Prof. Carsten Flohr discusses the evolving role of the UK–Irish systemic therapy register, alongside new data on drug survival and an analysis of treatment choices and clinical patterns in older patients with atopic eczema.
TouchDERMATOLOGY coverage from BAD 2026:
Over recent years, we have closely followed the real-world evidence emerging from the UK–Irish Atopic Eczema Systemic Therapy Register (A-STAR), with findings regularly presented at dermatology congresses around the world.
With centres across the UK and Ireland, A-STAR is a long-term observational study collecting real-world data from children and adults with atopic eczema who receive systemic treatments. The register explores important questions in the field of atopic dermatitis, such as treatment effectiveness, safety and cost-effectiveness.
At the British Association of Dermatologists Annual Meeting 2026, this growing body of data and developments from A-STAR continued with a dedicated plenary session and several presentations of new data.
To discuss some of these developments, we caught up with Prof. Carsten Flohr (King’s College London, UK), Chief Investigator of A-STAR.
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A-STAR beyond pharmacovigilance
Q. At the plenary session, A-STAR: Looking beyond pharmacovigilance in atopic eczema, you explored the wider role of the register. What was the aim of your talk, and what were the key take-home messages?
From my perspective, I hope the talk was able to demonstrate and highlight the real relevance of collecting real-world data in atopic dermatitis.
As a field, we increasingly understand that randomized controlled trials (RCTs) are very rigid vehicles and usually provide only a very short-term perspective, so they are not necessarily best suited to assessing drug safety, for instance. In addition, the inclusion and exclusion criteria for these types of trials are often very strict, so the patients enrolled do not necessarily reflect those we see in clinical practice.
This is where real-world evidence such as that from A-STAR really comes into its own, and it is encouraging to see this growing recognition reflected at a policy level. The UK regulator NICE has identified A-STAR as a key vehicle for collecting data to support its decision-making. It is also interesting to see NICE and the research arm of the Department of Health, the NIHR, moving away from viewing RCTs as the sole gold standard for informing policy, including decisions around access to medicines.
In our talk, I also wanted to highlight the valuable opportunities that A-STAR can provide. For colleagues involved in the register, it can offer a meaningful way to contribute to the wider scientific effort, develop their research experience, and help shape future analyses and research priorities.
One strong example comes from Epsom and St Helier University Hospitals, where a consultant dermatologist has partnered with a junior colleague who is an NIHR Associate Principal Investigator. Through their involvement in A-STAR, the junior colleague has been able to develop their research skills, contribute to data analysis, and present the findings.
The data will be presented at the 2026 EADV Annual Meeting, and those involved will also have the opportunity to write up the findings, take on first-author roles, and gain a real sense of ownership. This helps ensure that A-STAR is not seen as something led solely by one or two people in London, but as a wider collaborative effort with meaningful involvement from centers across the UK and Ireland.
It is also not just clinicians who can benefit from being involved. Nurses can play a leading role in A-STAR and receive recognition as local lead investigators. Because A-STAR is a register rather than a clinical trial, nurses can often drive the work locally without it needing to be led by a clinician. Patients can also find it very rewarding to participate in and contribute to the study.
At the session, we also discussed potential developments for the register. In keeping with A-STAR’s focus on patient involvement, we are keen to develop an app, hopefully sometime next year. This would allow patients to enter their own data, receive direct feedback, and track changes in their condition over time.
The app could also provide standardized advice and guidance. For example, if a patient’s disease activity appeared to be increasing, it could offer information on appropriate next steps, such as reviewing or stepping up their topical therapy.
Looking further ahead, the app could also incorporate external data, such as pollen counts. Many people live with both hay fever and atopic dermatitis, and their AD may flare during the pollen season. As pollen-count data are publicly available on an almost daily basis, this information could potentially be integrated into the app to help patients better understand changes in their condition. The message here is that there is a great deal more we can do to bring patients directly into the fold.
→ Plenary session: Flohr C. A-STAR: Looking beyond pharmacovigilance in atopic eczema. July 1, 2026. BAD 2026, Manchester UK
Atopic eczema in older patients
Q. Prof. David Gawkrodger presented findings from A-STAR on atopic eczema in older adults. What did the data reveal, and how might these findings inform clinical practice?
Older adults represent a distinct patient group. We know that atopic dermatitis is increasingly common in this population, yet real-world experience with systemic therapies remains limited. To learn more, Prof. Gawkrodger’s group used A-STAR to explore treatment choices and clinical patterns among patients aged 60 years and older.
Some of the findings were perhaps not surprising. We saw that comorbidities clearly play an important role in decisions around whether a patient should receive an advanced or conventional therapy.
We did, however, see some interesting differences in allergic comorbidities, with younger patients having much higher rates of food allergy, allergic rhinoconjunctivitis and asthma compared to older patients.
The clinical phenotyping within A-STAR also revealed some interesting differences that we had not previously explored in detail. More active inflammatory phenotypes, including follicular eczema and pompholyx, a subtype of hand eczema, were found to be more common in younger patients than in older adults.
In terms of how these findings might inform clinical practice, I think the main message is one of reassurance. Even older patients with certain comorbidities generally fare quite well on advanced systemic therapies. Seeing relatively large numbers of patients doing well on these treatments, without major safety concerns, should help clinicians feel more confident about using them in this population.
→ Abstract: Gawkrodger DJ, Tsoi MF, Gribaleva et al. BG03 Atopic eczema in older adults: findings from the UK-Irish Atopic eczema systemic therapy register (A-Star). British Journal of Dermatology, Volume 195, Issue Supplement_1, June 2026.
Drug survival comparisons in atopic eczemas
Q. At the meeting, Dr Man Fung Tsoi presented findings from A-STAR on the drug survival of dupilumab, methotrexate and ciclosporin in people with atopic eczema. What did the study reveal?
Drug survival of systemic medications in atopic eczema is a commonly used measure of effectiveness and tolerability informing clinical decision making. This study explored the drug survival of oral and subcutaneous methotrexate, ciclosporin and dupilumab in patients in the A-STAR register.
The study found that dupilumab had the longest drug survival, while ciclosporin had the shortest. Subcutaneous methotrexate had the second-longest drug survival, followed by oral methotrexate. These findings were perhaps not particularly surprising. Ciclosporin is often used for very severe disease when the aim is to switch off inflammation quickly, rather than as a long-term treatment.
However, these findings need to be considered within the context of treatment access. In a setting such as the UK, where conventional therapies still need to be used before advanced treatments, ciclosporin may remain useful for patients with very severe disease who need rapid control of inflammation. This differs from countries such as Germany, where patients may be able to move directly to a JAK inhibitor in this situation, rather than a biologic, which can take longer to achieve a treatment response.
Overall, I do not think these findings will fundamentally change clinical practice. It is more about reporting back to the BAD community on what we are seeing in A-STAR, including how these therapies are being used and how long patients remain on them.
Interestingly though, these findings form part of a piece on treatment-effectiveness data that we published in the British Journal of Dermatology a couple of years ago. At the time the findings generated some debate because they showed how well ciclosporin performed compared with dupilumab. However, I also received considerable feedback from colleagues who felt it was important for these data to be presented.
Ciclosporin works very quickly and, when only used for a short period in the right patients, it can work extremely well. Rather than simply labelling it as an immunosuppressive therapy and dismissing it, I think we need to recognise that, in the UK, we still have to understand how to use these treatments.
→ Abstract: Gribaleva, Tsoi MF, Prieto-Merino D. O05 Drug survival of dupilumab, methotrexate and ciclosporin in patients with atopic eczema: results from the UK-Irish Atopic eczema Systemic TherApy Register (A-STAR). British Journal of Dermatology, Volume 195, Issue Supplement_1, June 2026.
This content has been developed by Touch Medical Media for touchDERMATOLOGY in collaboration with Prof. Flohr. It is not affiliated with the British Association of Dermatologists (BAD). Views expressed are the speaker’s own and do not necessarily reflect the views of Touch Medical Media.
Disclosures: Carsten Flohr reports serving as a consultant for Apogee, Almirall, Incyte, LEO Pharma, Pfizer and Sanofi; receiving grant or research support from Pfizer and Sanofi; serving on advisory boards for Apogee, Almirall, Incyte, LEO Pharma, Pfizer and Sanofi; participating in speakers’ bureaus for Almirall, Pfizer and Sanofi; and receiving honoraria from these companies.
Cite: Flohr C. Atopic eczema: Latest real-world updates from A-STAR. touchDERMATOLOGY. July 20, 2026.
Editor: Gina Furnival
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