Title : Ethnic differences in biologic therapies for atopic dermatitis
Abstract:
Introduction & Objectives: Atopic dermatitis is the most prevalent skin condition globally and has become a significant public health concern due to its impact on quality of life. In recent years, the introduction of biological therapies has revolutionised care by targeting specific inflammatory and immune pathways, however, emerging evidence suggests that the immunology and genetic predisposition in AD varies across ifferent ethnic groups.Therefore, this raises the question of whether biological therapies and AD management should be tailored to the patient to optimise outcomes.
• To identify disparities in treatment response for AD across various ethnic groups
• To assess whether current guidelines require tailoring to the specific needs of patients on an individual basis
• To suggest areas for future research and develop strategies to address disparities in treatment response
Materials & Methods:
• Observational study from the electronic patient record across two hospitals
• Patients on various biologics were selected at random. and then stratified by self reported ethnicity
• 101 patients included in the study, across 6 different ethnic groups
• The EASI and DLQI scores, and percentage improvement were compared before and after commencing biological treatment for AD
• We also noted any switches in biologics, reasons for discontinuation, comorbidities, adverse and side effects
Results:
• No statistically significant differences were found in disease severity and quality of life scores across the different ethnic groups
• Some Asian groups showed a higher side effect rate (40%) compared to others
• Comorbidity trends differed by ethnicity, with asthma being most common in Chinese groups (71.4%) and obesity highest in Bangladeshi patients (20%)
• Black patients showed the highest DLQI improvement (12.9 average points), whilst Chinese patients had the lowest (7.9 points)
• Black patients showed the greatest EASI improvement (75.3%) whilst Asian-Bangladeshi patients had the lowest (66.5%)
• Regression analysis suggested mixed backgrounds and T1DM were associated with lowest treatment efficacy, whilst certain biologics (Lebrikizumab, Amlitelimab, Baricitinib) showed weaker responses
Analysis:
• There were no strong ethnic disparities detected, but certain groups showed lower efficacy in EASI and DLQI improvement
• The study was limited by small sample sizes, uneven ethnic representation due to the nature of the hospital patient demographic, and other confounding factors (e.g: treatment adherence and comorbidities)
• Genetic and biomarker data was not assessed, which could have provided greater insight into differences between patients’ responsiveness to treatment
Conclusion:
• Although this study found no statistically significant ethnic disparities in treatment response to biologics for AD, there was evidence to suggest some groups experienced lower efficacy and higher rates of side effects
• Ethnicity may still play a role in treatment variability, even if not statistically significant in this dataset due to limitations
• The findings highlight the need for a personalised approach to biologic therapy, considering factors such as ethnicity, comorbidities and baseline disease severity
• Future studies should include larger sample sizes with a greater representation of diverse ethnic groups
• There is a need for long term follow up studies and a focus on biomarker-driven approaches to improve effectiveness and reduce health inequities for AD patients
