Exploring Real-World Atopic Dermatitis Treatment Patterns | Written Recap

Gary M. Owens, M.D., is a medical and pharmacy management consultant in Ocean View, Delaware, with experience working for health insurers and as a family physician. Lawrence Eichenfield, M.D., is chief of pediatric and adolescent dermatology at Rady Children’s Hospital-San Diego and professor of dermatology and pediatrics and vice-chair of the department of dermatology at UC San Diego School of Medicine in California. In this Managed Healthcare Executive Between the Lines video series, Owens and Eichenfield discussed advances in the treatment of atopic dermatitis and two similar real-world studies of prescriptions of ruxolitinib cream, sold under the brand name Opzelura, and their apparent effect on prescribing patterns.

Many more treatments

Owens noted that atopic dermatitis used to be a disease that was “not in focus and largely unmanaged” from the perspective of payers because treatment was limited to moisturizers and topical corticosteroids. Eichenfield described atopic dermatitis as a “pretty complex disease” that involves a mix of skin barrier dysfunction, changes in the microbiome and inflammation. Like Owens, he noted the advances that have expanded treatment options, including nonsteroidal topical treatments, such as ruxolitinib cream, and systemic agents, including biologics and oral Janus kinase inhibitors. Eichenfield outlined the treatment goals. “Whether it be, mild, moderate or severe disease, what we want is to institute a regimen that’s going to minimize the eczema, minimize the cutaneous rashes, minimize pruritus, and minimize sleep disturbance and the secondary consequences of the disease, whether it be with a topical regimen or systemic regimen,” he said.

Fewer topical corticosteroid prescriptions

The first study Owens and Eichenfield discussed compared prescribing patterns for 383 patients six months before a prescription of ruxolitinib cream and six months afterward. Lead author Jinan Liu, M.B.B.S., Ph.D., of Incyte Corporation, the maker of Opzelura, presented the results of the study at the Academy of Managed Care Pharmacy Nexus meeting in October 2024. Liu and his colleagues used an Optum claims database to conduct their study, and some of the co-authors are Optum employees.

The average age of the patients was 50, and 38% had health insurance through Medicare. Owens noted that the group was older on average than what might be expected for a study of people with atopic dermatitis. People with atopic dermatitis frequently have other conditions. In this study, approximately 14% had allergic rhinitis and approximately 12% had asthma. Eichenfield said those proportions are lower than those typically seen in phase 3 clinical trials. Patients with vitiligo were excluded from the study because Opzelura is also approved as treatment for vitiligo and the researchers wanted to focus on prescribing patterns for atopic dermatitis.

The study showed a sharp decrease in claims for other topical treatments for atopic dermatitis after patients started ruxolitinib cream. In the six months prior to starting ruxolitinib cream, 54% of the patients in the study had a claim for a topical corticosteroid. In the six months afterward, that proportion dropped to 33%. The decrease was even greater for topical calcineurin inhibitors, a class that includes Protopic (tacrolimus) and Elidel (pimecrolimus). In the six months before starting ruxolitinib cream, 15% of the patients had a claim for a topical calcineurin inhibitor. In the six months afterward, that proportion fell to 6%. The pattern was similar for the much smaller group of patients with claims for prescriptions for a topical phosphodiesterase 4 (PDE4) inhibitor, a class that includes Eucrisa (crisaborole) and Zoryve (roflumilast).

Eichenfield acknowledged the limitations of a study based on claims data rather than clinical assessments and records. But the prescribing patterns, as evidenced by claims, suggest a reliance on ruxolitinib cream and less of a need for polypharmacy when it comes to topical treatments, he noted.

Eichenfield and Owens also discussed ruxolitinib cream and the prescribing patterns for biologics for atopic dermatitis. In the study by Liu and his colleagues, approximately 83% of the patients did not have a claim for a biologic in the six months before starting ruxolitinib cream. In the follow-up period, 93% of those patients didn’t have a claim for a biologic. Among the 17% who did have a claim for a biologic in the six months prior to starting ruxolitinib cream, 16% of them didn’t have a claim in the six months after starting ruxolitinib.

Eichenfield and Owens noted that Liu and his colleagues found that patients used, on average, 1.8 tubes of ruxolitinib cream during the six-month follow-up period; Owens said he thought the amount would have been much higher. Eichenfield said that level of utilization suggested that ruxolitinib cream was efficacious “and not just that people are laying off
their treatment.”

Longer, larger study

Owens and Eichenfield discussed another similarly designed study, also led by Liu, that had more patients — 556 — and analyzed claims data for a year after starting ruxolitinib cream. Eichenfield noted that a year of follow-up was important. “Atopic dermatitis is not a disease that stays constant,” said Eichenfield, so the longer follow-up is important to understanding prescribing patterns. The patients in this study were younger, with an average age of 40, than those in the study with six months of follow-up, and all but a small percentage were covered by commercial insurance. Owens said the patients in this study were more in line with what payers would expect for atopic dermatitis.

Like the other study, this one examined the periods before and after starting ruxolitinib cream and compared prescription claims for topical treatments for atopic dermatitis. Liu and his colleagues reported that 54% of the patients in this study had a claim for a topical corticosteroid in the six months before starting ruxolitinib. That proportion declined to 31% in the first six months after initiation of ruxolitinib cream and to 27% in the next six months. The study also showed the same pattern of fewer claims for topical calcineurin inhibitors and PDE4 inhibitor creams after starting ruxolitinib cream. The prescribing patterns for biologics before and after ruxolitinib cream also were similar to those seen in the study with just six months of follow-up. Owens said the results of this study with a year of follow-up may allay a common concern among payers that the response to medications with impressive short-term results may not be durable. Patients used an average of 2.1 tubes of ruxolitinib cream during the 12-month follow-up period. Eichenfield noted the similarity to the limited amount used during the six-month study.

Owens noted that a study lasting 18 months — six months before the use of ruxolitinib cream with 12 months of follow-up — would catch the eye of payers. “Typically, in a commercial population, we may have only a patient for two or three years before their employer decides to change carriers, so when you have a study that spans almost the lifespan of the patient in a plan, it’s a very cogent study.”

Topical corticosteroid withdrawal

Some patients experience a rebound effect when they stop using topical corticosteroids that results in a burning sensation, itching, redness and a number of other symptoms. Eichenfield said the condition has received social media attention and “is probably overblown to some degree.” Even so, the apparent 50% decrease in the use of a topical corticosteroid in the year after starting ruxolitinib cream may “bring a comfort level” to patients worried about topical corticosteroid withdrawal, Eichenfield said.

Eichenfield noted that patients using topical corticosteroid cream often utilize a number of different strengths — a low-potency cream on the face, for example, and a higher-potency cream elsewhere. He said that with ruxolitinib cream’s efficacy and side effect profile, ruxolitinib can be used on the face and eyelids with less of a concern about steroid atrophy and systemic effects compared with topical corticosteroid creams