Head, Biostatistics & Data Science OMNY Health Atlanta, United States
Background: Acne vulgaris (AV) is the one of the most common chronic skin conditions worldwide, affecting 9-10% of the global population. In addition to affecting patient quality of life and clinical outcomes, AV represents significant burdens on worldwide healthcare systems and economies. Several pharmacologic therapies and procedures are indicated for AV, but disease severity may greatly influence treatment strategy and disease management in the real-world setting.
Objectives: To characterize AV treatment patterns in the real-world setting by disease severity as measured by the physician global assessment (PGA).
Methods: Outpatient electronic health record data (2017-2022) from 6 specialty dermatology networks in the OMNY Health platform were accessed, and AV patients were selected if they had at least 1 PGA measurement. Prescription orders, administrations, and procedures were associated with each PGA measurement if they occurred within 7 days. Percent of patient assessments by PGA category was calculated for common topical therapies (benzoyl peroxide, dapsone, topical antibiotics [abx], corticosteroids [cs], retinoids), systemic therapies (oral abx, oral cs, isotretinoin, spironolactone), and procedures (comedo removal, laser therapy, photodynamic therapy, chemical peels).
Results: A total of 149,188 patients with 288,523 PGA measurements were included (58%/27%/15% mild/moderate/severe). Overall, with increasing severity (mild/moderate/severe), systemic therapies were used increasingly (37%/50%/58%), procedures were used decreasingly (4.4%/3.1%/1.9%), and topical therapies did not have a direct relationship (47%/52%/40%). Topical/systemic combination therapy was used about twice as much in moderate (23%) and severe (25%) PGA than in mild (14%) PGA. Specific therapies used most with mild PGA were as follows (mild/moderate/severe): benzoyl peroxide (13%/17%/13%), dapsone (5.6%/6.2%/4.7%), topical abx (17%/22%/18%), and topical retinoids (32%/39%/29%). With increasing severity (mild/moderate/severe), oral cs (0.22%/0.55%/1.9%) and isotretinoin (13%/15%/25%) were used increasingly, while topical cs (6.8%/5.5%/4.8%), spironolactone (9.6%/8.9%/7.5%), comedo removal (0.86%/0.75%/0.52%), and laser therapy (3.5%/2.3%/1.4%) were used decreasingly. Oral abx were used more in moderate and severe (28%) PGA than in mild (16%) PGA. No meaningful use of photodynamic therapy or chemical peels was detected during the observation window.
Conclusions: Disease management of AV, which can affect long-term safety/effectiveness, is influenced by PGA for many treatment strategies. Longer follow-up times or analysis of clinical notes for photodynamic therapy and chemical peels may be beneficial to detect these procedures.
