Advanced systemic therapies, such as biologic drugs and Janus kinase inhibitors, have revolutionized the management of atopic dermatitis (AD). Despite the guidance provided by the National Institute for Health and Care Excellence (NICE), disparities exist in how patients in the UK access these transformative therapies. A recent study delved into the impact of the type of healthcare centre, differentiating between district general hospitals and specialist centres, on prescribing practices, use of traditional immunosuppressants, and the timing of initiation of advanced systemic therapies for AD patients across the UK.
Conducted retrospectively across seven centres, this multi-site study scrutinized the clinical records of 350 patients. These patients were divided between four district general hospitals, where AD patients are typically managed in general dermatology clinics, and three specialist centres with dedicated AD services. Data collection encompassed patient demographics, immunosuppressant usage, selection of advanced systemic therapies, and the timeline for transitioning between treatments. To provide a comparative perspective, a cohort of patients with psoriasis was also included in the study.
The average age of the study population was 43.9 years, with a male preponderance of 56.2% and 44.6% being White patients. Notably, there were no significant demographic variations between the two types of hospitals. Methotrexate, ciclosporin, and phototherapy emerged as the most frequently prescribed immunosuppressants, with patients with AD spending significantly less time on such treatments compared to those with psoriasis (2.54 years versus 5.02 years), indicating divergence in treatment strategies based on the condition. Moreover, the incidence of side effects varied markedly depending on the type of medication.
A pivotal discovery from the study was that patients attending specialist centres encountered a notably shorter delay in transitioning from immunosuppressants to advanced systemic therapies, with a median delay of 1.9 months compared to 3.7 months in district general hospitals. Notably, the primary cause of delay was attributed to homecare services, which faced more challenges in district general hospitals than in specialist centres.
These findings underscore the swifter and more coordinated access to advanced systemic therapies in AD at specialist centres. The presence of streamlined care pathways and dedicated resources in such centres appears to culminate in expedited treatment timelines and potentially enhanced patient satisfaction levels.
Pathmarajah P et al. Comparative real-world analysis of national variations in advanced systemic therapy initiation in atopic dermatitis across the UK. Abstract 2062. EADV Congress 2025, 17-20 September, 2025.
Takeaways:
– Specialist centres demonstrate quicker access to advanced systemic therapies for AD patients.
– Disparities exist in treatment timelines between district general hospitals and specialist centres.
– Streamlined care pathways in specialist centres contribute to improved treatment timelines.
– Dedicated resources in specialist centres enhance patient satisfaction levels.
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