Five-year real-world drug survival of dupilumab in severe atopic dermatitis and associate predictors
Francesca Barei, Paolo Calzari, Luca Valtellini, Alessandra Chiei Gallo, Gabriele Perego, Simona Tavecchio, Martina Zussino, Angelo Valerio Marzano, Silvia Ferrucci
Abstract
Background Atopic dermatitis (AD) profoundly impacts patients’ lives, necessitating long-term systemic treatments.Methods This retrospective study involved 709 severe AD patients receiving dupilumab. Drug survival (DS) was analyzed using Kaplan-Meier curves, evaluating reasons for discontinuation. The log-rank test and Cox regression analysis were applied to assess differences in drug survival across baseline clinical characteristic groups.Results Dupilumab showcased remarkable overall drug survival, reaching 74.1% at 65 months. Survival rates remained robust even when considering discontinuation solely due to primary or secondary inefficacy (86.4% at 65 months). For overall DS, the log-rank test did not reveal a statistically significant difference among the groups. Cox regression analysis showed that patients with nummular eczema-like as a phenotype have an increased risk of discontinuing dupilumab due to the development of psoriasis (p < .001, hazard ratio = 26.15, confidence interval [CI] 6.903–99.016). The multivariate logistic regression analysis confirmed these results (p < .001, OD = 18.956, CI 4.205–85.458), even when considering other clinical and epidemiological characteristics.Conclusion This investigation establishes dupilumab’s enduring efficacy and safety in severe AD, emphasizing its potential as a sustained therapeutic option over 5+ years. Baseline characteristics did not seem to influence DS, with the exception of the nummular eczema-like phenotype, which emerged as a significant predictor of psoriasis occurrence.