Dupilumab may maintain its effectiveness in treating atopic dermatitis, with two-thirds of patients successfully extending their dosing interval while achieving sustained disease control, according to a recent cohort study.
In the study, published in JAMA Dermatology, researchers assessed the long-term effectiveness and reasons for discontinuation of dupilumab in 1,286 patients with atopic dermatitis treated across 14 hospitals in the Netherlands from October 2017 to December 2022, including pediatric, adult, and older adult patients.
The median age of the patients was 38 years, with an interquartile range (IQR) of 26 to 54 years. The study included 726 male patients, making up 56.6% of the total participants. The median follow-up duration for the entire group was 87.5 weeks, with an IQR of 32.0 to 157.0 weeks. For pediatric patients, the follow-up period was a median of 33.5 weeks (IQR = 6.0–74.0 weeks). Adult patients had a median follow-up time of 97.0 weeks (IQR = 39.0–163.0 weeks), and older adult patients had a median follow-up of 95.0 weeks (IQR = 31.0–162.0 weeks).
The researchers found that dupilumab maintained clinical effectiveness across all age groups. At the 5-year mark, the mean Eczema Area and Severity Index (EASI) score decreased to 2.7 (95% confidence interval [CI] = 1.2–4.2), and pruritus scores (NRS) remained low at 3.5 (95% CI = 2.7–4.3). Most patients achieved controlled atopic dermatitis, with EASI scores ≤ 7 and NRS scores ≤ 4.
Approximately two-thirds of the patients extended their dosing interval to every 3 or 4 weeks while maintaining disease control. Significant reductions in thymus- and activation-regulated chemokine (TARC) and eosinophil levels were observed, which remained low throughout the study period. TARC levels decreased from 1,751 pg/mL (95% CI = 1,614–1,900) to 390 pg/mL (95% CI = 368–413) after 6 months.
A total of 306 patients (23.8%) stopped using dupilumab after a median duration of 54 weeks (IQR = 29.0–110.0 weeks). The primary reasons for discontinuation were adverse events in 98 patients (7.6%) and lack of effectiveness in 85 patients (6.6%). The most common adverse events included ocular surface disease and musculoskeletal pain. Additionally, 3.2% of patients who initially discontinued treatment restarted dupilumab with positive responses.
The findings indicated that dupilumab may provide long-term benefits in managing atopic dermatitis across various age groups. The ability to adjust dosing intervals without compromising efficacy was notable.
Full disclosures can be found in the published study.
