Influence of disease control and perceived risk on atopic dermatitis treatment decisions

OBJECTIVE: Patients with atopic dermatitis (AD) face an increasingly complex treatment landscape with prescription options that vary in efficacy, safety, and mode of administration. The aim of this study was to evaluate how real-world factors such as risk tolerance, side effect (SE) concerns, and disease control influence treatment decisions. METHODS: A cross-sectional electronic survey (January-April 2025) of U.S. adults with self-reported AD and caregivers was conducted to assess how they weigh treatment benefits and risks. Negative binomial regression examined predictors of the number of SEs prioritized over rapid symptom relief when AD is at its worst. RESULTS: Included respondents (796 adults, 113 caregivers) most frequently reported unknown long-term SEs (618; 68.0%), liver or kidney problems (610; 67.1%), and allergic reactions (538; 59.2%) as SEs of concern. Over one quarter (26.1%) prioritized avoidance of ≥5 SEs over rapid symptom relief. Caregivers prioritized 40% more SEs over rapid relief than adult patients (adj IRR, 1.40; 95% CI, 1.22-1.61). Higher willingness to take health-related risks was associated with prioritizing fewer SEs (adj IRR, 0.95; 95% CI, 0.93-0.96), but AD control status was not significantly associated with SE prioritization. CONCLUSION: These findings demonstrate that safety concerns strongly influence treatment decision-making in AD, underscoring the need for transparent, personalized discussions to support shared decision-making.