ABSTRACT
Introduction (contexte de la recherche) Un algorithme relatif à la stratégie treat-to-target a récemment été développé pour guider l'utilisation des thérapies systémiques en vue du contrôle de la maladie chez l'adulte atteint d'une DA. Cet algorithme a mis en avant des critères visant à définir un objectif cible initial acceptable à 3 mois ainsi qu'un objectif cible optimal à 6 mois. Objectif Les objectifs de cette analyse sont d'utiliser l'algorithme lié à la stratégie treat-to-target pour évaluer l'efficacité de l'upadacitinib (UPA), chez des patients adultes atteints d'une DA modérée à sévère, traités par UPA 15mg ou 30mg par voie orale en monothérapie 1 fois par jour ;à partir des données poolées des études de phase III, randomisées, contrôlées en double aveugle vs placebo : Measure Up 1 (MU1, NCT03569293) et Measure Up 2 (MU2, NCT03607422) ;ainsi que de déterminer la proportion de patients atteints d'une DA modérée à sévère ayant obtenu une amélioration≥1 des principaux domaines de la DA (signes, symptômes et qualité de vie) aux semaines 2 et 16 dans les études MU1 et MU2. Méthodes L'atteinte de ces critères sous UPA (15mg et 30mg) en monothérapie, 1 fois par jour a été comparée au placebo chez les patients adultes, en utilisant les données poolées des études MU1et MU2 et l'imputation des non-répondeurs en intégrant l'imputation multiple pour les valeurs manquantes liées à l'épidémie de COVID-19. Résultats Une proportion plus élevée de patients traités par UPA (15mg et 30mg) vs placebo (p<0,001 pour tous) a atteint l'objectif cible initial acceptable de 3 mois à la semaine 2 (78,9 %, 82,6 % vs 25,0 %) et la semaine 16 (72,5 %, 80,2 % vs 22,9 %) ;et l'objectif cible optimal de 6 mois à la semaine 2 (52,8 %, 64,3 % vs 6,3 %) et la semaine 16 (56,2 %, 70,1 % vs 13,9 %). Conclusions Ces résultats semblent indiquer qu'UPA (15mg et 30mg) administré par voie orale, 1 fois par jour pourrait améliorer la prise en charge conventionnelle des patients souffrant d'une DA modérée à sévère, en permettant d'atteindre l'objectif cible optimal à 6 mois (signes, symptômes et qualité de vie) dès 16 semaines et même dès 2 semaines chez la plupart des patients.
ABSTRACT
Recommendations for a treat-to-target approach were recently developed to guide systemic therapy for disease control in adults with AD. Recommendations outlined criteria for a 3-month initial acceptable target goal: reduction from baseline ≥1 on a 5-level Patient Global Impression of Severity (PGIS) scale and ≥1 specific disease domain target (≥50% improvement from baseline in Eczema Area and Severity Index [EASI-50];≥50% reduction in Scoring of AD [SCORAD-50];and a reduction from baseline in Worst Pruritus Numerical Rating Scale [WP-NRS] ≥3, Dermatology Life Quality Index [DLQI] ≥4, or Patient Oriented Eczema Measure [POEM] ≥4);and a 6-month optimal target goal: PGIS ≤2 and ≥1 specific disease domain target (EASI-75 or EASI ≤7, SCORAD-75 or SCORAD ≤24, WP-NRS ≤4, DLQI ≤5, POEM ≤7). Achievement of these criteria with once-daily upadacitinib (15 mg and 30 mg) monotherapy was compared with placebo using integrated adult data from MU1 and MU2 trials and nonresponder imputation incorporating multiple imputation for missing values due to COVID-19. Greater proportions of patients treated with upadacitinib 15 mg;30 mg vs placebo (P <.001 for all) achieved the initial acceptable target goal at week 2 (78.9%;82.6% vs 25.0%) and week 16 (72.5%;80.2% vs 22.9%), and the optimal target goal at week 2 (52.8%;64.3% vs 6.3%) and week 16 (56.2%;70.1% vs 13.9%). These results suggest that once-daily oral upadacitinib (15 mg and 30 mg) may help improve standards of care in patients with moderate-to-severe AD by achieving 6-month target goals at 16 weeks and as early as 2 weeks for most patients.
ABSTRACT
Background: Atopic Dermatitis (AD) can result in intolerable symptoms, psychological hardships, and stigmatization that affect patient quality of life. Allergic comorbidities may be overlooked by both healthcare providers and patients;emphasizing the importance of allergist referral. The Atopic Dermatitis Quality of Care (ADQoC) Initiative seeks to demonstrate the global imperative for quality AD care, by identifying primary challenges and reporting good practice intervention solutions. The COVID-19 pandemic highlights the positive impact of eHealth in the delivery of care, including allergy care, as a potential good practice intervention for AD. Method: A literature review was conducted to establish a foundation of challenges to AD care. In-depth site visits, performed at thirty-two select international centers, documented challenges to, and examples of, leading AD care. Results: eHealth is a reported good practice intervention to the challenges in AD care including allergy complications. eHealth, along with mHealth and teleHealth, provide opportunities to improve the quality and efficiency of AD care. eHealth provides greater access to care, specifically to patients who otherwise may not be able to access it due to obstacles such as travel distance or financial difficulties. eHealth also benefits dermatologists, allergists, and other AD care providers who can collaborate more easily due to the readily available resources within eHealth platforms. TeleHealth and information sharing through eHealth allows patients to benefit from care afforded by centers that incorporate multi-disciplinary care teams and patient education. Some centers use local databases and patient registries to restructure patient assessment and improve care delivery. Smartphone applications such as Zalf (UMC, Utrecht) and Virtual Nurse (McGill UHC) are designed to improve assessment, care delivery, AD outcomes, and education. Mobile imaging can also improve AD assessment and speed treatment. Conclusion: eHealth, mHealth, and teleHealth may be good practice interventions that improve AD assessment, better manage allergic complications, and provide better outcomes. The efficiency and convenience of eHealth delivers quicker service, reduces patient burden and simultaneously lessens time demands of healthcare providers. Such systems may be particularly useful during social distancing and additional demands on health care providers during COVID-19.