Most patients with AD on dupilumab stick with this drug long-term

A real-world study indicated that the long-term drug survival rate of dupilumab in patients with moderate-to-severe atopic dermatitis (AD) is high. Few patients discontinued the agent due to side effects or ineffectiveness. An additional analysis showed that early onset of AD was associated with reduced dupilumab survival in the study population.

“Real-world data on the long-term survival of dupilumab use and the associated predictors in patients with moderate-to-severe AD is limited,” said Dr Elena Pezzolo (San Bortolo Hospital, Italy). Therefore, Dr Pezzolo and co-investigators prospectively evaluated dupilumab drug survival in a cohort of adult patients with moderate-to-severe AD [1].

Included were 363 participants who were followed for up to 4 years. Participants had received at least 4 weeks of dupilumab therapy to be eligible for this study. The classical AD phenotype accounted for 60.1% of the cases, whereas 16.2% of participants had the portrait phenotype (also referred to as head and neck dermatitis), and 10.7% had the prurigo nodularis-like phenotype. Allergic asthma, allergic rhinitis, and food allergy were present in 30.0%, 40.7%, and 34.1% of the participants, respectively. Furthermore, 28.6% had received 1 prior immunosuppressive agent, whereas 71.4% had received at least 2 prior immunosuppressive agents.

On average, the participants achieved a 60.8% reduction of the Eczema Area and Severity Index (EASI) score from baseline to week 4. In addition, 40.2% reached an EASI score of 7 or lower. After 4 years of follow-up, 12% of the patients had discontinued dupilumab. Adverse events (7.8%) and ineffectiveness (29.6%) were among the main reasons for discontinuation of the agent. Conjunctivitis (3.3%), psoriasiform, and/or urticarial lesions (1.1%) were the most frequently observed side effects that led to dupilumab discontinuation. Furthermore, early onset of AD (before the age of 18 years) was the only significant predictor of reduced duration of dupilumab drug survival (HR 1.32; 95% CI 1.12–1.78; P=0.04).

“Only a limited number of patients discontinued dupilumab due to adverse events or ineffectiveness after 4 years of follow-up, suggesting that the 4-year drug survival of dupilumab in patients with moderate-to-severe AD is good,” concluded Dr Pezzolo. “However, the sample size of the current study is limited, and larger real-world studies are needed to validate our findings and discover factors that are associated with dupilumab drug survival.

1. Pezzolo E, et al. Long-term drug survival of dupilumab and associated predictors in moderate-to-severe atopic dermatitis: a real-world prospective cohort study. Session Atopic dermatitis 2, WCD 2023, 3–8 July, Singapore, Singapore.