Good drug survival seen with dupilumab in atopic dermatitis

Dupilumab had good overall survival for up to 3 years in patients with atopic dermatitis, according to a study.

“Dupilumab is a monoclonal antibody that targets the interleukin (IL)-4 receptor subunit alpha (IL-4Ralpha). This results in the blocking of signaling of T2 cytokines, IL-4 and IL-13, and consequently the inhibition of the Th2 pathway,” Lotte S. Spekhorst, MD, of the National Expertise Center for Atopic Dermatitis and the department of dermatology and allergology at the University Medical Center Utrecht in the Netherlands, and colleagues wrote. “Overall, the clinical efficacy and safety of dupilumab have been demonstrated in clinical trials for the treatment of patients with AD. In these clinical trials, efficacy of dupilumab was investigated under ideal and controlled circumstances in selected patients, and therefore, results are hard to generalize to daily practice.”

Researchers conducted a cohort study of 715 patients with AD using data from the multicenter prospective daily practice BioDay registry. All patients received a dupilumab loading dose of 600 mg, followed by 300 mg injections every other week for the first year.

Tapering doses was considered for patients who had well-controlled disease or severe effects.

Using Kaplan-Meier survival curves, the trial organizers analyzed drug survival and detailed three drug survival events: discontinuation in overall drug survival, discontinuation due to ineffectiveness and discontinuation due to adverse events.

Drug survival of 1 year, 2 years and 3 years was 90.3%, 85.9% and 78.6%, respectively.

Shorter drug survival was associated with adverse effects, with use of immunosuppressive therapy at baseline, older age and severe disease being independent risk factors.

Discontinuation due to ineffectiveness was reported in 2.5% of patients, while 4.2% discontinued due to adverse effects. A combination of the two was responsible for 0.8% of discontinuations.

“In this daily practice cohort study, results demonstrate a good overall 1-year, 2-year and 3-year drug survival of dupilumab,” the authors wrote. “In the coming years, daily practice registry data will provide longer follow-up data of new advanced systemic treatments, which will give information on dupilumab drug survival compared with these new systemic treatments.”