Jenny Austin

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.

Introduction This study aimed to explore the relationship between atopic dermatitis (AD) disease severity and impact on patients and to describe AD treatment patterns and barriers to treatment in Brazil and Colombia. Methods Data were drawn from the Adelphi AD Disease Specific Programme™, a cross-sectional survey of physicians and their patients with AD, conducted in Brazil and Colombia between May 2022 and July 2023. Physicians provided data on demographics, clinical characteristics, treatments, and reasons for not prescribing targeted therapy (TT). Patients completed various patient-reported outcome (PRO) questionnaires: Patient-Oriented Eczema Measure, Dermatology Life Quality Index, EuroQol five-dimensional, and Work Productivity and Activity Impairment. Data were analysed descriptively. Comparisons between current severity were made using analysis of variance (ANOVA) or Kruskal–Wallis tests. Results Overall, 100 physicians provided data for 624 adult patients with AD from Brazil (n = 328) and Colombia (n = 296): 47% currently mild, 43% moderate, and 10% severe. For all the PRO measures analysed in Colombia and for the majority in Brazil, the impact on patients increased with increasing disease severity (p < 0.05). In total, 85% of patients with AD in Brazil and 73% in Colombia were treated with topical therapies, with 51% in Brazil and 77% in Colombia receiving systemic therapies, which included biologics (Brazil 12%; Colombia 33%) and oral Janus kinase inhibitors (Brazil 5% and Colombia 10%). The main barriers to TT in Brazil were patients being unable to pay for treatment and treatment not being covered by health insurance. In Colombia, the main barriers were formulary restrictions and patients being very recently diagnosed. Conclusions Increased AD disease severity was associated with a greater patient impact and reduced quality of life, with healthcare costs and formulary restrictions hindering optimal treatment across Brazil and Colombia.

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.

Atopic dermatitis (AD) is a common and burdensome disease. Treatment options for pediatric and adolescent patients (< 18 years old) with moderate‐to‐severe AD are limited, and real‐world data on disease burden are lacking. This study examined patient‐reported disease burden and treatments in pediatric and adolescent patients to identify opportunities for patient benefit. Data were drawn from the Adelphi Real World Pediatric AD Disease Specific Programme (DSP), a cross‐sectional survey of physicians and patients < 18 years old, conducted in Europe and the United States between February–June 2019. Physicians documented demographics, clinical characteristics, and treatment history. Patients and/or their caregivers described disease burden, the degree of symptomatic bother, and quality of life (QoL). Data from 772 patients with moderate–to‐severe AD were analyzed (pediatric; n = 393, 0–11 years, adolescent; n = 379, 12–17 years). Adolescents were more likely to be receiving a systemic corticosteroid (24% vs. 12%), phototherapy (15% vs. 6%), systemic immunosuppressant (15% vs. 6%) or a biologic treatment (5% vs. 1%) than pediatric patients (p < 0.0001). Two‐thirds of patients had a high degree of “bother” from itch, and 38% reporting itch as the “most bothersome” symptom. More adolescent patients reported “bother” related to anxiety than pediatric patients (67% vs. 49%, p < 0.0001). Adolescent patients reported a significantly higher burden of embarrassment/self‐consciousness (p < 0.0001) and AD impact on friendships (p < 0.05). Disease burden differed between pediatric and adolescent patients with AD. Treatment considerations for pediatric and adolescent patients with AD should take into account these factors, with future research directed toward improving the QoL in these patients.

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.

Introduction Atopic dermatitis (AD) is an inflammatory disease causing severe skin itching. Data on patient–physician disconnect on treatment satisfaction in patients with AD in Japan are limited. We investigated patient–physician disconnect on treatment satisfaction in AD and if it influences treatment patterns, clinical characteristics, and patient-reported outcomes (PROs). Methods Data were drawn from the Adelphi AD Disease Specific Programme (DSP), a real-world, point-in-time survey of physicians and patients with AD conducted in Japan from April to July 2019. Patients and physicians were grouped according to level of treatment satisfaction (“extremely satisfied” to “extremely dissatisfied”); with any level of dissatisfaction recorded as “less than satisfied.” Data were collected on treatment patterns, clinical characteristics, and PROs including the Dermatology Life Quality Index (DLQI), Patient-Oriented Eczema Measure (POEM), EQ-5D-3L questionnaire, and Work Productivity and Activity Impairment (WPAI) questionnaire. Results Data were provided by 184 patients with AD and 56 physicians; 72.8% of patient–physician pairs reported a fair (kappa coefficient: 0.40) level of agreement on treatment satisfaction, 51.6% of patient–physician pairs were both satisfied, and 21.2% were both less than satisfied. Satisfied physicians prescribed a mean 1.2 fewer treatments than dissatisfied physicians (p < 0.05). Cases where both physician and patient were less than satisfied or where patients were less satisfied than their physicians reported the worst PROs, DLQI (both less than satisfied: mean 10.7 versus patient less satisfied than physician: 10.6 versus overall: 7.9), POEM (19.5 versus 17.3 versus 17.0), EQ-5D-3L (0.82 versus 0.81 versus 0.87) (all, p < 0.05). Work impairment was highest when both patient and physician were less than satisfied (p < 0.05). Physicians cited treatment efficacy and patients cited efficacy and usability as main reasons for dissatisfaction. Conclusion Overall, 12.0% of patients were less satisfied with their AD treatment than the physician, demonstrating some of the worst PROs, suggesting unmet need that could be improved by better patient–physician communication.