Dupilumab Drug Survival and Associated Predictors in Patients With Moderate to Severe Atopic Dermatitis

TAKE-HOME MESSAGE

• In this cohort study, registry-based data were analyzed using Kaplan–Meier survival curves to determine the 1-year, 2-year, and 3-year drug survival of dupilumab in adult patients with moderate to severe atopic dermatitis. Overall, drug survival was high at all time points (90.3% at 1 year, 85.9% at 2 years, and 78.6% at 3 years). Factors associated with decreased drug survival included the Investigator Global Assessment score of very severe disease, no response at week 4, and use of immunosuppressive therapy at dupilumab initiation.

• Drug survival of dupilumab is high, with over three-quarters of patients still on therapy at 3 years. Knowledge of factors decreasing drug survival can help clinicians make treatment decisions.

–  Joshua R. Ortego, MD

Written by

 

 

Sarah L. Chamlin MD

This Dutch group evaluated drug survival in 715 adult patients with atopic dermatitis (AD) on dupilumab. Drug survival was measured as drug discontinuation due to ineffectiveness, adverse events, and overall. Overall, this cohort of patients remained on dupilumab at years 1 (90.3%), 2 (85.9%) and 3 (78.6%). The use of systemic immune suppressants at baseline, age >65 years, an IGA score of very severe AD, and being a non-responder at 4 weeks were associated with dupilumab discontinuation. 

Overall, drug discontinuation was very low and was mostly associated with adverse events. Notably, this study reports that no response or worsening of AD at 4 weeks is highly predictive of dupilumab ineffectiveness in the long term. Non-responders had EASI scores at weeks 4 and 16 that were strongly correlated. This is clinically useful, as those without improvement in AD in the first 1–2 months of therapy should be considered for other systemic therapy. As experience grows with other systemic agents in adults and dupilumab in the pediatric population, additional work on reasons and predictors of drug discontinuation will greatly inform our practices.   

IMPORTANCE

Long-term data on dupilumab drug survival in patients with atopic dermatitis (AD) are scarce. Furthermore, little is known about the factors associated with drug survival of dupilumab in AD.

OBJECTIVE

To describe the drug survival of dupilumab in patients with AD and to identify associated predictors.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study was based on data from the multicenter prospective daily practice BioDay registry, in which 4 university and 10 nonuniversity hospitals in the Netherlands participated. Analysis included patients (age ≥18 years) participating in the BioDay registry with a follow-up of at least 4 weeks. The first patient treated with dupilumab was recorded in the BioDay registry in October 2017; data lock took place in December 2020, and data analysis was performed from October 2017 to December 2020.

MAIN OUTCOMES AND MEASURES

Drug survival was analyzed by Kaplan-Meier survival curves and associated characteristics by using univariate and multivariate Cox regression analysis.

RESULTS

A total of 715 adult patients with AD (mean [SD] age, 41.8 [16.0] years; 418 [58.5%] were male) were included with a 1-year, 2-year, and 3-year overall dupilumab drug survival of 90.3%, 85.9%, and 78.6%, respectively. Characteristics associated with shorter drug survival owing to ineffectiveness were the use of immunosuppressant drugs at baseline (hazard ratio [HR], 2.64; 95% CI, 1.10-6.37) and being a nonresponder at 4 weeks (HR, 8.68; 95% CI, 2.97-25.35). Characteristics associated with shorter drug survival owing to adverse effects were the use of immunosuppressant drugs at baseline (HR, 2.69; 95% CI, 1.32-5.48), age 65 years or older (HR, 2.94; 95% CI, 1.10-7.87), and Investigator Global Assessment score of very severe AD (HR, 3.51; 95% CI, 1.20-10.28).

CONCLUSIONS AND RELEVANCE

This cohort study demonstrated a good overall 1-year, 2-year, and 3-year dupilumab drug survival. Patients using immunosuppressive therapy at baseline and those with an absence of treatment effect at week 4 tended to discontinue treatment owing to ineffectiveness more frequently. Using immunosuppressant drugs at baseline, older age, and Investigator Global Assessment score of very severe AD were characteristics associated with an increased risk for discontinuation owing to adverse effects. These data provide more insight and new perspectives regarding dupilumab treatment in AD and can contribute to the optimization of patient outcomes.

JAMA Dermatology

Dupilumab Drug Survival and Associated Predictors in Patients With Moderate to Severe Atopic Dermatitis: Long-term Results From the Daily Practice BioDay Registry

JAMA Dermatol 2022 Aug 10;[EPub Ahead of Print], LS Spekhorst, M de Graaf, NPA Zuithoff, JMPA van den Reek, M Kamsteeg, CM Boesjes, GLE Romeijn, L Loman, I Haeck, AJ Oosting, A de Boer-Brand, WRH Touwslager, A Flinterman, AMT van Lynden-van Nes, AH Gostynski, MS de Bruin-Weller, ML Schuttelaar 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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