Abstract
The International Society of AD (ISAD) organized a roundtable on global aspects of AD at the WCD 2023 in Singapore. According to the Global Burden of Disease (GBD) consortium, at least 171 million individuals were affected with AD in 2019, corresponding to 2.23% of the world population, with age-standardized prevalence and incidence rates that were relatively stable from 1990 to 2019. Based on the panel experience, most AD cases are mild-to-moderate. Without parallel data on disease prevalence and severity, the GBD data are difficult to interpret in many regions. This gap is particularly important in countries with limited medical infrastructure, but indirect evidence suggests a significant burden of AD in low-and-medium resource settings, especially urban areas. The Singapore roundtable was an opportunity to compare experiences in World Bank category 1 (Madagascar and Mali), 3 (Brazil, China) and 4 (Australia, Germany, Qatar, USA, Singapore, Japan) countries. The panel concluded that current AD guidelines are not adapted for low resource settings and a more pragmatic approach, as developed by WHO for skin NTDs, would be advisable for minimal access to moisturizers and topical corticosteroids. The panel also recommended prioritizing prevention studies, regardless of the level of existing resources. For disease long-term control in World Bank category 3 and most category 4 countries, the main problem is not access to drugs for most mild-to-moderate cases, but rather poor compliance due to insufficient time at visits. Collaboration with WHO, patient advocacy groups and industry may promote global change, improve capacity training and fight current inequalities. Finally, optimizing management of AD and its comorbidities needs more action at the primary care level, because reaching specialist care is merely aspirational in most settings. Primary care empowerment with store and forward telemedicine and algorithms based on augmented intelligence is a future goal.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 801-811 |
| Number of pages | 11 |
| Journal | Journal of the European Academy of Dermatology and Venereology |
| Volume | 38 |
| Issue number | 5 |
| DOIs | |
| State | Published - May 2024 |
Funding
Collaboration with patient advocacy groups and industry is also on the agenda to change our vision on a global scale and fight current inequalities. The predictable growing economy of level 1 and 2 countries offers a good business model to industry partners who market generic products at a reasonable price with many affected patients. AD for most patients of mild\u2010to\u2010moderate severity can be treated as recommended by EU guidelines steps 1\u20132 with moisturizers and topical anti\u2010inflammatory drugs. With the Accord initiative, Pfizer has committed to provide its entire portfolio, including patented medicines and vaccines available in the United States or EU on a not\u2010for\u2010profit basis to the governments of 45 lower\u2010income countries most vulnerable to healthcare inequalities to support patients through public health systems. This includes all 27 low\u2010income countries plus 18 lower\u2010middle\u2010income countries that have moved from low\u2010income status in the last 10\u2009years, as defined by the World Bank. Other foundations are supporting research and education in Sub\u2010Saharan Africa such as the Pierre Fabre Foundation, the Leo Pharma Foundation or Foundation Sanofi (S) or promote AI in these regions such as the Passion project supported by the foundation Botnar or logistical support such as help logistics. Finally, the prevalence of AD, and its related allergic disorders and comorbidities needs more action at the primary care level, because reaching specialist care is merely aspirational in most settings, including in level 4 countries because of location, time commitments (e.g. work, childcare demands and distance to the specialist), and finances. Primary care empowerment is possible with new tools such as store and forward (SAF) telemedicine for non\u2010urgent care. The rapid advances using augmented intelligence may further simplify the patient journey in the future. The International Society of Atopic Dermatitis (ISAD) is funded by annual membership fees, revenues of annual meetings, donations of charities, foundations and corporate pharma members (see website www isad.org ). Ten authors of this article (OF, KK, LM, ASP, MS, JCS, RT, AW, PSG and AT) are members of the Board of Directors of the ISAD. The summary of each author's Conflict of Interest forms is as follows: Carsten Flohr: Almirall, Bioderma, Sanofi, Pfizer, Lilly, Abbvie, LEO pharma, Novartis and Almirall (Grants and honoraria). Kenji Kabashima: LEO pharma, Japan Tobacco Inc., P&G Japan, Tanabe Mitsubishi, Ono Pharmaceutical, Kyowa Kirin, Pola Pharma, AbbVie, Sanofi, Kose, Maruho, Kyorin Pharmaceutical, Kao, LEO Pharma, Torii, Chugai Pharmaceutical, Abbvie, Lilly, Sanofi and Pfizer (Grants and honoraria). Amy Paller: AbbVie, Applied Pharma Research, Dermavant, Lilly, Incyte, Janssen, Krystal, Regeneron, UCB, Aegerion Pharma, Azitra, BioCryst, Boehringer\u2010Ingelheim, Bristol Myers Squibb, Castle Creek, LEO Pharma, Novartis, Sanofi/Genzyme, Seanergy, TWI Biotechnology, Abeona, Catawba, Galderma and InMed (Grants, consulting fees, honoraria, Advisory Boards). Peter Schmid\u2010Grendelmeir: Abbvie, Almirall, Biomed, Lilly, Galderma, Leo, L'Oreal, Pierre Fabre, Pfizer, Sanofi, Amgen, Coloplast, CK Care (Grants, Consulting fees, honoraria, Advisory boards). M. Steinhoff: Galderma, Abbvie, Pfizer, Novartis, Janssen, Lilly, Leo, Incyte, Almirall and L'Oreal (Consulting fees, honoraria, advisory boards). John C Su: AbbVie, Amgen, ASLAN, AstraZeneca, Bristol Myers Squibb, Lilly, Janssen, Pfizer, Pierre Fabre, Sanofi, Ego Pharmaceuticals, LEO Pharma and Novartis (Grants and advisory boards). The other authors: O Faye, L Ma, F Rabenja Rapelanoro, R Takaoka, A Wollenberg, YW Yew, JA Ruiz Postigo and A Ta\u00EFeb have no disclosure. The meeting and its report was supported by the International Society of Atopic Dermatitis and the World Health Organization.
ASJC Scopus subject areas
- Dermatology
- Infectious Diseases