A clinic aimed at managing patients with difficult-to-control atopic dermatitis (AD) by involving assessments from a team of clinicians from different disciplines led to significant improvements in severity of the disease, results from a single-center study showed.
“A significant challenge in caring for patients with atopic dermatitis is lack of collaboration between healthcare providers, leading to disjointed care, inconsistent treatment plans, and conflicting dialogue with patients,” first author Alexis Tracy, MD, a combined allergy and dermatology research fellow at Rady Children’s Hospital, San Diego, and colleagues wrote in the study, which was published online on January 14, 2024, in Pediatric Dermatology.
Launched in 2019, the clinic, which is called the Multidisciplinary Atopic Dermatitis Program (MADP), is a collaborative effort between with Rady Children’s Hospital and the University of California San Diego Health Division of Dermatology, Division of Allergy & Immunology, and the hospital’s clinical pharmacy. Patients referred to the MADP undergo a concurrent, comprehensive evaluation by a dermatologist, allergist, clinical pharmacist, and others who help to assess AD severity, provide family education about the disease, and form a care plan using the model of shared decision-making. Visits take about 2 hours, and the frequency of follow-up visits varies.
Core members of the Rady/UCSD Multidisciplinary Atopic Dermatitis Program are, from left, Dr Lawrence Eichenfield (dermatology), Lauren Loop (research coordinator), Alyssa Wu (clinical pharmacist), Dr Bob Geng (allergy), Katie Smiley (physician assistant and clinic cooordinator), and Dr Mira Choi (visiting scholar).
In the dermatology realm, tools used to compare the extent and severity of AD between visits include the Eczema Area and Severity Index (EASI), Patient-Oriented Eczema Measure (POEM), the Children’s Dermatology Life Quality Index (CDLQI), Validated Investigator Global Assessment (vIGA), Body Surface Area (BSA), and the Numerical Rating Scale. To investigate the MADP’s success to date, Dr Tracy and colleagues evaluated 44 patients with a history of moderate to severe, persistent AD who were referred to the clinic between April 3, 2019, and October 22, 2022, and had between one and three follow-up visits. The patients ranged from age 4 months to 18 years (mean, 7.74 years).
Compared with baseline, EASI scores of patients decreased significantly, with an average mean improvement of 9.61 by the second visit, 15.12 by the third visit, and 17.42 by the fourth visit (P <.001 for all three these represent average decreases of and respectively.>
At the seventh visit, the EASI score decreased by a mean of 33.48 (P=.008), which represents an average decrease of 91.52% from baseline. Of the 44 patients, 32 achieved an EASI 50 and 21 achieved an EASI 75.
In other findings, the mean vIGA improved with each visit, with the largest observed improvement at the seventh visit (a mean of 2.25 points; P=.009), and the greatest mean improvement in the POEM score was seen at the sixth visit (a mean of 11.13 points; P <.001 the mean difference in cdlqi scores also increased with each visit largest improvement seen at sixth increase of points p>
Similarly, BSA progressively improved at each clinic visit, from a mean decrease of 16.02% at the second visit to a mean decrease of 56.04% at the seventh visit (P <.001 for both meanwhile the largest mean improvement in pruritus was seen at sixth visit of points p=".001).</p">
In an interview, MADP’s codirector, Lawrence Eichenfield, MD, chief of pediatric and adolescent dermatology at Rady Children’s Hospital, San Diego, California, said that the consistency of data showing rapid, consistent improvement with a varied set of physician-assessed scores and patient-reported outcomes “was very impressive, especially given the variation in severity, extent and difficult course of many of the patients we saw, and spectrum of interventions — from topical regimens to advanced systemic therapies,” he said. “As clinicians, we tend to remember the ‘tough cases’, and it was tremendous to see the impact and utility of the clinic.”
He noted that he and Bob Geng, MD, an allergist/immunologist at Rady Children’s who codirects the MADP, regularly discuss how much they have learned from the program. “Some takeaways are simple, like ‘do body surface area assessment in pediatric patients with moderate to serve atopic dermatitis’, ” Dr Eichenfield said. “These help us show the severity to the patient and family, and everyone loves to see the objective improvement measures over time.”
The MADP providers and personnel have become better at explaining AD “and understanding how families come in with broad differences in understanding of the disease, therapies and prior treatments,” he added. “And I have learned that discussing environmental allergies and food allergies, even if they might not be triggers of the AD, is appreciated by patients and families, as they are part of the family experience and they appreciate our ‘broadly caring’ beyond our narrow niches of intervention.”
Important Model of Care
Asked to comment on the results, pediatric dermatologist Moise L. Levy, MD, professor of internal medicine and pediatrics at the University of Texas at Austin, who was not involved with the study, characterized the MADP as an important model of care. “Multi-interdisciplinary care of such conditions is well-known to be of great help for patients and their families,” he told this news organization.
“A key part of the ‘team’ is the family/patient engagement and shared decision-making. The use of visual aides to highlight components of care was likely of great use, as well,” he said. “All such interventions impact the disease, as well as associated problems, such as itch, sleep, and mental health. Importantly, such interventions, while known to be useful as demonstrated by the authors, take time, and relate to improved outcomes as noted by the date outlined by the authors.”
The study authors acknowledged certain limitations of the study, including the lack of a control group with single-specialty visits. “The real takeaway is that taking the time to do more holistic assessments of health — with skin and allergy issues being discussed, and consistent education and messaging — helps make our medical interventions more successful, with both objective disease improvement and patient/family satisfaction,” Dr Eichenfield said in the interview.
Pfizer and Sanofi provided financial support to MADP and for the study. Dr Eichenfield disclosed that he serves as a scientific adviser, consultant, and/or clinical trial investigator for AbbVie, Amgen, Aslan, Castle Biosciences, Dermavant, Eli Lilly and Company, Forté, Galderma, Incyte, Janssen, LEO Pharma, Novartis, Ortho Dermatologics, Pfizer, Regeneron Pharmaceuticals, Sanofi-Genzyme, Trialspark, and UCB. Dr Geng disclosed ties with Sanofi, Regeneron, Pfizer, and AbbVie and is an adviser to Incyte, Galderma, Eli-Lilly, and LEO. The other authors reported having no disclosures. Dr Levy disclosed ties with Abeona, Amgen, Arcutis, Castle Creek, Dusa Pharma, Krystal Bio, Novan, Regeneron, and Sanofi Genzyme. He is also an investigator for Janssen.
This article originally appeared on MDedge.com, part of the Medscape Professional Network.
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