683 - Risk of major adverse cardiovascular events in patients with moderate-to-severe atopic dermatitis: a United States population-based study
Authors: Bunick Christopher G , Grada Ayman , Del Rosso James , Armstrong April W , Yue Emma , Krueger Whitney 
Published: August 2024

Abstract

Introduction/Background
Chronic systemic inflammation is a recognized risk factor for cardiovascular disease. Atopic dermatitis (AD) has been associated with multiple comorbidities.1 However, risk of major adverse cardiovascular events (MACE) among patients with moderate-to-severe AD is not well understood in the US population.

Objectives
To characterize risk of MACE in patients with AD vs matched controls without AD (non-AD) and patients with rheumatoid arthritis (RA). To evaluate the effect of disease activity, analyses were repeated in patients with moderate-to-severe disease.

Methods
In this retrospective analysis of US administrative claims data from Optum's Clinformatics Data Mart, eligible patients were aged ≥18 years with diagnosed AD (≥2 claims for AD or ≥1 claim for AD or eczema with asthma and/or hay fever, food allergies, or allergic rhinitis) from 03/2017–03/2023. The date of the first qualifying disease diagnosis was defined as the cohort entry date. Comparator groups included non-AD controls (matched 1:1 by age, sex, and cohort entry) and patients diagnosed with RA (≥2 claims ≥7 days apart; diagnostic codes identified by rheumatologists). Patients were classified as having moderate-to-severe disease if they received dupilumab for AD or advanced systemic therapy for RA at any time during the follow-up period. Patients with moderate-to-severe AD were also matched to a non-AD control cohort. The crude incidence of MACE, defined as inpatient hospitalization with myocardial infarction or stroke, was quantified. Relative risk was calculated using multivariable Cox proportional hazards model adjusted for baseline demographics, comorbidities, and medication use.

Results
This analysis included 391,753 patients with AD (7136 with moderate-to-severe AD) and 97,445 patients with RA (35,846 with moderate-to-severe RA). The matched AD and non-AD cohorts included 381,221 patients each; the matched moderate-to-severe AD and non-AD cohorts comprised 7134 patients each. Mean (SD) age in years at cohort entry was 58.0 (18.8) for AD, 67.0 (13.6) for RA, and 58.1 (18.8) for non-AD controls. Incidence of MACE (per 100 patient-years) in patients with AD (1.78 [95% CI 1.76, 1.81]) was similar to non-AD matched controls (1.83 [1.80, 1.86]) and lower vs patients with RA (2.12 [2.07, 2.17]). Patients with moderate-to-severe AD had a lower MACE incidence (1.18 [95% CI 1.01, 1.35]) than non-AD matched controls (1.52 [1.33, 1.74]) and patients with moderate-to-severe RA (1.67 [1.59, 1.75]). The relative risk of MACE in patients with AD was lower vs non-AD controls (adjusted hazard ratio [aHR] [95% CI]: 0.91 [0.89, 0.93]) and patients with RA (0.83 [0.80, 0.85]). Among patients with moderate-to-severe AD, MACE risk was similar to non-AD matched controls (aHR [95% CI]: 0.92 [0.73, 1.14]) and lower vs moderate-to-severe RA (0.83 [0.73, 0.94]). MACE risk in AD was greater in patients who were older (per year, aHR [95% CI]: 1.05 [1.05, 1.05]), male (1.23 [1.19, 1.27]), Black vs White (1.16 [1.11, 1.21]), received systemic corticosteroids in the 3 months before diagnosis (1.10 [1.06, 1.14]), hospitalized in the year before diagnosis (1.35 [1.30, 1.41]); and had history of smoking (1.20 [1.16, 1.24]) and drug abuse (1.34 [1.25, 1.43]). History of cardiovascular disease and other comorbidities were significantly associated with increased MACE risk.

Conclusions
Among patients with AD, the risk of MACE was lower than the risk in non-AD matched controls and patients with RA. Among patients with moderate-to-severe AD, the risk of MACE was similar to the risk in non-AD matched controls but lower than the risk in moderate-to-severe RA. Patients with AD had an increased MACE risk if they were older, male, Black, hospitalized in the year before diagnosis; and had a history of smoking/drug abuse, cardiovascular disease, and other comorbidities. Characterizing the underlying MACE risk in AD can inform treatment benefit-risk assessments.