The treatment journey of children with moderate to severe atopic dermatitis in Türkiye: unmet needs

Deniz İlgün Gürel, Hilal Ünsal, Elif Soyak Aytekin, Özge Soyer, Ü. Şahiner, S. Ersoy Evans, B. Sekerel
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Abstract

Background. Atopic dermatitis (AD) substantially burdens individuals, families, and healthcare systems. We aimed to document the treatment journey of pediatric patients with moderate-to-severe AD in a referral center based in our country. Methods. This retrospective study reviewed patients aged 1-18 years diagnosed with AD, seeking systemic treatment recommendations from the “pediatric allergy and dermatology multidisciplinary team meeting”. Results. Over the 14-month study period, 30 (12.5%) of 240 AD patients were evaluated in the pediatric dermato-allergy team meetings. The median age of the patients was 13.66 years (Q1-Q3: 7.94-17.27), of whom 60% were male. The median annual healthcare visits for AD were 4 (Q1-Q3: 1.00-8.75). Among the study group, 70% were sensitized to aeroallergens, and admission markers included total IgE (median: 1980 IU/mL, Q1-Q3: 794.50-5446), and eosinophil counts (median: 650, Q1-Q3: 275-1275). All patients utilized intermittent and/or continuous topical corticosteroids (CS), with 56.6% employing short-term/long-term topical tacrolimus. Over the past two years, systemic CSs were utilized in 93.3% of the patients, whereas 57.1% received more than one course. Approximately 43.3% of the patients agreed to receive systemic cyclosporine treatment, with only 30.8% benefiting and 3.3% reporting adverse effects (hypertrichosis and cellulitis). Three patients self-funded dupilumab, all benefiting without adverse effects. Omalizumab, mycophenolate mofetil and narrow-band  ultraviolet (UV) treatments were used in one patient each, with limited benefit observed. Health insurance did not grant approval for a Janus kinase inhibitor for one patient. Conclusions. Managing moderate to severe AD is complex and costly, considering disease heterogeneity, comorbidities, care pathways, and health system challenges. Addressing the unmet needs should be a priority in Türkiye’s healthcare systems.
土耳其中重度特应性皮炎患儿的治疗历程:未满足的需求
背景。特应性皮炎(AD)给个人、家庭和医疗保健系统带来沉重负担。我们旨在记录我国一家转诊中心的中重度特应性皮炎儿科患者的治疗历程。这项回顾性研究对 1-18 岁确诊为 AD 的患者进行了回顾,这些患者寻求 "儿科过敏和皮肤病多学科团队会议 "的系统治疗建议。在 14 个月的研究期间,240 名 AD 患者中有 30 人(12.5%)接受了儿科皮肤过敏小组会议的评估。患者的中位年龄为 13.66 岁(Q1-Q3:7.94-17.27),其中 60% 为男性。AD 年就诊次数中位数为 4 次(Q1-Q3:1.00-8.75 次)。研究组中,70%的患者对空气过敏原过敏,入院指标包括总 IgE(中位数:1980 IU/mL,Q1-Q3:794.50-5446)和嗜酸性粒细胞计数(中位数:650,Q1-Q3:275-1275)。所有患者均使用间歇性和/或持续性局部皮质类固醇激素(CS),其中 56.6% 的患者使用短期/长期局部他克莫司。在过去两年中,93.3%的患者使用了全身性皮质类固醇激素,57.1%的患者使用了一个疗程以上。约 43.3% 的患者同意接受系统性环孢素治疗,只有 30.8% 的患者从中受益,3.3% 的患者报告了不良反应(多毛症和蜂窝组织炎)。有 3 名患者自费接受了杜比鲁单抗治疗,全部获益且无不良反应。奥马珠单抗、霉酚酸酯和窄带紫外线(UV)疗法各用于一名患者,但观察到的获益有限。一名患者使用的 Janus 激酶抑制剂未获得医疗保险批准。考虑到疾病的异质性、合并症、治疗途径和医疗系统的挑战,中重度AD的治疗是复杂而昂贵的。解决未满足的需求应成为土耳其医疗系统的优先事项。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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