NCT03732807) had clinically significant hair regrowth and patient‐reported improvements with ritlecitinib versus placebo, but patient‐reported improvements in AA Patient Priority Outcomes (AAPPO) emotional symptoms (ES) or activity limitations (AL) were not observed during the 24‐week placebo‐controlled phase. This study compared AAPPO scores between the 50‐mg ritlecitinib maintenance dose (+/− 200‐mg 4‐week loading dose) and subtherapeutic 10‐mg ritlecitinib through Week 48 of ALLEGRO‐2b/3. Methods: Least squares mean (LSM) changes from baseline (CFBs) in domain scores were estimated for the full analysis population and for participants with baseline domain scores ≥ 1. Item‐level responses (scores < 2) were evaluated for participants with baseline item scores ≥ 2, since lower baseline item scores (measured on 5‐point response scales; range, 0–4) indicated less frequent/severe impacts from hair loss. Results: There were 325 participants (200/50‐mg [ n = 132] and 50‐mg [ n = 130], combined and as subgroups; 10‐mg [ n = 63]). LSM CFBs in ES and AL domain scores generally improved through Week 48 for all 50‐mg groups, with significant differences versus 10‐mg starting at Week 34 for ES and Week 40 for AL. The proportion of responders for all ES and AL items generally increased through Week 48 for all 50‐mg groups. The largest improvements versus 10‐mg were for ES items 5 and 6 (self‐consciousness and embarrassment) and AL item 11 (interactions with others). Conclusions: ALLEGRO‐2b/3 participants reported greater improvements in ES and AL due to hair loss by Week 48 with the 50‐mg ritlecitinib maintenance dose (+/− 200‐mg loading dose) versus subtherapeutic 10‐mg ritlecitinib.

Introduction Alopecia areata (AA) may negatively impact patient quality of life (QoL), disease perception, and work productivity. AA severity is not solely based on scalp hair loss; individuals with AA can experience psychosocial burdens, including emotional symptoms and activity limitations (ES/AL). Our objective was to identify discrete AA severity profiles and evaluate the association with patient-reported outcomes (PROs). Methods Dermatologist and patient surveys from the Alopecia Areata Disease Specific Programme in France, Germany, Italy, Spain, and the United Kingdom were analyzed. PRO instruments included the Alopecia Areata Patient Priority Outcomes (AAPPO), Work Productivity Activity Index—AA, Skindex-16 AA, Patient Satisfaction with Hair Growth (P-Sat), and Hospital Anxiety and Depression Scale (HADS). Latent class analysis identified distinct classes using the AAPPO hair loss, ES, and AL response options. Results A 5-class model was selected. Each class exhibited distinct profiles based on patient-reported hair loss and ES/AL burden: (1) very mild hair loss, very mild ES/AL (n = 175); (2) mild hair loss, mild ES/AL (n = 165); (3) moderate hair loss, very severe ES/AL (n = 111); (4) severe hair loss, moderate ES/AL (n = 52); and (5) very severe hair loss, severe ES/AL (n = 33). Class 3 reported significantly more overall work impairment [β = 16.3 (95% CI, 7.8–24.7)] than class 1. Overall Skindex-16 AA scores were highest for class 3 [β = 38.7 (95% CI, 33.3–44.2)]. Class 3 reported significantly more HADS anxiety [β = 6.0 (95% CI, 4.9–7.0)] and depression [β = 5.7 (95% CI, 4.6–6.9)] than class 1. Across all P-Sat domains, class 5 reported the least satisfaction with therapy. Conclusion Generally, patients with more severe patient-reported hair loss and ES/AL had decreased QoL and satisfaction with care and greater work productivity impairment. Although class 3 had moderate patient-reported hair loss, patients experienced the most severe ES/AL burden, suggesting that AA impacts well-being and daily activities in patients with less extensive hair loss.

Introduction This study assessed Dermatology Life Quality Index (DLQI) scores of patients with alopecia areata (AA) and compared scores between adults and adolescents. Methods This was a retrospective chart review in France, Germany, Spain, and the UK. Patients with ≥ 50% scalp hair loss (SHL) due to AA and a DLQI score recorded at their index date (first date of ≥ 50% SHL) were included. The DLQI (scale 0–30; higher scores indicate greater impact) assesses the impact of AA on health-related quality of life (QOL). Multivariable linear regression was used to examine the effect of age on DLQI score, adjusting for covariates. Modified Poisson regression analysis was used to estimate relative risks (RRs) between age groups and DLQI categories (none to moderate effect, very large effect, and extremely large effect), adjusting for covariates, including baseline Severity of Alopecia Tool (SALT) score. Results Overall, 335 patients were included (249 adults, 86 adolescents). At index, adults had a higher mean (SD) SALT score than adolescents (63.7 [15.5] vs 60.4 [12.8]), whereas mean (SD) DLQI scores were higher in adolescents than adults (22.1 [5.3] vs 18.2 [7.5]). Most patients (84%) had DLQI scores indicating a very large or extremely large impact on their lives; this was more pronounced in adolescents than adults (98% vs 80%). In the multilinear model, adolescents had significantly higher DLQI scores than adults (β = 3.51; P < 0.001), indicating a 3.51-point increase in DLQI score associated with being an adolescent. The RR (95% CI) of a DLQI score indicating a very large effect (1.28 [1.07–1.53]) or extremely large effect (1.40 [1.21–1.61]) relative to no or moderate effect was significantly higher for adolescents vs adults. Conclusion This study demonstrates that, at the time of experiencing ≥ 50% SHL due to AA, both adults and adolescents reported significant impacts on their QOL, with a higher impact on adolescents.

Introduction Vitiligo may negatively impact quality of life (QOL). This study aimed to classify patients on the basis of the impact of vitiligo on emotional/psychological and social functioning and describe patient characteristics and patient-reported outcome (PRO) responses for each profile. Methods Physician and patient surveys from the Vitiligo Disease Specific Programme in France, Germany, Italy, Spain, and the USA were analyzed. PROs were assessed using the Vitiligo Patient Priority Outcomes (ViPPO), Work Productivity Activity Index–Vitiligo, Vitiligo-Specific Quality-of-Life instrument, 5-level EuroQol 5-dimensional questionnaire (EQ-5D-5L), and Hospital Anxiety and Depression Scale questionnaires. Latent class analysis identified distinct classes on the basis of ViPPO response options. Results A three-class model was selected. Of 530 patients, 64.2%, 24.3%, and 11.5% were grouped into classes 1, 2, and 3, respectively. Class 3 reported the most emotional/psychological and social functioning impact; classes 1 and 2 reported mild and moderate impact, respectively. More patients in classes 1 and 2 had moderate physician-assessed disease; class 3 had a higher proportion of patients with moderate-to-severe disease; however, approximately one third had limited/mild physician-reported disease. Class 3 had the highest mean body surface area involvement and proportion of patients with face involvement (n = 30 [49.2%]). Across all 4 PRO measures, class 3 reported more severe impacts. Conclusions Generally, classes with more severe impacts had more severe physician-assessed disease and lesion involvement and greater work productivity and QOL impairment. Although patients in class 3 had severe psychosocial burden, a large proportion had mild physician-reported disease severity, suggesting that only physical symptoms were considered when assessing disease severity.

Background: Hair loss due to alopecia areata (AA) can negatively impact patients’ health‐related quality of life (HRQoL). Patient‐reported outcome measures (PROMs) like the EQ‐5D‐5L and the Alopecia Areata Patient Priority Outcomes (AAPPO) represent treatment outcomes and can guide decision‐making. However, the EQ‐5D‐5L potentially underestimates AA‐specific impacts, while the AAPPO may provide a more disease‐specific assessment.Objectives: This study uses the EQ‐5D‐5L and the AAPPO emotional symptom (ES) and activity limitations (AL) subscales to characterise HRQoL among patients with AA.Methods: This analysis uses secondary data from the Adelphi Alopecia Areata Disease Specific Programme (AA‐DSP), a survey of dermatologists and patients with AA in five European countries. Included patients completed a survey containing the EQ‐5D‐5L and AAPPO. Descriptive summary statistics were reported for AAPPO ES/AL subscales and EQ‐5D‐5L scores, overall and stratified by physician‐reported percentage of scalp hair loss (%SHL). Cramer's V effect sizes were calculated across each of the AAPPO ES/AL and EQ‐5D anxiety/depression and usual activities items to examine the relationship between varying degrees of SHL and the PROMs.Results: Four hundred thirty‐five patients with AA completed the AAPPO and EQ‐5D‐5L. The mean (SD) overall EQ‐5D‐5L index and EQ‐VAS score was 0.85 (0.15) and 74.07 (17.86), respectively. The mean (SD) overall AAPPO ES and AL subscale scores were 1.70 (1.03) and 0.88 (0.93), respectively. For the AAPPO ES and AL items, effect sizes were largest between the extreme values of SHL (0%–10% vs. 100%), while the effect sizes between intermediate SHL groups (e.g., 11%–20% and 21%–49%) tended to be smaller. The two EQ‐5D‐5L items demonstrated lower effect size values.Conclusions: Our findings suggest the AAPPO suitably discriminates between clinically relevant groups of patients with AA. The EQ‐5D‐5L was not as effective in measuring the specific psychological or social dimensions by SHL, potentially underestimating disease burden among patients with AA.

Introduction Alopecia areata (AA) is an autoimmune disease that causes scalp, face, and/or body hair loss. Recently, oral treatments with kinases inhibition became the first approved therapies for severe AA. An understanding of the use and effectiveness of traditional therapies in real-world treatment settings is needed to guide integration of novel therapies into the treatment paradigm. This study aimed to describe traditional treatment patterns, dermatologists’ reasons for therapy choice, and dermatologists’ satisfaction with disease control among patients with AA. Methods Data were drawn from the 2021–2022 Adelphi Real World AA Disease Specific Programme™, a cross-sectional survey of dermatologists and adult patients with AA, conducted in France, Germany, Italy, Spain, and the UK. For each patient, using data from patient consultation and medical records, dermatologists reported % scalp hair loss (SHL), characteristics of current and prior AA therapies, and satisfaction with disease control. Results Overall, 239 dermatologists provided data for 1720 patients with AA. Mean (SD) patient age was 35.8 (11.6) years, and 51% were male. Based on dermatologist perception, among patients with ≤ 10% SHL, 74% were experiencing mild AA, while ≥ 95% of patients with ≥ 50% SHL were experiencing severe/very severe AA. In patients with ≥ 50% SHL, the most common therapies received included systemic immunosuppressants (31%), topical corticosteroids (24%), and oral corticosteroids (24%). Among all patients who had switched therapies, 49%, 26%, and 24% switched because of worsening AA, lack of initial efficacy with prior treatment, and loss of response over time, respectively. Among those with SHL ≥ 50%, dermatologists reported satisfaction with current therapy in < 30% of patients. Conclusion Dermatologists reported low satisfaction with traditional AA therapies used in patients with extensive SHL, with some patients discontinuing treatment because of worsening disease. This suggests more effective treatments are needed for patients with severe AA.