How do you treat Atopic Dermatitis?

In collaboration with
Dr. Jordana Schachter

In just 1 week, we surveyed 42 Canadian Dermatologists on:
  • their decision making factors for treatment,
  • how they've interacted with manufacturers of treatments,
  • and their awareness of a new treatment coming to market.

The average physician sees 10 atopic dermatitis patients every week, with about one third of patients being moderate to severe.

A bigger proportion of atopic dermatitis patients have private coverage compared to the overall patient population. Dupilumab is the most well-known drug for atopic dermatitis, most report having expert-level familiarity.

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20% of survey respondents were from the west provinces, 50% from Ontario and 30% from Quebec.
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We partnered with Dr. Jordana Schachter, a Quebec Dermatologist, who has provided a reflection of her thoughts on the results throughout the final report.

Contributing to our knowledge of diversity in Atopic Dermatitis patients, Dermatologists identified that Chinese patients are more likely to have severe atopic dermatitis, followed by Indigenous and South Asian patients.

68% of atopic dermatitis patients are chinese, 27% are Aboriginal/ Indigenous, 27% are South Asian, 25% are Other East Asians, 20% are Black, 20% are white, 5% are hispanic, 2% are multiracial and 5% are listed as other.
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When asked about the most important factors when recommending an atopic dermatitis treatment, Dermatologists heavily weighted efficacy.

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Dr. Schachter says:

I'm surprised at how low 'mode of action' ranked in importance.

39% said efficacy, 27% safety profile, 16% provincial funding, 9% private insurance coverage and 9% mode of action.
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88% of physicians who are familiar with upadacitinib* recall being detailed on this drug in the previous 2 months.
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Dr. Schachter says:

"It’s interesting to see how many respondents believe abrocitinib should be second line to dupilumab. It will be interesting to see if the government will agree in how they organize reimbursement.

57% agreed that upon approval, abrocitinib should have the same conditions as dupilimab to be used as a systemic therapy. 30% of survey respondents agreed that upon approval, abrocitinib should be limited to second line treatment after dupilumab.
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"I know that dupixent sometimes is less effective for eczema on the face. I would go with another treatment [topical]. If it fails, I would have the criteria to go with rinvoq after"
- Quebec Dermatologist


"I’m not putting someone on a $30k drug if they only have limited and isolated disease"
- Dr. Michael Corbo, QC

"Would try topicals then adtralza if systemic tx needed, rinvoq if severe and patient with no comorbidities"
- Dr. Dominique Fausto de Souza, QC

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Dr. Schachter says:

There seems to be no census on what to do in cases of difficult to control facial dermatitis. More research is likely needed and guidelines developed.

If a patient has facial dematitis, 36% of surveyed dermatologists would prescribe upadacitinib, 16% said tralokinumab, 13% said dupilumab and 33% said other.

When asked what they would do with an uncontrolled patient like Patient A, physicians' responses vary, with nearly half choosing to decrease dose interval.

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Dr. Schachter says:

When a treatment isn’t working we seem to decrease duration between doses. I’d be interested to see if this differed based on province.

41% of surveyed dermatologists said they would decrease the interval between doses if their patient was uncontrolled.

Respondent profile

32%

Male respondents

68%

Female respondents

38

Average age

6.5

Average years in practice

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