A comprehensive global analysis has revealed significant disparities in access to biologic medications for atopic dermatitis treatment, with socioeconomic factors playing a decisive role in medication availability and utilization across different nations.
The study, led by Arbie Sofia P. Merilleno from Women's College Hospital in Toronto, examined pharmaceutical sales data from 2017 to 2022, focusing on biologics such as dupilumab and tralokinumab across 50 countries.
Dramatic Growth in Global Biologic Utilization
The research documented a remarkable expansion in biologic availability over the five-year study period. In 2017, only three high-SDI countries - the United States, France, and Germany - had access to these medications, with an average utilization rate of 1.1 units per 100,000 individuals. By 2022, availability had expanded to 47 additional countries, resulting in a 175.4-fold increase in average utilization, reaching 192.9 units per 100,000 individuals.
Socioeconomic Status Drives Access Disparities
The analysis revealed stark contrasts in biologic utilization based on countries' sociodemographic index (SDI). High-SDI nations demonstrated significantly higher access rates, with an average utilization of 329.6 units per 100,000 people - 28.2 times greater than the rate in lower-middle/middle-SDI countries (11.7 units per 100,000).
Multivariable linear regression analysis confirmed the strong correlation between SDI and biologic use. Countries with high-middle SDI utilized 10.9 more medication units per 100,000 individuals (95% CI; -87.6 to 109.5), while high-SDI countries used 118.0 more units (95% CI; 27.7–208.3) compared to those with low-middle/middle SDIs.
Disease Burden vs. Access Patterns
Surprisingly, the researchers found no clear correlation between biologic usage and atopic dermatitis burden, as measured by disability-adjusted life years (DALY) rates. Each increase of 1 DALY per 100,000 patients corresponded to only a minimal 0.7-unit rise in biologic implementation (95% CI; -0.3 to 1.7). Similarly, no significant relationship was found between eczema prevalence rates and biologic utilization.
Financial Barriers and Healthcare Implications
"Biologics have transformed the treatment of moderate-to-severe atopic dermatitis, but new treatments are expensive and not universally accessible," noted Merilleno and colleagues. The study's findings suggest that financial constraints, rather than medical need, primarily determine access to these innovative treatments, particularly in lower-income nations.
The research team emphasized that while biologics are technically available in some Latin American countries, financial barriers significantly restrict their practical use. These findings highlight the urgent need for strategies to improve global access to advanced treatments for atopic dermatitis, particularly in regions where economic factors limit healthcare options.
