Longitudinal atopic dermatitis control and persistence vary with timing of disease onset in children: A cohort study - 09/11/19
, Nandita Mitra, PhD c, d, Ole J. Hoffstad, MA c, Albert C. Yan, MD b, David J. Margolis, MD, PhD a, c, dAbstract |
Background |
Wide variation exists in the timing of atopic dermatitis (AD) disease onset among children. Distinct trajectories of early-onset, mid-onset, and late-onset AD have been previously described.
Objective |
To evaluate longitudinal disease control and persistence with respect to age at onset of AD.
Methods |
A cohort study was performed using the Pediatric Eczema Elective Registry, a prospective observational cohort of subjects with childhood-onset AD. AD control and persistence were assessed biannually for up to 10 years.
Results |
A total of 8015 subjects with 41,934 person-years of follow-up were included. In longitudinal analyses using generalized linear latent and mixed modeling, older age at onset of AD was associated with better disease control and less-persistent AD. For each additional year of age at onset of AD, the adjusted odds ratios for poorer AD control and for persistent AD were 0.93 (95% confidence interval, 0.91-0.94) and 0.84 (95% confidence interval, 0.80-0.88), respectively. Differences in AD control and persistence among subjects with early-, mid-, and late-onset AD were most pronounced from early adolescence onward.
Limitations |
Misclassification bias may arise from using self-reported data on age at onset. Attrition and missing data in longitudinal studies may introduce bias.
Conclusion |
Early-, mid-, and late-onset pediatric AD appear to be clinically distinct subtypes of the disease.
Il testo completo di questo articolo è disponibile in PDF.Key words : atopic dermatitis, disease control, disease persistence, early onset, eczema, epidemiology, late onset, prognosis
Abbreviations used : aOR, AD, CI, IQR, PEER
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| Funding sources: Supported in part by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant T32-AR007465 [to Dr Wan]) and a Dermatology Foundation Dermatologist Investigator Research Fellowship (to Dr Wan). The data source used in this study is the Pediatric Eczema Elective Registry, which is a study funded by Valeant Pharmaceuticals through a grant to Dr Margolis. No funding sources had a role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the article; or decision to submit the article for publication. |
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| Disclosure: Dr Wan receives research fellowship funding from Pfizer Inc (to the Trustees of the University of Pennsylvania) and has received payment for consulting work with Health Union LLC. Dr Margolis has served on advisory committees for Sanofi/Regeneron and Pfizer Inc. Dr Yan has served as a consultant to Sanofi/Regeneron, Pfizer Inc, Procter and Gamble, and Ortho Dermatologics/Valeant. Dr Mitra and Mr Hoffstad have no conflicts of interest to disclose. |
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| Reprints not available from the authors. |
Vol 81 - N° 6
P. 1292-1299 - dicembre 2019 Ritorno al numero
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