Long-Term Dupilumab for AD Evaluated in Cohort Study

TOPLINE:

Dupilumab remained effective in most patients with atopic dermatitis (AD) up to 5 years, although nearly a quarter of patients in the cohort study discontinued treatment because of adverse events (AEs) and/or ineffectiveness, researchers report.

METHODOLOGY:

• A prospective multicenter cohort study evaluated 1286 patients with AD from the BioDay registry (130 children, 1025 adults aged 18-64 years, and 131 adults aged ≥ 65 years) in the Netherlands treated with dupilumab between October 2017 and December 2022.
• Patients received a loading dose of 600 mg dupilumab at baseline, followed by 300 mg every other week. A standardized dose reduction method that has been in practice since 2019 was applied.
• The median follow-up time was 87.5 weeks; patients were seen at baseline, 4 weeks, and then every 3-6 months.
• Researchers evaluated clinical effectiveness using the Eczema Area and Severity Index (EASI), Investigator Global Assessment, and numeric rating scale (NRS) for pruritus. Mean E ASI and NRS for pruritus at baseline were 17.8 and 6.8, respectively.

TAKEAWAY:

• The mean EASI at 16 weeks was 5.1 and continued to improve to 4.1 and 2.7 after 2 years and 5 years, respectively (all P < .001). NRS for pruritus improved to 3.4 at 16 weeks (P < .001) and remained low for up to 5 years.
• Most patients (75.2%) achieved an EASI score ≤ 7 at 16 weeks, as did 12 of the 17 (92.3%) patients evaluated at 5 years. After 16 weeks, 71.2% of patients achieved NRS scores for pruritus ≤ 4, as did 15 of the 17 (88.2%) evaluated at 5 years.
• Thymus- and activation-related chemokine levels and eosinophil levels decreased and remained low over time (both P < .001).
• Overall, 23.8% of patients discontinued dupilumab after a median of 54 weeks, 7.6% and 6.6% cited AEs and ineffectiveness, respectively, as the primary reasons for discontinuation.

IN PRACTICE:

“In this multicenter daily practice study with up to 5 years of follow-up…dupilumab showed clinical effectiveness,” with a “fairly similar response” seen for children, adults, and older adults, the authors wrote. In addition, “two thirds of the patients tapered to a dosing interval of mostly every 3 or 4 weeks. A total of 23.8% of patients discontinued treatment, mainly due to AEs and/or ineffectiveness. Thymus- and activation-related chemokine and eosinophil levels showed a statistically significant decrease and remained low over time,” they added. 

SOURCE:

The study was led by Celeste M. Boesjes, MD, of the National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands. It was published online on August 7, 2024, in JAMA Dermatology. 

LIMITATIONS:

Limitations included the observational design and the lack of a control group. The relatively short follow-up period for pediatric patients and varying follow-up times for all participants could have affected the generalizability of the findings. Self-reported data for some outcomes may have introduced reporting bias. 

DISCLOSURES:

This study did not receive any funding. Boesjes received personal fees from AbbVie and Eli Lilly and Company outside this work. Several authors reported financial ties outside this work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.