Impact of minimal disease activity on quality of life in patients with atopic eczema

Achieving minimal disease activity (MDA) in atopic eczema was associated with improvement in other patient-reported outcomes (PROs) in post hoc analyses of clinical trials. There is limited evidence for this association in the real-world setting. We set out to describe the impact of achieving MDA on other PROs in patients with atopic eczema in the A-STAR register. In total, 530 patients were included who were aged ≥ 12 years, initiated systemic treatment and had Eczema Area and Severity Index (EASI) and Peak Pruritus Numerical Rating Scale score (PP-NRS) measurements at both drug initiation and 4–6 months. Patients were stratified by achieving MDA at 4–6 months. MDA was defined as a composite of EASI 90 (≥ 90% improvement from baseline) with absolute EASI ≤ 3 and PP-NRS 0 or 1 at the same visit. Improvement in PROs included reduction in Dermatology Life Quality Index (DLQI) and Patient-Oriented Eczema Measure (POEM) by ≥ 4 points, absolute DLQI 0 or 1 and absolute POEM ≤ 2. Appropriate adjusted regression models were used to compare between the two groups. Those patients not achieving MDA at 4–6 months were used as the reference. At 4–6 months, 81 patients (15.3%) achieved MDA. At baseline, those achieving MDA had lower PROs (non-MDA vs. MDA, mean and SD): DLQI, 14.9 (7.6) vs. 11.7 (8.2); PP-NRS, 6.8 (2.1) vs. 5.6 (2.6) and POEM, 19.9 (6.4) vs. 16.3 (8.2); P ≤ 0.001. However, the difference in baseline EASI was not statistically significant: mean 15.7 (SD 10.9) vs. mean 18.0 (SD 11.9); P = 0.10. Using those not achieving MDA as the reference, MDA achievement, reported as the adjusted regression coefficient and 95% confidence interval (CI) was associated with higher reduction in DLQI, −5.4 (−6.9 to −4.0) and POEM, −8.7 (−10.4 to −7.0) at 4–6 months. Achieving MDA was also associated with increased odds of DLQI reduction by ≥ 4 points [adjusted odds ratio (aOR) 16.8, 95% CI 7.0–47.7], absolute DLQI ≤ 1 (aOR 13.3, 95% CI 7.2–25.1), POEM reduction ≥ 4 (aOR 11.6, 95% CI 4.9–32.7) and absolute POEM ≤ 2 (aOR 17.9, 95% CI 9.4–35.2). In conclusion, achieving MDA at 4–6 months was associated with larger improvements in PROs. Further studies are needed to assess predictors and long-term benefits of achieving MDA in the real-world setting.

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