In a study evaluating drug survival in pediatric atopic dermatitis, dupilumab demonstrated the highest 1-year survival rate, with 84.1% of patients remaining on the drug.
In the recent multicenter cohort study, published in JAMA Dermatology, researchers evaluated the drug survival rates of dupilumab, methotrexate (MTX), and cyclosporine A (CsA) in 362 pediatric patients aged 2 to 17 years with atopic dermatitis (AD) treated between 2013 and 2023 across five tertiary centers in the Netherlands. The study included 502 treatment episodes.
Dupilumab demonstrated the highest overall drug survival at 1, 2, and 3 years. The researchers found that 1-year survival rates were 84.1% for dupilumab, 60.7% for MTX, and 43.9% for CsA. At 3 years, survival rates declined to 62.0%, 25.3%, and 10.4%, respectively. The primary reasons for drug discontinuation were ineffectiveness, occurring in 35.5% of episodes, and adverse effects in 18.7% of episodes. Discontinuation related to ineffectiveness was most common with CsA, whereas MTX showed higher discontinuation rates related to adverse effects.
Hazard ratios (HR) for drug discontinuation related to ineffectiveness were significantly higher for MTX (HR = 4.45, 95% confidence interval [CI] = 2.38–8.34) and CsA (HR = 10.88, 95% CI = 6.23–19.02) when compared with dupilumab. Similarly, MTX (HR = 4.39, 95% CI = 2.05–9.39) and CsA (HR = 3.83, 95% CI = 1.85–7.92) were associated with higher risks of discontinuation related to adverse effects compared with dupilumab. Additionally, older age (12 to 17 years) was independently associated with an increased likelihood of discontinuation related to ineffectiveness (HR = 1.55, 95% CI = 1.10–2.20) and adverse effects (HR = 2.39, 95% CI = 1.33–4.30).
The availability of dupilumab was associated with decreased survival of MTX and CsA, indicating a potential shift in treatment practices. The findings offered valuable insights into the long-term effectiveness, safety, and tolerability of systemic therapies in pediatric patients with AD, with implications for optimizing treatment strategies in this population.
Full disclosures can be found in the published study.