Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan.
Department of Dermatology, Nippon Medical School, Tokyo, Japan.
J Dermatol. 2022 Sep;49(9):903-911. doi: 10.1111/1346-8138.16485. Epub 2022 Jun 17.
Atopic dermatitis (AD), a chronic relapsing inflammatory skin disease with a high disease burden, is one of the most common dermatological conditions in Japan. Herein, we report the disease profiles and current AD treatment during 2-year management of Japanese adults with moderate-to-severe AD. ADDRESS-J was a prospective, longitudinal, observational study that evaluated real-world effectiveness and safety of current AD treatments of adult patients with moderate-to-severe AD (Investigator's Global Assessment score 3 or 4) in Japan. The maximum follow-up period was 2 years. Among 300 patients enrolled, 288 had ≥1 post-baseline evaluation and were analyzed (mean age, 35.5 years; 60.1% male). Almost all patients (99.7%) received topical therapy; the most commonly used therapy was topical corticosteroids of the second-highest potency (86.5%) (e.g., 0.1% mometasone furoate) followed by medium-potency topical corticosteroids (50.3%) (e.g., 0.05% clobetasol butyrate). At month 12 of the study, 10.4% of patients had Investigator's Global Assessment 0/1, similarly at month 24 (10.8%). A total of 132 patients (45.8%) had ≥1 AD flare-up during the observation period, with the majority of first flares occurring within the first year of the study. Various physician- and patient-reported outcomes improved considerably during the first 3 months of the study, with only minor changes after this time. In this cohort, 16.7% of patients had skin infections requiring treatment; 7.3% had adverse events (AE) potentially related to treatment; 1.7% had serious AE; and 1.0% had treatment discontinuations due to AE. Limitations include missing data at later timepoints and the inclusion criteria limiting generalizability. In summary, this analysis of the ADDRESS-J study showed that some patients with moderate or severe AD respond to conventional therapies, while others do not. For those with inadequately controlled moderate-to-severe AD, the newly emerged systemic agents, such as biologics, may provide a potential strategy for long-term disease management.
特应性皮炎（AD）是一种慢性复发性炎症性皮肤病，疾病负担高，是日本最常见的皮肤病之一。在此，我们报告了在 2 年的时间里，日本中重度 AD 成年患者的疾病特征和当前 AD 治疗情况。ADDRESS-J 是一项前瞻性、纵向、观察性研究，评估了日本中重度 AD（研究者整体评估评分 3 或 4）成年患者当前 AD 治疗的真实世界疗效和安全性。最大随访时间为 2 年。在入组的 300 例患者中，有 288 例（平均年龄 35.5 岁；60.1%为男性）至少进行了 1 次基线后评估并进行了分析。几乎所有患者（99.7%）均接受了局部治疗；最常用的治疗方法是使用第二强效的局部皮质类固醇（86.5%）（如 0.1%糠酸莫米松），其次是中效局部皮质类固醇（50.3%）（如 0.05%丙酸氯倍他索）。在研究的第 12 个月，有 10.4%的患者达到研究者整体评估 0/1，在第 24 个月时同样为 10.8%。在观察期间，共有 132 例患者（45.8%）发生了 1 次或多次 AD 发作，大多数首次发作发生在研究的前 1 年内。在研究的前 3 个月内，各种医生和患者报告的结局有了显著改善，此后变化很小。在该队列中，有 16.7%的患者发生了需要治疗的皮肤感染；有 7.3%的患者出现了可能与治疗相关的不良事件（AE）；有 1.7%的患者发生了严重 AE；有 1.0%的患者因 AE 而停止治疗。局限性包括后期时间点的数据缺失和纳入标准限制了普遍性。总之，对 ADDRESS-J 研究的这项分析表明，一些中重度 AD 患者对常规治疗有反应，而另一些患者则没有。对于那些中重度 AD 控制不佳的患者，新出现的全身性药物，如生物制剂，可能为长期疾病管理提供一种潜在策略。
