Patients with Atopic Dermatitis and Insufficient Response to Conventional Systemic Therapy in Germany: A Health Claims Data Analysis

INTRODUCTION: Atopic dermatitis (AD) is a prevalent, chronic, inflammatory skin disorder causing significant quality-of-life impairment. Some patients need systemic therapy depending on disease course and effectiveness of topical treatment. Current systemic treatments may have limitations for long-term use and/or for different patient age groups. This study investigates conventional systemic therapy use and indicators of insufficient disease control on the basis of German statutory health insurance health claims data. METHODS: This retrospective cohort study used claims-based data from the Institute for Applied Health Research Berlin GmbH (InGef) sample database from 1 October 2019 to 31 December 2022, with the index period defined as 1 October 2021 to 30 September 2022. The pre-index period was from 1 October 2019 to 30 September 2021, and the observation period was from 1 October 2021 to 31 December 2022. Patients diagnosed with AD (ICD-10-GM code L20.8 or L20.9) with continuous insurance during the index period were included. RESULTS: Of 4 million eligible patients in the InGef sample database, 3400 were eligible for systemic drug therapy. Of these patients, 1016 were treated with targeted systemic therapy, and 1719 treated with conventional systemic therapy had insufficient disease control. The overall 1-year administrative prevalence of AD was estimated at 2.4%, and the incidence of AD was estimated at 0.3%. Prevalence was highest in children aged ≤ 4 years (7.0%) and decreased with advancing age. The most prevalent criterion of insufficient disease control was AD-related infections, affecting 58.4% of patients, followed by prolonged use of topical treatment (44.2%) and frequent active flares (36.9%). CONCLUSIONS: These findings highlight the challenges in managing AD with conventional systemic therapies and underscore the need for improved treatment strategies. Insights into the patterns of systemic therapy use and disease control can inform future therapeutic approaches and policy decisions to enhance patient outcomes in AD management.