Published on in Vol 6 (2023)

Preprints (earlier versions) of this paper are available at https://preprints.jmir.org/preprint/41194, first published .
Prescribing Patterns of Dupilumab for Atopic Dermatitis in Adults: Retrospective, Observational Cohort Study

Prescribing Patterns of Dupilumab for Atopic Dermatitis in Adults: Retrospective, Observational Cohort Study

Prescribing Patterns of Dupilumab for Atopic Dermatitis in Adults: Retrospective, Observational Cohort Study

Original Paper

1Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, United States

2University of Colorado School of Medicine, Aurora, CO, United States

3Center for Innovative Design and Analysis, The Colorado School of Public Health, University of Colorado School of Medicine, Aurora, CO, United States

4Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States

5Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, United States

6The Colorado School of Public Health, University of Colorado School of Medicine, Aurora, CO, United States

7Dermatology Service, Eastern Colorado Health Care System, US Department of Veterans Affairs, Denver, CO, United States

Corresponding Author:

Ani Oganesyan, BA

University of Colorado School of Medicine

13001 E 17th Pl

Aurora, CO, 80045

United States

Phone: 1 818 441 6860

Email: ani.oganesyan@cuanschutz.edu


Background: Atopic dermatitis (AD) is a common inflammatory disease caused by a type 2 T helper cell–mediated immune response to environmental antigens. Approximately 1 in 5 patients with AD presents with moderate to severe disease, and treatments approved by the Food and Drug Administration include emollients, topical glucocorticoids, and calcineurin inhibitors. Dupilumab, a fully human monoclonal antibody, improves AD via inhibition of interleukin-4 and interleukin-13.

Objective: Our aim was to characterize the prescribing patterns of dupilumab for AD in adults at a large university-affiliated health system.

Methods: A retrospective, observational cohort study was conducted using electronic data from the Observational Health Data Sciences and Informatics database, assessing data from the University of Colorado Medical Campus and its affiliates. The outcome measured was the prevalence of dupilumab prescribed for adults with AD (n=6421), between March 28, 2013, and March 28, 2021. We assessed whether the characteristics of patients who received dupilumab were different from those who did not. Each patient characteristic was assessed using a univariate logistic regression with the binary outcome of receiving or not receiving dupilumab.

Results: We found a population prevalence of 5.6% (6421/114,476) for AD. In our cohort, Black patients with AD were more than twice as likely to have received dupilumab compared to White patients (odds ratio 2.352, 95% CI 1.58-3.39). Patients with a diagnosis of atopic neurodermatitis were approximately twice as likely to have received dupilumab compared to those with other diagnostic variants of AD (odds ratio 1.87, 95% CI 1.01-3.22).

Conclusions: Our results demonstrate that both patient racial characteristics and specific AD diagnoses were associated with variations in dupilumab prescription patterns.

JMIR Dermatol 2023;6:e41194

doi:10.2196/41194

Keywords



Atopic dermatitis (AD) is a chronic inflammatory disease that affects US children and adults, with a reported prevalence of 10%-13% and 7%, respectively [1-4]. Higher disease severity is associated with lower quality of life, worsened mental status, and higher use of health care resources [1,5]. This includes emergency department visits and hospitalizations as well as increased pharmaceutical and outpatient costs [6-8]. Consequently, effectively treating patients with AD has substantial clinical and economic implications.

Assessing the severity of AD is determined by the number of sites involved (eg, head and neck, upper extremities, or trunk and lower extremities), the lesion characteristics (eg, erythema, edema or papulation, and lichenification), as well as reported symptoms. Patients who have 10%-29% bodily involvement with notable signs of inflammation are classified as having moderate disease, and those with greater or equal to 30% bodily involvement are considered to have severe disease. This classification is important in the diagnosis and treatment of AD, thereby affecting therapeutic outcomes [9]. Treatment of AD with a systemic immunomodulating agent is indicated when the disease is considered moderate to severe [10]. A variety of systemic agents, including cyclosporine, azathioprine, methotrexate, mycophenolate mofetil, and systemic steroids, are used in practice without strict guidelines or recommendations to guide treatment choices [10,11]. In March 2017, dupilumab became the first biologic drug approved for the treatment of AD in adults, and in May 2020, it gained approval for use in children aged 6 years and older. Dupilumab blocks the interleukin (IL)-4 alpha receptor, inhibiting IL-4 and IL-13 signaling and preventing the release of type 2 cytokines that promote inflammation in AD [12]. Compared with the aforementioned systemic immunomodulating agents, dupilumab may be more effective as a long-term maintenance therapy and has the advantage of an overall improved side-effect profile, with no required drug-specific laboratory monitoring [11]. However, access to this immunomodulator may be limited by its novelty and cost (depending upon the dose, up to US $59,000/year for patients without insurance) [13].The disease burden of AD disproportionately affects non-Hispanic Black patients; the source of this disparity is multifactorial. Although the specific gene-environment interactions in the pathophysiology of AD are unknown, many factors—such as differences in environmental pollution, contact with tobacco smoke, hygiene practices, access to health care, diet, and exposure to disease—likely play a role [4,14,15]. Loss of function mutations in the filaggrin gene is linked with an increased risk of developing AD, oftentimes leading to persistent disease. Filaggrin loss-of-function mutations are less common in Black patients compared to White patients, yet Black patients are still more likely to experience persistent disease [16,17]. In addition, Black patients have lower skin ceramide/cholesterol ratios, attenuated T helper 1 and T helper 17 immunophenotypes, and higher serum immunoglobulin (Ig) E levels, which predisposes to skin breakdown, dysregulated immunity, and increased inflammation [18,19]. Despite higher AD disease severity and increased health care needs, Black patients are less likely to receive outpatient dermatologic care [3,20-22]. A prior investigation reporting on race- and ethnicity-related disparities in the treatment of AD found that Black patients had statistically significant lower odds of receiving dupilumab compared to White patients [23]. Previous research has also shown that Black patients with psoriasis are less likely than White patients to receive biologic treatment, independent of demographic or socioeconomic factors and comorbidities [24,25].

Data related to the prescription patterns of dupilumab for AD are needed to inform health equity and decision-making in everyday practice.


Ethical Considerations

The Colorado Multiple Institutional Review Board determined that this research did not involve human subjects, and therefore, was exempt from ethics approval.

Data Source

We performed a retrospective, observational cohort study of adult patients treated for AD, using electronic data from the University of Colorado Anschutz Medical Campus and its affiliates (hospital wards and outpatient clinics) via Health Data Compass (HDC), an electronic health data warehouse [26]. Records of patients who visited any of the institution’s facilities from January 1, 2010, to March 28, 2021, were pulled from HDC and remained in the format of the Observational Health Data Sciences and Informatics (OHDSI) Observational Medical Outcomes Partnership common data model. Data extracted included demographics, prescription history, diagnosis history, and visit details.

Study Design and Study Population

The outcome of interest was the prevalence of dupilumab prescribed for AD, stratified by patient characteristics. The study cohort, consisting of individuals with specific AD diagnoses and various dupilumab prescription types, was developed using the OHDSI Atlas cohort and concept set tools (Table 1). All study participants were between the ages of 18 and 85 years as of March 28, 2017, with a diagnosis of AD, as defined by at least two encounter diagnoses of AD (Figure 1). The drug of interest was any prescription order of dupilumab (200 mg or 300 mg syringe or pen). Records included were those of ordered medications. Information regarding fulfilment for this study was not used, nor did we include orders external to our institution. Included dupilumab prescriptions were required to have a start date on or after March 28, 2017, and to have occurred following a diagnosis of AD. Prescriber data, including their medical credential and practice setting, were not analyzed.

Table 1. Concept set for diagnosis of atopic dermatitis, displaying International Classification of Diseases, Tenth Revision (ICD-10) source codes that map to the included Observational Medical Outcomes Partnership concept IDs.
Concept IDConcept codeConcept nameClassDomainVocabulary
45601213L20.84Intrinsic (allergic) eczema5-character billing codeConditionICD-10-CMa
45596150H60.54Acute eczematoid otitis externa5-character nonbilling codeConditionICD-10-CM
45581716H60.549Acute eczematoid otitis externa, unspecified ear6-character billing codeConditionICD-10-CM
45572269L30.1Dyshidrosis (pompholyx)ICD-10 codeConditionICD-10-CM
45572263L20.83Infantile (acute, chronic) eczema5-character billing codeConditionICD-10-CM
45567351L20.89Other atopic dermatitis5-character billing codeConditionICD-10-CM
45562535L30.0Nummular dermatitisICD-10 codeConditionICD-10-CM
45557698L20Atopic dermatitisICD-10 hierarchyConditionICD-10-CM
45557486H60.542Acute eczematoid otitis externa, left ear6-character billing codeConditionICD-10-CM
45557485H60.541Acute eczematoid otitis externa, right ear6-character billing codeConditionICD-10-CM
45552974L20.82Flexural eczema5-character billing codeConditionICD-10-CM
45548191L20.9Atopic dermatitis, unspecifiedICD-10 codeConditionICD-10-CM
45547951H60.543Acute eczematoid otitis externa, bilateral6-character billing codeConditionICD-10-CM
45533637L20.8Other atopic dermatitisICD-10 codeConditionICD-10-CM
35208498L30.1Dyshidrosis (pompholyx)4-character billing codeConditionICD-10-CM
35208497L30.0Nummular dermatitis4-character billing codeConditionICD-10-CM
35208450L20.9Atopic dermatitis, unspecified4-character billing codeConditionICD-10-CM
1569766L20.8Other atopic dermatitis4-character nonbilling codeConditionICD-10-CM
1569765L20Atopic dermatitis3-character nonbilling codeConditionICD-10-CM
1418386L30.100Dyshidrosis (pompholyx)ICD-10 codeConditionICD-10-CM
1418385L30.1Dyshidrosis (pompholyx)ICD-10 codeConditionICD-10-CM
1418384L30.000Nummular dermatitisICD-10 codeConditionICD-10-CM
1418383L30.0Nummular dermatitisICD-10 codeConditionICD-10-CM
1418239L20.900Atopic dermatitis, unspecifiedICD-10 codeConditionICD-10-CM
1418238L20.9Atopic dermatitis, unspecifiedICD-10 codeConditionICD-10-CM
1418237L20.806Newborn skin eczema (machine translation)ICD-10 codeConditionICD-10-CM
1418236L20.805Diffuse neurodermatitis (machine translation)ICD-10 codeConditionICD-10-CM
1418235L20.804Baby eczema (machine translation)ICD-10 codeConditionICD-10-CM
1418234L20.803Atopic neurodermatitis (machine translation)ICD-10 codeConditionICD-10-CM
1418233L20.802Allergic eczema (machine translation)ICD-10 codeConditionICD-10-CM
1418232L20.801Neurodermatitis (machine translation)ICD-10 codeConditionICD-10-CM
1418231L20.800Other atopic dermatitisICD-10 codeConditionICD-10-CM
1418230L20.8Other atopic dermatitisICD-10 codeConditionICD-10-CM
1418227L20Atopic dermatitisICD-10 hierarchyConditionICD-10-CM

aICD-10-CM: International Classification of Diseases, Tenth Revision, Clinical Modification.

Figure 1. Flowchart of included patients. UCHEALTH: University of Colorado Health; CHCO: Children's Hospital Colorado.

Statistical Analysis

We assessed whether the characteristics of patients with AD who received dupilumab were different from those who did not. Each patient characteristic was gathered based on AD-associated billing and nonbilling codes. These codes were based on the International Classification of Diseases, Tenth Revision and are listed in Table 1. The characteristics were then assessed using a univariate logistic regression, with the binary outcome of receiving dupilumab or not receiving dupilumab (Table 2). The resulting P values associated with multilevel categorical characteristics (eg, race and diagnosis) were corrected for multiple testing using the False Discovery Rate (Benjamini-Hochberg correction) method. Reference levels included White race, non-Hispanic ethnicity, female sex, and AD as the first eligible diagnosis.

Table 2. Summary statistics—overall and by patients who did and did not receive dupilumab.
User prevalenceDid not receive (n=6172)Received (n=249)Overall (N=6421)
Age (years), mean (SD)53.3 (17.9)51.4 (16.7)53.2 (17.9)
Age (years), median (min, max)54.0 (22.0, 89.0)52.0 (22.0, 87.0)54.0 (22.0, 89.0)
Sex, n (%)

Female3532 (57.2)146 (58.6)3678 (57.3)

Male2621 (42.5)102 (41)2723 (42.4)

Missing19 (0.3)1 (0.4)20 (0.3)
Race, n (%)

American Indian and Alaska Native20 (0.3)1 (0.4)21 (0.3)

Asian246 (4)11 (4.4)257 (4)

Black or African American397 (6.4)34 (13.7)431 (6.7)

Multiple race161 (2.6)6 (2.4)167 (2.6)

Native Hawaiian and other Pacific Islander12 (0.2)0 (0)12 (0.2)

White or Caucasian4912 (79.6)179 (71.9)5091 (79.3)

Other340 (5.5)13 (5.2)353 (5.5)

Missing84 (1.4)5 (2.0)89 (1.4)
Ethnicity, n (%)

Hispanic563 (9.1)20 (8)583 (9.1)

Non-Hispanic5491 (89)226 (90.8)5717 (89)

Missing118 (1.9)3 (1.2)121 (1.9)
Diagnosis, n (%)

Atopic dermatitis3050 (49.4)213 (85.5)3263 (50.8)

Atopic neurodermatitis107 (1.7)14 (5.6)121 (1.9)

Flexural eczema758 (12.3)5 (2)763 (11.9)

Nummular eczema1120 (18.1)6 (2.4)1126 (17.5)

Vesicular eczema1137 (18.4)11 (4.4)1148 (17.9)

Summary statistics gathered based on the International Classification of Diseases, Tenth Revision billing codes are provided in Table 2. There were 249 dupilumab prescriptions among 6421 patients. Our cohort had a mean age of 53.2 (SD 17.9) years and was composed of mostly non-Hispanic (n=5491, 89%), White (n=4912, 79.3%), and female (n=3532, 57%) patients. The most common recent diagnosis was a general diagnosis of atopic dermatitis (n=3263, 50.8%), followed by vesicular eczema (n=1148, 17.9%), nummular eczema (n=1126, 17.5%), flexural eczema (n=763, 11.9%), and lastly, atopic neurodermatitis (n=12, 1.9%). Among those who received dupilumab, the mean age was 51.4 (SD 16.7) years and 58.6% (n=146) were female. Every patient who received a prescription had either multiple prescriptions, prescriptions for quantities greater than 1, or received refills. The majority of patients were White (n=179, 71.9%), followed by patients identifying as Black or African American (n=34, 13.7%) and “Other” races (n=13, 5.2%). Among the most common recent diagnoses, 85.8% (n=213) were general diagnoses of AD, and the remaining were diagnoses of atopic neurodermatitis (n=14, 5.6%), flexural eczema (n=5, 2.2%), nummular eczema (n=6, 2.2%), or vesicular eczema (n=11, 4.1%).

We assessed whether the proportion of patients who received dupilumab was different based on patient characteristics. Each patient characteristic (Table 3) was assessed using logistic regression with the binary outcome of receiving dupilumab or not receiving it. The P values associated with multilevel categorical characteristics (eg, race or diagnoses) were corrected for multiple testing using the False Discovery Rate (Benjamini-Hochberg correction) method. Reference levels included white race, non-Hispanic ethnicity, female sex, and AD as the first eligible diagnosis.

In our cohort, Black patients were approximately twice as likely to have received dupilumab for AD compared to White patients (odds ratio 2.352, 95% CI 1.58-3.39). Similarly, those diagnosed with atopic neurodermatitis were about twice as likely to have received dupilumab compared to those who were diagnosed with AD (odds ratio 1.87, 95% CI 1.01-3.22). Conversely, those with other eczema diagnoses, including flexural eczema, nummular eczema, or vesicular eczema, were less likely to have received dupilumab compared to those with a most recent diagnosis of atopic neurodermatitis.

Table 3. Univariate analysis by patient characteristics.
VariableOdds ratio (CI)P value
Age (per 10-year increase)0.944 (0.879-1.013).11
Sex
Male1.00 (reference)a
Female0.941 (0.726-1.217).65
Race
American Indian or Alaska Native
Asian1.228 (0.622-2.183).86
Black or African American2.352 (1.583-3.397)<.001
Multiple Race1.024 (0.398-2.15).96
Native Hawaiian or Other Pacific Islander
White or Caucasian1.00 (reference)
Other1.05 (0.564-1.791).96
Ethnicity
Non-Hispanic or Latino1.00 (reference)
Hispanic or Latino0.863 (0.526-1.340).54
Diagnoses
Atopic dermatitis1.00 (reference)
Atopic neurodermatitis1.87 (1.01-3.22).03
Flexural eczema0.0945 (0.0335-0.207)<.001
Nummular eczema0.0767 (0.0302-0.158)<.001
Vesicular eczema0.139 (0.0708-0.243)<.001

aNot applicable.


Principal Findings

We found that patient racial characteristics as well as specific eczema diagnoses were associated with different frequencies of dupilumab prescriptions.

Specifically, our results suggest that patients who reported their race as African American or Black were more likely to have received a dupilumab prescription compared to White patients in our health care system. This result is surprising, as previous research demonstrated less outpatient dermatologic care and fewer biologic prescriptions among the population of Black patients with AD [27,28].

Our study also revealed that patients with a diagnosis of atopic neurodermatitis were twice as likely to be prescribed dupilumab compared to patients with a diagnosis of AD. The term “neurodermatitis” refers to localized, circumscribed patches of lichenified skin that are commonly associated with itching. This term is increasingly being used to describe skin eruptions associated with anxiety [29].

Our study also revealed that patients with specific AD diagnoses, such as flexural eczema, nummular eczema, and vesicular eczema, are less likely to receive dupilumab than those with general AD, without further specification. One possible explanation may be that patients with certain subtypes of AD respond well to more conservative, first-line therapies (ie, topical corticosteroids, emollients, and topical calcineurin inhibitors) [30].

Limitations

Although the study results provide novel insights pertaining to the prescribing practices of dupilumab, there are important limitations. Data capturing patients’ insurance status and type of insurance at the time of visit would have been useful to provide further clarity regarding prescribing relationships; unfortunately, our HDC data warehouse only has the current insurance status and type available from our electronic health record system. Furthermore, the type of health care provider prescribing dupilumab as well as their specific sector of medical employment were not analyzed. Additional studies evaluating the background of the clinicians prescribing dupilumab may provide a better understanding of these unique prescription patterns.

Conclusions

We found that Black patients and patients diagnosed with atopic neurodermatitis were approximately twice as likely to have received dupilumab compared to White patients and those with a diagnosis of AD, respectively. Future studies may consider exploring possible factors contributing to the dupilumab prescription patterns we discovered, such as AD disease severity as a potential contributing factor and the role of insurance type in dupilumab prescribing frequency. Investigating similar trends among other OHDSI network sites might also be beneficial in elucidating the trends noted among our study population and would contribute to the generalizability of the results. Furthermore, there is little existing data regarding the treatment of AD in the pediatric demographic—additional research would allow clinicians to provide evidence-based care to this population subset.

Conflicts of Interest

RD is editor in chief of the JMIR Dermatology, an editor for Cochrane Skin, a dermatology section editor for UpToDate, a social media editor for the Journal of the American Academy of Dermatology (JAAD), and a Cochrane council cochair. TES is an editorial board member at large for JMIR Dermatology. RD receives editorial stipends (JMIR Dermatology), royalties (UpToDate), and expense reimbursement from Cochrane. TES receives fellowship funding from Pfizer, Inc. All other authors declare no conflicts of interest.

  1. Chiesa Fuxench ZC, Block J, Boguniewicz M, Boyle J, Fonacier L, Gelfand J, et al. Atopic dermatitis in America study: a cross-sectional study examining the prevalence and disease burden of atopic dermatitis in the US adult population. J Invest Dermatol. Mar 2019;139(3):583-590. [FREE Full text] [CrossRef] [Medline]
  2. Shaw T, Currie G, Koudelka C, Simpson E. Eczema prevalence in the United States: data from the 2003 National Survey of Children's Health. J Invest Dermatol. Jan 2011;131(1):67-73. [FREE Full text] [CrossRef] [Medline]
  3. Silverberg J, Hanifin J. Adult eczema prevalence and associations with asthma and other health and demographic factors: a US population-based study. J Allergy Clin Immunol. Nov 2013;132(5):1132-1138. [CrossRef] [Medline]
  4. Silverberg J, Simpson E. Associations of childhood eczema severity: a US population-based study. Dermatitis. 2014;25(3):107-114. [FREE Full text] [CrossRef] [Medline]
  5. Silverberg JI, Gelfand JM, Margolis DJ, Boguniewicz M, Fonacier L, Grayson MH, et al. Patient burden and quality of life in atopic dermatitis in US adults: a population-based cross-sectional study. Ann Allergy Asthma Immunol. Sep 2018;121(3):340-347. [FREE Full text] [CrossRef] [Medline]
  6. Kwa L, Silverberg JI. Financial burden of emergency department visits for atopic dermatitis in the United States. J Am Acad Dermatol. Sep 2018;79(3):443-447. [CrossRef] [Medline]
  7. Narla S, Hsu DY, Thyssen JP, Silverberg JI. Inpatient financial burden of atopic dermatitis in the United States. J Invest Dermatol. Jul 2017;137(7):1461-1467. [FREE Full text] [CrossRef] [Medline]
  8. Shrestha S, Miao R, Wang L, Chao J, Yuce H, Wei W. Burden of atopic dermatitis in the United States: analysis of healthcare claims data in the commercial, medicare, and Medi-Cal databases. Adv Ther. Aug 2017;34(8):1989-2006. [FREE Full text] [CrossRef] [Medline]
  9. Hanifin JM, Baghoomian W, Grinich E, Leshem YA, Jacobson M, Simpson EL. The eczema area and severity index—a practical guide. Dermatitis. 2022;33(3):187-192. [FREE Full text] [CrossRef] [Medline]
  10. Sidbury R, Davis D, Cohen D, Cordoro K, Berger T, Bergman J, et al. American Academy of Dermatology. Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol. Aug 2014;71(2):327-349. [FREE Full text] [CrossRef] [Medline]
  11. Seger EW, Wechter T, Strowd L, Feldman SR. Relative efficacy of systemic treatments for atopic dermatitis. J Am Acad Dermatol. Feb 2019;80(2):411-416.e4. [CrossRef] [Medline]
  12. Guttman-Yassky E, Bissonnette R, Ungar B, Suárez-Fariñas M, Ardeleanu M, Esaki H, et al. Dupilumab progressively improves systemic and cutaneous abnormalities in patients with atopic dermatitis. J Allergy Clin Immunol. Jan 2019;143(1):155-172. [FREE Full text] [CrossRef] [Medline]
  13. Team S. How much is Dupixent without insurance? 2022. URL: https://www.singlecare.com/blog/dupixent-without-insurance/ [accessed 2023-08-11]
  14. Croce EA, Levy ML, Adamson AS, Matsui EC. Reframing racial and ethnic disparities in atopic dermatitis in Black and Latinx populations. J Allergy Clin Immunol. Nov 2021;148(5):1104-1111. [FREE Full text] [CrossRef] [Medline]
  15. Tackett KJ, Jenkins F, Morrell DS, McShane DB, Burkhart CN. Structural racism and its influence on the severity of atopic dermatitis in African American children. Pediatr Dermatol. Jan 18, 2020;37(1):142-146. [CrossRef] [Medline]
  16. Polcari I, Becker L, Stein S, Smith M, Paller A. Filaggrin gene mutations in African Americans with both ichthyosis vulgaris and atopic dermatitis. Pediatr Dermatol. 2014;31(4):489-492. [CrossRef] [Medline]
  17. Margolis DJ, Mitra N, Wubbenhorst B, D'Andrea K, Kraya AA, Hoffstad O, et al. Association of filaggrin loss-of-function variants with race in children with aAtopic dermatitis. JAMA Dermatol. Nov 01, 2019;155(11):1269-1276. [FREE Full text] [CrossRef] [Medline]
  18. Jungersted J, Høgh JK, Hellgren L, Jemec G, Agner T. Ethnicity and stratum corneum ceramides. Br J Dermatol. Dec 2010;163(6):1169-1173. [CrossRef] [Medline]
  19. Sanyal RD, Pavel AB, Glickman J, Chan TC, Zheng X, Zhang N, et al. Atopic dermatitis in African American patients is T2/T22-skewed with T1/T17 attenuation. Ann Allergy Asthma Immunol. Jan 2019;122(1):99-110.e6. [CrossRef] [Medline]
  20. Fischer A, Shin D, Margolis D, Takeshita J. Racial and ethnic differences in health care utilization for childhood eczema: an analysis of the 2001-2013 Medical Expenditure Panel Surveys. J Am Acad Dermatol. Dec 2017;77(6):1060-1067. [FREE Full text] [CrossRef] [Medline]
  21. Wan J, Oganisian A, Spieker AJ, Hoffstad OJ, Mitra N, Margolis DJ, et al. Racial/ethnic variation in use of ambulatory and emergency care for atopic dermatitis among US children. JID. Sep 2019;139(9):1906-1913.e1. [CrossRef]
  22. McKenzie C, Silverberg JI. The prevalence and persistence of atopic dermatitis in urban United States children. Ann Allergy Asthma Immunol. Aug 2019;123(2):173-178.e1. [CrossRef] [Medline]
  23. Bell MA, Whang KA, Thomas J, Aguh C, Kwatra SG. Racial and ethnic disparities in access to emerging and frontline therapies in common dermatological conditions: a cross-sectional study. J Natl Med Assoc. Dec 2020;112(6):650-653. [CrossRef] [Medline]
  24. Takeshita J, Eriksen W, Raziano V, Bocage C, Hur L, Shah RV, et al. Racial differences in perceptions of psoriasis therapies: implications for racial disparities in psoriasis treatment. J Invest Dermatol. Aug 2019;139(8):1672-1679.e1. [FREE Full text] [CrossRef] [Medline]
  25. Takeshita J, Gelfand J, Li P, Pinto L, Yu X, Rao P, et al. Psoriasis in the US Medicare population: prevalence, treatment, and factors associated with biologic use. J Invest Dermatol. Dec 2015;135(12):2955-2963. [FREE Full text] [CrossRef] [Medline]
  26. Health Data Compass. URL: https://www.healthdatacompass.org/ [accessed 2023-08-11]
  27. Tripathi R, Knusel KD, Ezaldein HH, Scott JF, Bordeaux JS. Association of demographic and socioeconomic characteristics with differences in use of outpatient dermatology services in the United States. JAMA Dermatol. Nov 01, 2018;154(11):1286-1291. [FREE Full text] [CrossRef] [Medline]
  28. Flasar MH, Johnson T, Roghmann M, Cross RK. Disparities in the use of immunomodulators and biologics for the treatment of inflammatory bowel disease: a retrospective cohort study. Inflamm Bowel Dis. Jan 2008;14(1):13-19. [CrossRef] [Medline]
  29. An J, Liu Y, Xiao S, Wang J, Geng S, Dong Y. Quality of life of patients with neurodermatitis. Int J Med Sci. 2013;10(5):593-598. [FREE Full text] [CrossRef] [Medline]
  30. Tavecchio S, Angileri L, Pozzo Giuffrida F, Germiniasi F, Marzano A, Ferrucci S. Efficacy of dupilumab on different phenotypes of atopic dermatitis: one-year experience of 221 patients. J Clin Med. Aug 19, 2020;9(9):2684. [FREE Full text] [CrossRef] [Medline]


AD: atopic dermatitis
HDC: Health Data Compass
IL: interleukin
OHDSI: Observational Health Data Sciences and Informatics


Edited by R Alhusayen; submitted 18.07.22; peer-reviewed by V Palmer, L Misery, H Patel, H Tibble, S Pesälä; comments to author 15.04.23; revised version received 28.06.23; accepted 07.08.23; published 30.08.23.

Copyright

©Torunn E Sivesind, Ani Oganesyan, Grace Bosma, Camille Hochheimer, Lisa M Schilling, Robert Dellavalle. Originally published in JMIR Dermatology (http://derma.jmir.org), 30.08.2023.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Dermatology, is properly cited. The complete bibliographic information, a link to the original publication on http://derma.jmir.org, as well as this copyright and license information must be included.