Systematic scoping review on the barriers to access of biologics in <scp>moderate‐to‐severe</scp> adult atopic dermatitis

To the editor, Atopic dermatitis (AD) is a chronic pruritic inflammatory skin disorder associated with significant psychosocial comorbidity. Biologic treatment has provided patients with previously recalcitrant moderate-to-severe AD an opportunity to regain near-normal qualities of life. However, despite favourable efficacy and safety profiles, prescription rates remain low relative to the number of eligible patients, suggesting potential barriers to access.1 A comprehensive review exploring existing disparities in access to optimize treatment outcomes is absent from the literature. A systematic literature search was performed using MEDLINE, Embase and Web of Science on 3 April 2023. An inclusive list of all search terms can be found in Table S1. Publication screening was conducted by two independent reviewers (V.W. and A.H.) following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews guidelines according to pre-determined inclusion and exclusion criteria (Figure S2). Of the 1,367 records identified, 10 studies were included in this review. Study characteristics are further detailed in Table 1. Identified barrier themes were grouped into patient-, prescriber-, medication- and organizational-level factors (Table 2) correlating to findings of existing literature.2 Medicine-level factors, notably concerns surrounding cost (n = 6) and potential side effects and long-term safety (n = 3), were most frequently reported. Similar concerns have predominated reports in the treatment of moderate-to-severe psoriasis.3 A more comprehensive summary of findings is in Table S3. Patient-level factors Prescriber-level factors Regarding patient-related factors, our results demonstrate discrepancy in the prescription rates of biologics and perception of disease severity in AD amongst Black and Hispanic patient groups. Existing disparities in the treatment of dermatological conditions amongst Black individuals may stem from a complex interplay of genetics, socio-economic status, structural racism, clinical trial underrepresentation and general mistrust in the healthcare system.4 Such dynamics have culminated in both reduced medication exposure and heightened presentations of severe disease amongst people of colour, pressing the need for systemic reform. Furthermore, while previous studies have documented disparities in the uptake of new medications linked to factors like age, education, socio-economic status and general health, specific patient populations affected in AD remain undefined.2 Regarding prescriber-related factors, concerns commonly surrounded limited experience with biologics and unfamiliarity with prescription guidelines. Healthcare providers also expressed reservations about side effect profiles and the long-term safety of these medications, emphasizing the potential value of extended education in this area. Notably, continuing medical education has been linked to increased comfort in prescribing novel medications.5 Other potential prescriber barriers, such as gender, duration of practice and geographical location, have been noted in literature but are yet to be explored in the context of AD, revealing another knowledge gap.2 This scoping review underscores a striking lack of high-quality evidence identifying barriers to accessing biologics in AD patients. A better understanding of the patient perspective is imperative, especially as existing literature leans heavily on healthcare professional reports, which may carry inherent biases. Further research is needed to better identify barriers in the treatment of moderate-to-severe AD so that clinicians and policymakers can improve individual treatment outcomes. None. None declared. Appendix S1. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.