ISSN 1752-5713 (Print)ISSN 1752-5721 (Email)

ISSUE 10/19

For further information on our full range of Disease Specific Programmes (DSPs) and Bespoke services, please contact:Peter Andersonemail: peter.anderson@adelphigroup.comTel: +44 (0)1625 577335

Recent Adelphi Real World DermatologyPublicationsSilverberg et al. Adult patients with mild or moderate atopic dermatitis are significantly impacted by their condition: results from a real-world study in the United States. AMCP 2019

Lio et al. Impact of atopic dermatitis lesion location on quality of life in adult patients - results from a real-world study. EADV 2019

Leversedge et al. Use of an Adelphi Disease Specific Programme to assess the impact of institute for clinical and economic review report publication on specialty category management by US insurers; a physician-based approach. ISPOR US 2019

Korman et al. Assessing differences between psoriasis patients who are aligned with their physician on their current disease severity versus patients who are misaligned. SPIN 2019

No systemic medications are currently approvedfor AA but, despite risk of adverse events,patients have been willing to try off-label drugsas a result of the condition being associated withsignificant stigmatism and mental stress.

Emotional impact of the condition is confirmed inAdelphi’s recently-completed benchmark USAlopecia Areata Disease Specific Programme.

Regardless of patient severity, physiciansreported high levels of emotional disorder with,for example, two thirds of mild patientsexperiencing anxiety, rising to 84% in moderateand in severe patients.

However factors such as depression, impairedsocial interaction and inability to participate/enjoy activities tend to be experienced morefrequently as severity increases.

Physicians were most likely (72%) to consider %hair loss the single most important factor fordetermining severity but 17% indicated thatpatient distress was most important.

Alopecia Areata is one of the nextinflammatory skin diseases set fora dramatic change in treatment

options with improved outcomes for patients.

Data from 2019 Alopecia Areata DSP - % of patients experiencing (physician-reported)

High emotional impact of alopecia

65%69%

74%78%

84% 86% 84% 87%84%89% 89% 92%

Mild (n=91)

Moderate (n=243)

Severe (n=118)

Anxiety Frustration Embarrassment Fear of persistence

Current severityof patient

Mean percentage hair loss for mild patients was5.8%, increasing to 8.1% in moderate patientsand 46.2% in severe patients.

A number of molecules already at various stagesof development for other autoimmuneconditions are potential candidates fortreatment of AA - these include JAK (januskinase), PDE4 (phosphodiesterase 4) and IL-17A(interleukin 17A) inhibitors.

In addition, in October 2018, JAMA Dermatologydescribed how a 13-year-old patient witheczema and alopecia totalis – complete loss ofscalp hair - experienced significant hair regrowthwhile being treated with dupilumab.

The AA DSP describes the adult AA patientpopulation in terms of physician-reported clinicalcharacteristics, demographics and treatmentpatterns associated with routine clinical practiceand how this relates to patients’ clinical andhumanistic burden. The patient-completedquestionnaire includes Skindex-16 AA as well asthe EQ-5D and WPAI validated tools.

US data from the AA DSP completed in Q3 2019are available now and the study will beexpanded in 2020 to include 5EU and othercountries where requested.

ALOPECIA AREATA REAL WORLD DATA AVAILABLE NOW

DSP PORTFOLIORASpACrohn’s/UCPsoriasis/PsALupusSjogren’s SyndromeAtopic DermatitisAlopecia AreataHeart FailureStrokeAtrial FibrillationDyslipidemiaDiabetesDMONASHCKDHypothyroidismEndometriosisHMB/UFAsthma/COPDPulm. HypertensionIPFNasal PolypsMultiple SclerosisDementiaParkinson’sDepression/AnxietySchizophreniaNeuropathic/CLBPMigraineOsteoporosisOsteoarthritisHuntington’sHemophiliaPSPFabry Disease

Breast CancerProstate CancerNSCLCGastric CancerHCCOvarian CancerMelanomaHead/Neck CancerMultiple MyelomaAMLCLLFL/DLBCLGBM + OTHERS

The adult Psoriasis (PsO) treatmentlandscape has expanded rapidly in the last decade, led principally by

biologic therapies. This expansion has continued with the morerecent introduction of biosimilars, novel orals,such as apremilast, and biologics with newmechanisms of action, namely the ILs.Adelphi’s Adult PsO Disease Specific Programme(DSPTM) has tracked these market developmentsacross 9 waves and 2019 results point to therapychoice being increasingly driven by desire forfaster speed of onset, longer sustainability ofeffect, and even complete skin clearance (i.e.PASI 100).As such, advanced therapies may be movingfrom their traditional use among more severepsoriasis patients, into moderate and even mildPsO sufferers.

In contrast, advanced therapy use in thePediatric PsO patient population is more limited,with many patients having to rely on topicaland/or phototherapy only.

Currently, the choice faced by dermatologistsaround the prescribing of biologics is difficultwith widespread fears remaining over the use ofthese potent drugs in younger patients.

Given that several biologics are currently indevelopment for pediatric PsO, including the IL-17s secukinumab and ixekizumab, the need tounderstand the triggers for biologic prescription,in addition to the risk/benefits associated withthis class, is paramount.

The new Adelphi Pediatric PsO DSP willinvestigate these issues and more. Resultscovering the US and EU are due from early Q22020.

Full Spectrum Range of Dermatology DSPs™

URTICARIAATOPIC DERMATITIS

ALOPECIA AREATA

HIDRADENITIS SUPPURATIVA

PEDIATRICAD

ADULT AD

PSORIASIS

PART OF THE WIDER ADELPHI AUTOIMMUNE FRANCHISE

ADULT PsO

PEDIATRIC PsO

PSORIATICARTHRITIS

TARGET SAMPLEUS/5EU

Fieldwork in design Q4 2019270 Dermatologists + 1,540 HS Patients

Ever more aggressive Tx goals in adult PsOBut how will the pediatric market compare?

56%

48%

44%

41%

33%

29%

Data from 2019 Adult Psoriasis DSP - % of patients for whom each was a reason for choice of interleukin inhibitor (IL)

Clearance of PsO lesions PASI >90

Maintains efficacy in long-term

Fast onset of action

Clearance of PsO lesions PASI 100

100% clearance of skin

Clearance of PsO lesions PASI >75