Among patients with moderate to severe atopic dermatitis (AD) treated with dupilumab, 88.6% and 76.1% continued treatment 1 and 2 years after initiation, respectively, according to study results published in the Journal of Dermatological Treatment.
Researchers assessed the drug survival rate associated with dupilumab treatment up to 2 years, and the clinical, demographic, and predictive factors affecting treatment persistence in a retrospective study among adults with moderate to severe AD.
Eligible patients had been treated with dupilumab for 16 weeks or longer and were referred to 7 dermatologic outpatient clinics in Italy from January 2019 to August 2021. Treatment discontinuation was defined as interruption longer than 2 months.
The study included 659 adult patients (mean age, 42.8±19.90 years; 52.3% male). At treatment initiation, the mean (SD) Eczema Area Severity Index (EASI) score was 28.0 (6.7), mean itch Numeric Rating Scale score was 8.2 (1.9), and mean Dermatology Life Quality Index score was 15.9 (7.5).
Start and end data on dupilumab treatment were available for 580 patients, of whom 115 (19.8%) discontinued dupilumab therapy. The primary reason for discontinuation was inefficacy (29.6%), followed by failed compliance (17.4%), stable efficacy (20.8%), and adverse events (AEs; 7.8%). Among the AEs leading to treatment discontinuation, ocular AEs (xerosis, conjunctivitis) accounted for 55.6% and injection site AEs accounted for the remainder.
Dupilumab discontinuation occurred significantly more frequently in adult patients with AD (18 years and older; 24.2%) vs those with early-onset disease (younger than 18 years; 15.1%; P =.008).
Mean (SD) treatment duration was 23.3 (16.8) months. Overall, the researchers reported that 88.6% (95% CI, 85.5%-91.1%) and 76.1% (95% CI, 70.8%-80.7%) of patients continued to receive dupilumab at 12 and 24 months, respectively. The cumulative probability of drug survival considering discontinuation resulting from AEs or ineffectiveness was 95.0% (95% CI, 92.6%-96.6%) at 12 months and 90.0% (95% CI, 86.1%-92.9%) at 24 months.
In the multivariate analysis, disease severity as measured by absolute EASI score during the last follow-up visit was the only factor predictive of overall drug discontinuation, with a 13% increased likelihood of treatment discontinuation for each unit increase in the EASI score (hazard ratio [HR], 1.13; 95% CI, 1.104-1.166; P <.0001). A similar trend occurred with drug discontinuation for ineffectiveness and AEs (HR, 1.17; 95% CI, 1.123-1.223; P <.0001).
Limitations of the study include its retrospective design; recent introduction of new drugs for treatment of moderate to severe AD, which could affect replicability of the findings; and financial constraints for patients in underdeveloped countries.
“The introduction of dupilumab filled an unmet therapeutic need in AD by providing prolonged effectiveness and tolerability that could not be achieved with previous conventional therapies,” the researchers concluded. “However, further research on the role of age and disease chronicity as well as on other potential predictive factors for treatment discontinuation is required to optimize and tailor the therapeutic approach to AD.”
Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
This article originally appeared on Dermatology Advisor
Gori N, Sernicola A, Tolino E, et al. Analysis of predictive factors influencing dupilumab continuation rate in adult patients with atopic dermatitis: results from an Italian multicenter study. J Dermatolog Treat. Published online July 3, 2023. doi:10.1080/09546634.2023.2230685