Atopic Dermatitis (AD), also known as atopic eczema, is a chronic, relapsing, inflammatory skin disease that often has a negative physical, psychological, and socioeconomic effect on patients’ lives.1,2 The burden of AD increases with disease severity and with the repeated occurrence of disease flares, adversely affecting patient Quality of Life (QoL).2–4

The management of AD aims to reduce symptoms (e.g., itch, pain, sleep disturbance), and inflammation, induce skin clearance, improve QoL, and control the disease over the long term.1 Treatment strategy varies by disease severity, patient age, and country and can be influenced by treatment accessibility and local recommendations as well as differences in healthcare resources across countries and geographic regions.5–9

Few studies have reported AD disease severity and treatment patterns in Latin America. The overall prevalence of AD among children and adolescents from Latin America has been reported to range from 2.8% to 24.6% across countries,10,11 whereas, generally, a lower prevalence has been reported among adults (Argentina, 3%–5%;12,13 Brazil, Mexico, and Colombia, 2%–10%).13,14 In three studies conducted in Brazil and Colombia, approximately two-thirds of patients were reported to have moderate to severe disease (65%–87% across studies and assessment methods).15–17 In the same studies, the most common treatments included topical corticosteroids and oral antihistamines followed by systemic corticosteroids.15–17 The use of biologic therapies remained low (approximately 10% of patients).16,17 A negative impact on QoL, work productivity, and direct and indirect costs has also been reported.15,16,18,19 However, gaps remain in the authors’ understanding of the effect of AD on the lives of patients with moderate to severe disease in Latin America.

The objective of this analysis of the MEASURE-AD study was to assess the physical, psychological, and socioeconomic burden of disease, treatment patterns, and Healthcare Resource Utilization (HCRU) in adolescent and adult patients with moderate to severe AD in Latin America who were receiving or were candidates for systemic therapy.

The MEASURE-AD Latin American population (Brazil, Mexico, Argentina) consisted of 180 patients (adults, n=157; adolescents, n=23). Mean (SD) age was 33.8 (17.0) years, and 52.2% of patients were male (Table 1). At the time of the study visit, patients had a history of AD averaging 16.5 years (adults, 17.2 years; adolescents, 11.6 years).

All patients were receiving AD treatment, including 74.4% receiving topical therapy alone or in combination (6.1% topical therapy alone). Although all patients were eligible for systemic treatment, only 65.6% were receiving systemic therapy alone or in combination and 12.2% were receiving systemic therapy alone; 18.9% of patients had continuous systemic therapy over the last 12 months (Table 1).

Among the 118 patients receiving systemic therapies, the most common were systemic corticosteroids (34.7%), methotrexate (33.1%), dupilumab (24.6%), and cyclosporine (16.9%); among all 180 patients, the usage was 22.8% for systemic corticosteroids, 21.7% for methotrexate, 16.1% for dupilumab (15.3% among adults), and 11.1% for cyclosporine. The mean (SD) time between AD diagnosis and until first administration of systemic treatment was 10.3 (10.6) years (adults, 10.8 [11.1] years; adolescents, 7.3 [5.1] years). Approximately one-quarter of patients overall (26.8% in the adult population and 13.0% of the adolescent population) reported that they had inadequately controlled disease.

Primary endpoints: Itch and QoL

The mean WP-NRS score was 6.1, and median score was 7 (adults, 6.3 and 7, respectively; adolescents, 4.7 and 5) (Fig. 1A). Severe pruritus (WP-NRS ≥7) was reported by 54.4% of patients (adults, 57.3%; adolescents, 34.8%) (Fig. 1B). The mean DLQI was 11.4, and the mean CDLQI was 8.1 (Fig. 2A). A very or extremely large effect on QoL (DLQI or CDLQI≥11) was reported by 50.0% of patients ≥ 16 years old and 42.9% of patients 12 to 15 years old (Fig. 2B).

Fig. 1.

Primary endpoint (A) mean (SD) WP-NRS and (B) proportion of patients in WP-NRS categories. WP-NRS, Worst Pruritus Numeric Rating Scale.

(0.17MB).

Fig. 2.

Primary endpoint (A) mean (SD) DLQI/CDLQI and (B) proportion of patients in DLQI/CDLQI categories. CDLQI, Children’s Dermatology Life Quality Index; DLQI, Dermatology Life Quality Index.

(0.16MB).

Subgroup analyses

In a subgroup analysis by current systemic therapy use (yes, n=118; no, n=62), no significant differences in primary or secondary endpoints were observed between groups (Table 4). The only exceptions were a slightly higher mean SF-12 mental component summary score (worse mental health) and a greater proportion of patients with EASI≥16.0 among systemic therapy users versus non-systemic therapy users (Table 4). Substantial disease burden was observed among patients who were and who were not currently receiving systemic therapy, as based on mean WP-NRS (6.1 and 6.1), mean DLQI (11.8 and 10.7), mean EASI (18.1 and 14.7), mean SCORAD (53.2 and 51.3), and mean number of flares in the past 6 months (4.8 and 5.3, respectively) (Table 4).

Table 4.

Clinical, psychosocial, and economic burden of AD by systemic therapy use.

	Current Use of Systemic Therapy
	Yes			No	p-value
	Any systemic(n=118)	Dupilumab(n=29)	Systemic other than dupilumab(n=89)	No systemic therapy(n=62)	Systemic vs. no systemic	Dupilumab vs. other systemic
Primary endpoints
WP-NRS, mean(SD)/median (IQR)	6.1 (.1)	4.2 (3.3)	6.7 (2.7)	6.1 (3.0)	0.987	<0.001
	7.0 (4.0–8.0)	4.0 (1.0–7.0)	7.0 (5.0–9.0)	7.0 (3.0–8.0)
WP-NRS 0–1, n (%)	14 (11.9)	9 (31.0)	5 (5.6)	7 (11.3)	0.909	<0.001
WP-NRS ≥ 4, n (%)	90 (76.3)	16 (55.2)	74 (83.1)	46 (74.2)	0.758	0.002
DLQI, mean(SD)/median (IQR)	11.8 (8.0)	9.6 (8.6)	12.6 (7.6)	10.7 (7.3)	0.451	0.055
	11.0 (5.0–18.0)	8.0 (2.0–15.0)	12.0 (5.0–19.0)	9.0 (4.0–15.0)
	n=104	n=26	n=78	n=58
CDLQI, mean(SD)/median (IQR)	8.3 (7.3)	5.3 (8.4)	9.6 (7.1)	7.8 (6.2)	0.943	0.305
	7.0 (2.0–14.0)	1.0 (0.0–15.0)	9.0 (3.0–14.0)	8.0 (3.0–13.0)
	n=10	n=3	n=7	n=4
Clinical outcomes
EASI, mean (SD)/median (IQR)	18.2 (12.6)	12.2 (10.7)	20.1 (12.7)	14.7 (8.4)	0.131	0.002
	17.0 (8.6–26.4)	10.7 (1.9–17.2)	18.3 (11.0–26.8)	13.2 (9.0–20.4)
EASI≥7.1, n (%)	94 (79.7)	19 (65.5)	75 (84.3)	55 (88.7)	0.127	0.029
EASI≥16.0, n (%)	62 (52.5)	10 (34.5)	52 (58.4)	23 (37.1)	0.049	0.025
SCORAD, mean (SD)/median (IQR)	53.2 (23.1)	‒	‒	51.3 (15.0)	0.236	‒
	57.6 (40.4–70.6)			52.0 (41.0–61.7)
	n=117			n=62
SCORAD≥25, n (%)	103 (88.0)	‒	‒	59 (95.2)	0.122	‒
vIGA-AD categories, n (%)					0.055	‒
Clear (0)	5 (4.2)	‒	‒	1 (1.6)
Almost clear (1)	7 (5.9)	‒	‒	5 (8.1)
Mild (2)	12 (10.2)	‒	‒	5 (8.1)
Moderate (3)	56 (47.5)	‒	‒	42 (67.7)
Severe (4)	38 (32.2)	‒	‒	9 (14.5)
Body surface area, %, mean (SD)/median (IQR)	28.1 (22.8)	‒	‒	23.4 (17.8)	0.283	‒
	25.0 (10.0–40.0)			20.0 (8.0–38.0)
Number of flares in the past 6 months, mean (SD)/median (IQR)	4.8 (6.8)	4.3 (5.8)	5.0 (7.1)	5.3 (7.5)	0.433	0.167
	3.0 (2.0–6.0)	3.0 (1.0–4.0)	3.0 (2.0–6.0)	4.0 (2.0–6.0)
	n=110	n=28	n=82	n=59
Number of flares categories, n (%)					0.358	0.253
0	9 (8.2)	4 (14.3)	5 (6.1)	6 (10.2)
1–2	35 (31.8)	9 (32.1)	26 (31.7)	14 (23.7)
3–4	36 (32.7)	9 (32.1)	27 (32.9)	20 (33.9)
5–6	10 (9.1)	0	10 (12.2)	11 (18.6)
> 6	20 (18.2)	6 (21.4)	14 (17.1)	8 (13.6)
Inadequately controlled AD, n (%)	33 (28.0)	‒	‒	12 (19.4)	0.205	‒
Average hours of sleep per night in the past week, mean (SD)/median (IQR)	6.1 (1.9)	‒	‒	6.1 (1.9)	0.899	‒
	6.0 (5.0–8.0)			6.0 (5.0–7.0)
Psychosocial outcomes
HADS Anxiety subscale ≥8, n (%)	66 (55.9)	‒	‒	33 (53.2)	0.729	‒
HADS Depression subscale ≥8, n (%)	41 (34.7)	‒	‒	19 (30.6)	0.579	‒
SF-12 MCS, mean (SD)/median (IQR)	40.4 (10.9)	‒	‒	44.2 (11.2)	0.046	‒
	38.7 (33.2–49.4)			45.2 (35.7–53.4)
	n=98			n=56
Work Productivity and Activity Impairment
Absenteeism, mean (SD)/median (IQR), %	11.9 (22.4)	14.6 (21.8)	11.2 (22.8)	12.3 (21.4)	0.519	0.171
	0.0 (0.0–16.7)	6.2 (0.0–19.1)	0.0 (0.0–16.7)	4.8 (0.0–16.7)
	n=48	n=10	n=38	n=27
Presenteeism, mean (SD)/median (IQR), %	30.6 (27.1)	41.0 (32.5)	27.9 (25.4)	32.1 (29.8)	0.963	0.215
	20.0 (10.0–50.0)	30.0 (10.0–60.0)	20.0 (0.0–50.0)	30.0 (0.0–50.0)
	n=49	n=10	n=39	n=29
Overall work productivity impairment, mean (SD)/median (IQR), %	35.8 (28.3)	45.1 (32.3)	33.2 (27.0)	34.5 (30.1)	0.876	0.246
	32.3 (10.0–55.0)	42.9 (12.5–67.7)	31.2 (10.0–50.0)	29.2 (4.8–58.5)
	n=47	n=10	n=37	n=26
Activity impairment, mean (SD)/median (IQR), %	41.2 (36.5)	30.0 (37.8)	44.8 (35.6)	37.3 (31.2)	0.679	0.032
	30.0 (10.0–70.0)	10.0 (0.0–60.0)	40.0 (10.0–70.0)	30.0 (10.0–60.0)
Hours missed from work, mean (SD)/median (IQR)	7.4 (25.4)	5.5 (9.2)	7.9 (28.4)	6.2 (15.4)	0.262	0.152
	0.0 (0.0–3.0)	2.0 (0.0–7.0)	0.0 (0.0–2.0)	2.0 (0.0–5.0)
	n=50	n=11	n=39	n=28
Healthcare resource utilization
Number of acute care visits in the previous 6-months, mean (SD)/median (IQR)	0.4 (2.8)	‒	‒	0	0.053	‒
	0.0 (0.0–0.0)			0.0 (0.0–0.0)
	n=84			n=37
Number of healthcare visits in the previous 6-months, mean (SD)/median (IQR)	7.1 (7.6)	6.5 (5.7)	7.3 (8.2)	7.8 (12.2)	0.987	0.622
	4.0 (2.0–8.0)	6.0 (3.0–8.0)	4.0 (2.0–8.0)	4.5 (2.0–8.0)
	n=87	n=21	n=66	n=36
Monthly healthcare-related expenses and costs due to AD, mean (SD)/median (IQR), USD	108.4 (146.2)	113.2 (134.9)	106.8 (150.7)	93.6 (100.6)	0.778	0.471
	64.5 (33.4–120.0)	74.4 (41.1–109.2)	60.0 (33.0–126.0)	59.5 (33.6–117.0)
	n=110	n=28	n=82	n=58

AD, Atopic Dermatitis; CDLQI, Children's Dermatology Life Quality Index; DLQI, Dermatology Life Quality Index; EASI, Eczema Area and Severity Index; HADS, Hospital Anxiety and Depression Scale; IQR, Interquartile Range; SCORAD, SCORing Atopic Dermatitis; SF-12 MCS, 12-item Short-Form Health Survey Mental Component Summary; USD, US Dollars; vIGA-AD, Validated Investigator Global Assessment for Atopic Dermatitis; WP-NRS, Worst Pruritus Numeric Rating Scale.

For comparison of dupilumab (monotherapy or combination, n=29) versus other systemic therapy (n=89), patients receiving dupilumab generally had lower disease severity and activity impairment, but differences were only significant for mean EASI (p=0.002), mean WP-NRS (p<0.001), and activity impairment (p=0.032) and for proportions of patients with EASI≥7.1 (p=0.029), EASI≥16.0 (p=0.025), WP-NRS 0–1 (p<0.001) and WP-NRS ≥ 4 (p=0.002; Table 4). Substantial disease burden was still observed among patients receiving dupilumab based on mean WP-NRS (4.2), mean DLQI (9.6), mean EASI (12.2), and mean number of flares in the last 6 months (4.3) (Table 4).

In a subgroup analysis by EASI severity, overall work productivity impairment, activity impairment, and overall number of acute care visits were significantly associated with increasing disease severity (Table 5). Similarly, higher DLQI (Fig. 3), more severe POEM (Fig. 4), and greater ADerm-SS TSS-7 (Fig. 5) were associated with significantly greater disease severity, itch severity, and impairments in work productivity and activity.

Table 5.

Psychosocial and economic burden of AD by EASI disease severity level.

	EASI Severity Levels
	Clear (n=7)	Mild (n=18)	Moderate (n=107)	Severe (n=48)	p-value
Psychosocial outcomes
HADS Anxiety subscale ≥ 8, n (%)	4 (57.1)	7 (38.9)	57 (53.3)	31 (64.6)	0.298
HADS Depression subscale ≥ 8, n (%)	2 (28.6)	6 (33.3)	28 (26.2)	24 (50.0)	0.059
SF-12 MCS, mean (SD)/median (IQR)	42.3 (15.3)	44.3 (10.0)	43.0 (10.3)	38.1 (12.3)	0.072
	43.4 (29.7–54.9)	41.6 (37.6–49.5)	43.4 (34.7–51.4)	35.7 (29.7–50.1)
	n=4	n=14	n=94	n=42
Work Productivity and Activity Impairment
Absenteeism, mean (SD)/median (IQR), %	12.5 (NA)	1.3 (2.3)	11.0 (20.7)	20.9 (28.6)	0.127
	12.5 (12.5–12.5)	0.0 (0.0–2.4)	0.0 (0.0–12.7)	10.8 (0.0–28.8)
	n=1	n=8	n=50	n=16
Presenteeism, mean (SD)/median (IQR), %	50.0 (NA)	18.9 (19.7)	29.2 (27.9)	43.1 (29.8)	0.121
	50.0 (50.0–50.0)	20.0 (0.0–20.0)	20.0 (5.0–45.0)	45.0 (20.0–60.0)
	n=1	n=9	n=52	n=16
Overall work productivity impairment, mean (SD)/median (IQR), %	56.3 (NA)	16.0 (17.3)	32.9 (28.8)	52.1 (26.1)	0.029
	56.3 (56.3–56.3)	15.0 (0.0–24.0)	30.0 (10.0–55.0)	50.0 (31.2–70.0)
	n=1	n=8	n=49	n=15
Activity impairment, mean (SD)/median (IQR), %	12.9 (26.3)	16.1 (18.5)	34.1 (31.4)	65.4 (33.2)	<0.001
	0.0 (0.0–20.0)	10.0 (0.0–30.0)	30.0 (10.0–60.0)	75.0 (35.0–100.0)
Hours missed from work, mean (SD)/median (IQR)	6.0 (NA)	0.4 (0.9)0.0 (0.0–0.0)	7.3 (25.6)	9.6 (16.4)	0.119
	6.0 (6.0–6.0)	n=9	0.0 (0.0–4.0)	2.0 (0.0–12.0)
	n=1		n=52	n=16
Healthcare resource utilization
Number of acute care visits in the previous 6-months, mean (SD)/median (IQR)	0	0	0 (0.17)	1.1 (4.5)	0.037
	0.0 (0.0–0.0)	0.0 (0.0–0.0)	0.0 (0.0–0.0)	0.0 (0.0–0.0)
	n=5	n=14	n=71	n=31
Number of healthcare visits in the previous 6 months, mean (SD)/median (IQR)	6.5 (7.8)	13.6 (12.1)	7.1 (9.9)	6.4 (5.9)	0.574
	6.5 (1.0–12.0)	9.0 (3.0–27.0)	4.0 (2.0–7.0)	4.0 (3.0–8.0)
	n=2	n=9	n=75	n=37
Monthly healthcare-related expenses and costs due to AD, mean (SD)/median (IQR), USD	94.0 (80.1)	99.4 (63.6)	89.7 (106.6)	135.0 (191.3)	0.288
	72.0 (48.0–90.0)	66.0 (49.5–144.0)	54.5 (31.2–110.4)	67.5 (30.2–144.0)
		n=17	n=98	n=46

AD, Atopic Dermatitis; EASI, Eczema Area and Severity Index; HADS, Hospital Anxiety and Depression Scale; IQR, Interquartile Range; SD, Standard Deviation; SF-12 MCS, 12-item Short-Form Health Survey Mental Component Summary; USD, US Dollars.

Fig. 3.

Clinical outcomes and economic burden of AD by DLQI. AD, Atopic Dermatitis; DLQI, Dermatology Life Quality Index; EASI, Eczema Area and Severity Index; WP-NRS, Worst Pruritus Numeric Rating Scale.

(0.19MB).

Fig. 4.

Clinical outcomes and economic burden of AD by POEM. AD, Atopic Dermatitis; EASI, Eczema Area and Severity Index; POEM, Patient Oriented Eczema Measurement; WP-NRS, Worst Pruritus Numeric Rating Scale.

(0.19MB).

Fig. 5.

Clinical outcomes and economic burden of AD by ADerm-SS TSS-7. AD, Atopic Dermatitis; ADerm-SS TSS-7, Atopic Dermatitis Symptom Scale Total Symptom Score-7; EASI, Eczema Area and Severity Index; WP-NRS, Worst Pruritus Numeric Rating Scale.

(0.14MB).

This analysis of 180 adults and adolescents with AD from 3 Latin American countries demonstrated considerable clinical, psychosocial, and economic burden of disease. More than half of the adult patients (57%) and 35% of adolescent patients reported severe itch. A very large or extremely large effect on QoL was reported by 50% of adults and 43% of adolescents. In addition, anxiety, depression, and sleep problems were prevalent, with 54% of adults reporting HADS-A ≥ 8 (65% of adolescents), 33% reporting HADS-D ≥ 8 (35% of adolescents), and 53% reporting sleep problems occurring somewhat to very much (17% of adolescents).

Although all patients received treatment and two-thirds received systemic therapies, moderate to severe disease was reported by 90% and 86% of patients based on SCORAD and EASI scores, respectively, suggesting inadequately controlled disease. In a subgroup analysis by systemic therapy use, no difference in disease burden was observed between patients receiving systemic therapy versus patients not receiving systemic therapy; disease burden (including number of flares, QoL impact, and economic burden) remained high in both groups. However, among patients receiving the biologic therapy dupilumab, a trend for lower disease severity, better QoL, and lower activity impairment was observed compared with patients receiving other conventional systemic therapies or patients not receiving systemic therapy. Nevertheless, a substantial disease burden was still observed among patients receiving dupilumab, indicating a remaining unmet need for effective AD therapies.

Overall, the results in the Latin American population from MEASURE-AD indicated that a considerable disease burden still exists among patients with AD, regardless of current treatment, including systemic therapy.

These results are also in line with previous studies from Latin America. In a retrospective, registry-based study conducted in Brazil between 2016 and 2017, 87% (85/98) of patients had moderate to severe disease as assessed by SCORAD and 75% (24/32) as assessed by EASI.17 The use of oral corticosteroids (33% [61/187]) was slightly higher in that population than in the MEASURE-AD Latin America population (23% [41/180]).17 In another observational study from Colombia enrolling patients between 2019 and 2020, 76% (SCORAD) and 61% (EASI) of patients had moderate to severe disease with 63% (133/212) using oral corticosteroids and 7% (14/212) using dupilumab (vs. 23% [41/180] and 16% [29/180], respectively, in MEASURE-AD Latin America).16 Similar results have been demonstrated in other studies from Latin America.15,23 Furthermore, psychological, social-functioning, and economic effects are also relevant among patients from Latin America.15,18 In a web-based survey involving 1650 adult and pediatric patients with AD in Argentina, 86.5% of patients reported a negative impact on QoL, with frustration, anger, mood alternations, stress, sleep and routine alterations, pain, and economic impact being among the highest ranked domains.18 Topical treatments were frequently used, including by 60% of patients receiving topical corticosteroids; however, 21.7% of patients reported treatment satisfaction as moderate, and 40.5% were dissatisfied with their treatment regimen. Another important finding from the study was a delay in diagnosis, which was more evident in the provinces away from Buenos Aires, and a lack of knowledge about the diagnosis of the disease among specialists.18

Results from studies in children and adolescents with AD also show a high impact of disease. In the international PEDISTAD study of 732 children (with 23% from Latin America), a significant impact of moderate to severe AD on itch, sleep, QoL, and family was demonstrated in children and their caregivers. This might have been explained by the low use of systemic therapies (23%).24 Similarly, a study of 50 children and adolescents with AD from Brazil demonstrated a moderate to high negative effect of AD on QoL in 72% of patients and 74% of families.25 These results are consistent with the findings of the MEASURE-AD study, which demonstrated considerable disease burden (including itch) and sleep and QoL impairment among Latin American adolescents, of whom only 22% used systemic treatment continuously over the previous 12 months.

A slightly higher disease burden was reported in the Latin American population versus the global MEASURE-AD population, in which severe itch was reported by 42% of patients, a very large or extremely large effect on QoL was reported by 46% of adults and 32% of adolescents, and moderate to severe disease was reported by 69% (EASI≥6) and 76% (SCORAD≥25) of patients.20

Interestingly, the time to first systemic therapy was longer in the MEASURE-AD global (17 years) versus Latin American (10 years) population, which may indicate that the Latin American patients with AD sought treatment later in the disease course and escalated to systemic therapy more rapidly than the global population. Although the use of systemic therapies was slightly higher in the Latin American versus global population (66% vs. 56%), the use of biologic therapy (dupilumab) among systemic therapy users was considerably lower in Latin America (25% vs. 56%, respectively), which could explain the higher disease burden. In contrast, the use of systemic corticosteroids (35% vs. 18%) and methotrexate (33% vs. 16%) among systemic therapy users was higher in the Latin American versus the global population. Among all adult patients enrolled in MEASURE-AD (n=1434), the use of biologic therapy (dupilumab) was much lower in Latin America (15% [24/157]) compared with other geographic regions, such as Saudi Arabia, Kuwait, and United Arab Emirates (62% [26/42]), Italy (57% [67/118]), Germany (46% [96/210]), Canada (44% [88/200]), Switzerland and Austria (46% [43/94]), and Spain (42% [38/91]). In Latin America, the cost of systemic medication affects treatment choices in addition to access to treatment. Both methotrexate and oral corticosteroids are less expensive and easier to administer, which may explain their high use versus dupilumab. Of note, the COVID-19 pandemic was ongoing at the time of the study, which could have affected access to dupilumab and lowered its use. Overall, these findings may be explained by market access differences across countries and indicate that not all patients from Latin America have access to systemic medications and remain undertreated.26

Of note, dupilumab was the only biological therapy approved for AD at the time of MEASURE-AD study. The number of treatment options for AD has since increased with the approval of Janus kinase inhibitors (baricitinib, upadacitinib, and abrocitinib) and biologics (such as tralokinumab) in some countries. Thus, future studies are needed to assess the effect of the approval of these therapies on AD disease burden.

The strengths of this study included the reporting of a wide variety of both physician- and patient-reported outcomes, including QoL. Furthermore, this was the largest study assessing the multidimensional burden of AD (clinical, psychological, socioeconomic) and the impact of available systemic treatments on disease burden in Latin America. Limitations of this study included relying on patient self-reported measures and recall during a single office visit and that only patients who were receiving or were candidates for systemic therapy were included. Furthermore, dupilumab was the only approved biological therapy at the time of the study, which was conducted before Janus kinase inhibitors were available. In addition, local regulatory approval status and market access/reimbursement policies varied across countries and some patients had limited access to innovative treatments.

Patients with moderate to severe AD in Brazil, Mexico, and Argentina continue to experience substantial multidimensional disease burden and uncontrolled disease. Although most patients used topical treatments, two-thirds were receiving systemic treatments (mainly corticosteroids or methotrexate) either alone or in combination. Future studies need to look at the effect of newer and more effective therapies on the burden of disease. Overall, a significant unmet need remains for effective treatments to improve patients’ psychosocial and clinical outcomes and reduce the economic burden of AD.

Argentina

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  Fundación Cidea Allergy and Respiratory Research Unit, Buenos Aires, Argentina

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  Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina

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  Instituto de Neumonologia y Dermatologia, Hospital Alemán, Ciudad Autónoma de Buenos Aires, Argentina

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  Psoriahue Medicina Interdisciplinaria, Ciudad Autónoma de Buenos Aires, Argentina

Brazil

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  Centro Universitário Saúde ABC, Santo André, SP, Brazil

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  Clínica de Alergía, Sorocaba, SP, Brazil

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  Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil

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  Santa Casa de Misericordia de Porto Alegre, Porto Alegre, RS, Brazil

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  University of Rio Grande do Sul - Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil

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  University of São Paulo School of Medicine, São Paulo, SP, Brazil

México

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  GA2LEN Atopic Dermatitis Center of Reference and Excellence, Secretaria de la Defensa Nacional, Ciudad de México, México

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  Grupo Clínico CATEI (Centro de Atención en Enfermedades Inflamatorias) Sociedad Civil, Guadalajara, Jal, México

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  Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México

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  NEKI Servicios Médicos, Vicente Guerreo, Toluca, Méx, México

AbbVie Inc. funded the studies and participated in the study design, research, analyses, data collection and interpretation, reviewing, and approval of the publication. No honoraria or payments were made for authorship. All authors had access to relevant data and participated in the drafting, review, and approval of this publication.

Catalina Rincón Pérez: Approval of the final version of the manuscript; critical literature review; data collection, analysis, and interpretation; intellectual participation in propaedeutic and/or therapeutic management of studied cases; effective participation in research orientation; analysis and interpretation of data; manuscript critical review; preparation and writing of the manuscript.

Valeria Aoki: Approval of the final version of the manuscript; critical literature review; data collection, analysis, and interpretation; intellectual participation in propaedeutic and/or therapeutic management of studied cases; effective participation in research orientation; analysis and interpretation of data; manuscript critical review; preparation and writing of the manuscript.

Roberta F. Criado: Approval of the final version of the manuscript; data collection, analysis, and interpretation; intellectual participation in propaedeutic and/or therapeutic management of studied cases; effective participation in research orientation; analysis and interpretation of data; manuscript critical review; preparation and writing of the manuscript.

Martti Antila: Approval of the final version of the manuscript; critical literature review; data collection, analysis, and interpretation; intellectual participation in propaedeutic and/or therapeutic management of studied cases; effective participation in research orientation; analysis and interpretation of data; manuscript critical review; preparation and writing of the manuscript.

Maria Valeria Angles: Approval of the final version of the manuscript; data collection, analysis, and interpretation; intellectual participation in propaedeutic and/or therapeutic management of studied cases; effective participation in research orientation; analysis and interpretation of data; manuscript critical review; preparation and writing of the manuscript.

Tania Ferreira Cestari: Approval of the final version of the manuscript; data collection, analysis, and interpretation; intellectual participation in propaedeutic and/or therapeutic management of studied cases; effective participation in research orientation; analysis and interpretation of data; manuscript critical review; preparation and writing of the manuscript.

Delfina Guadalupe Villanueva Quintero: Approval of the final version of the manuscript; data collection, analysis, and interpretation; intellectual participation in propaedeutic and/or therapeutic management of studied cases; effective participation in research orientation; analysis and interpretation of data; manuscript critical review; preparation and writing of the manuscript.

Gabriel Magariños: Approval of the final version of the manuscript; data collection, analysis, and interpretation; intellectual participation in propaedeutic and/or therapeutic management of studied cases; effective participation in research orientation; analysis and interpretation of data; manuscript critical review; preparation and writing of the manuscript.

Carla Castro: Approval of the final version of the manuscript; data collection, analysis, and interpretation; intellectual participation in propaedeutic and/or therapeutic management of studied cases; effective participation in research orientation; analysis and interpretation of data; manuscript critical review; preparation and writing of the manuscript.

Adriana López Tello-Santillán: Approval of the final version of the manuscript; data collection, analysis, and interpretation; intellectual participation in propaedeutic and/or therapeutic management of studied cases; effective participation in research orientation; analysis and interpretation of data; manuscript critical review; preparation and writing of the manuscript.

Magda Weber: Approval of the final version of the manuscript; data collection, analysis, and interpretation; intellectual participation in propaedeutic and/or therapeutic management of studied cases; effective participation in research orientation; analysis and interpretation of data; manuscript critical review; preparation and writing of the manuscript.

Daniel Lorenzini: Approval of the final version of the manuscript; data collection, analysis, and interpretation; intellectual participation in propaedeutic and/or therapeutic management of studied cases; effective participation in research orientation; analysis and interpretation of data; manuscript critical review; preparation and writing of the manuscript.

Caio Cesar Silva de Castro: Approval of the final version of the manuscript; data collection, analysis, and interpretation; intellectual participation in propaedeutic and/or therapeutic management of studied cases; effective participation in research orientation, analysis and interpretation of data; manuscript critical review; preparation and writing of the manuscript.

Jorge Maspero: Approval of the final version of the manuscript; critical literature review; data collection, analysis, and interpretation; intellectual participation in propaedeutic and/or therapeutic management of studied cases; effective participation in research orientation; analysis and interpretation of data; manuscript critical review; preparation and writing of the manuscript.

Linda García-Hidalgo: Approval of the final version of the manuscript; data collection, analysis, and interpretation; intellectual participation in propaedeutic and/or therapeutic management of studied cases; effective participation in research orientation; analysis and interpretation of data; manuscript critical review; preparation and writing of the manuscript.

Limei Zhou: Approval of the final version of the manuscript; data collection, analysis, and interpretation; analysis and interpretation of data; manuscript critical review; preparation and writing of the manuscript; statistical analysis; study conception and planning.

Shereen Hammad: Approval of the final version of the manuscript; critical literature review; data collection, analysis, and interpretation; analysis and interpretation of data; manuscript critical review; preparation and writing of the manuscript; study conception and planning.

Lucila de Campos: Approval of the final version of the manuscript; critical literature review; data collection, analysis, and interpretation; analysis and interpretation of data; manuscript critical review; preparation and writing of the manuscript; study conception and planning.

Tatiane Cristina Rodrigues: Approval of the final version of the manuscript; critical literature review; data collection, analysis, and interpretation; analysis and interpretation of data; manuscript critical review; preparation and writing of the manuscript; study conception and planning.

Carolina Arzelán: Approval of the final version of the manuscript; critical literature review; data collection, analysis, and interpretation; analysis and interpretation of data; manuscript critical review; preparation and writing of the manuscript; study conception and planning.

Paula C. Luna: Approval of the final version of the manuscript; data collection, analysis, and interpretation; intellectual participation in propaedeutic and/or therapeutic management of studied cases; effective participation in research orientation; analysis and interpretation of data; manuscript critical review; preparation and writing of the manuscript.

Catalina Rincón Pérez has been an investigator, speaker, and/or advisor for AbbVie and a speaker and/or advisor for Janssen, Leo, Lilly, Novartis, Pfizer, and Sanofi Genzyme.

Valeria Aoki has received research grants as an investigator from Lilly and Sanofi Laboratories (the funds were administered by her institution) and served as an advisor/speaker for AbbVie, LEO Pharma, and Pfizer.

Roberta F. Criado has served as an advisor and/or speaker for AbbVie, Mantecorp, Novartis, and Sanofi.

Martti Antila has served as a speaker/consultant for Abbott, AbbVie, Aché, AstraZeneca, Chiesi, Eurofarma, IPI ASAC, and Sanofi and received research support from AbbVie, AstraZeneca, EMS, Eurofarma, GSK, Humanigen, Janssen, Novartis, Sanofi, and Veru.

Maria Valeria Angles has received honoraria or fees for serving on advisory boards, as a speaker, and as a consultant; grants as an investigator from AbbVie, L'Oréal, Pfizer, Raffo, and Sanofi; and grants/research support (paid to the institution) from or participated in clinical trials for AbbVie and Sanofi.

Tania Ferreira Cestari has received research grants as an investigator from AbbVie (including for the MEASURE-AD study), Janssen Cilag, Lilly, Pfizer, and Vichy Laboratories; the funds were administered by her institution (Hospital de Clinicas de Porto Alegre).

Delfina Guadalupe Villanueva Quintero has served as a speaker, advisor, and principal investigator for AbbVie, Amgen, BI, BMS, Janssen, Lilly, Novartis, Sanofi, and Teva.

Gabriel Magariños declares consultancy fees from AbbVie, BI, BMS, Janssen, Lilly, Novartis, Pfizer, and Sanofi, and research grants from AbbVie, BI, BMS, Janssen, Lilly, Merck, MSD, Novartis, and Pfizer.

Carla Castro has received consultancy fees and/or research grants from AbbVie, Amgen, BI, Biogen, Galderma, Isdin, Janssen, Knight, Lilly, L'Oréal, Merck, Novartis, Pfizer, and Sanofi.

Adriana López Tello-Santillán has served as a speaker, investigator, and advisor for AbbVie, Janssen, LEO, Lilly, Novartis, Pfizer, and UCB.

Magda Weber has been an investigator, speaker, and/or advisor for AbbVie and has received funds from ISCMPA.

Daniel Lorenzini has been an investigator, speaker, and/or advisor for AbbVie, Galderma, LEO, Lilly, Pfizer, and Sanofi-Genzyme.

Caio Cesar Silva de Castro has served as a speaker or consultant for AbbVie, Aché, Janssen, Knight, LEO, Novartis, Sanofi, and Sun Pharma.

Jorge Maspero has been an investigator for, received grants or speaker fees from, or has been an advisor for AbbVie, AstraZeneca, GSK, Inmunotek, Menarini, MSD, Novartis, Sanofi-Genzyme, and Uriach.

Linda García-Hidalgo has served as a speaker and advisor for AbbVie, Eucerin, Janssen, Novartis, Novo Nordisk, and Sanofi.

Limei Zhou, Shereen Hammad, Lucila de Campos, Tatiane Cristina Rodrigues, and Carolina Arzelán are full-time, salaried employees of AbbVie and may own AbbVie stock or stock options.

Paula C. Luna received honoraria or fees for serving on advisory boards, as a speaker, or as a consultant, and grants as an investigator, from AbbVie, Amgen, BI, Lilly, Janssen, Pfizer, Novartis, Raffo, and Sanofi. She serves as a doctor at Hospital Aleman, which receives research funds from AbbVie, BI, and Pfizer.