Drug survival of dupilumab compared to cyclosporin in moderate‐to‐severe atopic dermatitis patients

Abstract

Dupilumab and cyclosporin are recommended treatments for moderate-to-severe atopic dermatitis (AD). The objective of this study was to investigate drug survival of dupilumab in comparison with CsA, reasons of drug discontinuation, and predictive parameters of drug survival in daily practice. Retrospective study including patients with moderate-to-severe AD treated with dupilumab or cyclosporin (CsA) from January 1, 2019 to April 30, 2020. Drug survival analysis was performed using the Kaplan-Meier method and predictive factors were analyzed using multivariate Cox regression analyses. Adult patients with AD (n = 251) treated with dupilumab (n = 149) or CsA (n = 102) were included. Sixteen months from baseline, 82% of patients receiving dupilumab were still on treatment vs 11% of those treated with CsA. Reason for withdrawing dupilumab were primary inefficacy in 4.7% of patients, persistent clinical remission in 7.4%, and cutaneous adverse effects in 2.0%. Older age at diagnosis and shorter AD duration predicted shorter dupilumab survival. Reasons for CsA withdrawal included adverse effects in 23.5% of patients, persistent clinical remission in 15.6%, and a minimal or absent improvement in 11.7%. Dupilumab has a longer drug survival compared to CsA. Only a limited number of dupilumab patients discontinued treatment due to adverse effects and/or ineffectiveness.

Drug survival rate of dupilumab in Japanese patients with atopic dermatitis

“…Four previous studies in Western countries disclosed that the drug survival rates for dupilumab in AD patients were 91% at 12 months, 82% at 16 months, 89% at 800 days (about 26 months), and 94% at 20 months, respectively 2‐5 . Our study in Japan showed almost the same tendency of high drug survival rates for dupilumab.…”

“…Dupilumab, a fully human monoclonal antibody which blocks signaling pathways of interleukin (IL)‐4 and IL‐13, was shown to be effective in treating patients with atopic dermatitis (AD) in daily practice 1 . There have been few studies on drug survival of dupilumab in AD patients in Western countries 2–5 . In this study, we investigated the drug survival rate of Japanese AD patients, reasons for drug discontinuation, and predictive parameters of drug survival.…”

“…1 There have been few studies on drug survival of dupilumab in AD patients in Western countries. [2][3][4][5] In this study, we investigated the drug survival rate of Japanese AD patients, reasons for drug discontinuation, and predictive parameters of drug survival. This retrospective study included patients with moderate to severe AD aged 15 years and older, prescribed dupilumab at Nippon Medical School from April 2018 to July 2019, and observed for 12 months.…”

A Literature Review of Real-World Effectiveness and Safety of Dupilumab for Atopic Dermatitis

“…In routine clinical practice, long-term effectiveness is related to persistence on therapy, which is generally defined as "the duration of time from initiation to discontinuation of therapy (Cramer et al, 2008)." Dal Bello et al (Dal Bello et al, 2020) and Silverberg et al (Silverberg et al, 2021a) reported high persistence of dupilumab in the real world, indicting patients' satisfaction with its effectiveness, tolerability, and treatment regimen. In some countries, there are still many patients who receive dupilumab injections at a clinic or hospital.…”

From Emollients to Biologicals: Targeting Atopic Dermatitis

“…In the absence of well-powered head-to-head trials comparing all possible combinations of systemic immunomodulatory treatments, a systematic review and network meta-analysis demonstrated that dupilumab and cyclosporine may have better short-term effectiveness than methotrexate and azathioprine for the treatment of AD in adults [ 93 ]. Retrospective studies have shown longer drug survival for dupilumab compared to cyclosporine in severe AD [ 94 , 95 ].…”