The high rate of persistence found in the real-world study indicates dupilumab was well tolerated and patients were satisfied with its effectiveness.
In 2017, dupilumab was approved for use in patients with moderate to severe atopic dermatitis (AD) that is not adequately controlled by topical therapies based on results in clinical trials. However, little has been known about how dupilumab performs in a real-world setting.
A retrospective cohort study of 1963 adults with AD found that persistence on dupilumab remained high at 12 months, indicating patient satisfaction with the therapy. The findings were published in Annals of Allergy, Asthma & Immunology.
“Discontinuation of treatment may contribute to poor patient outcomes and increase health care resource utilization and costs, but persistence itself may be dependent on both the effectiveness and tolerability of the drug,” the authors explained.
They used data from the 2016-2018 IBM MarketScan Commercial and Medicare supplemental databases to identify patients who started using dupilumab between March 28, 2017, and March 31, 2018. A total of 3187 patients were identified, but only 1963 met the study inclusion criteria. The mean (SD) age was 42.1 (15.7) years, and 50.7% of the patients were women. Half (49.8%) of patients had 1 or more atopic comorbidity, such as chronic spontaneous urticaria (37.8%), allergic rhinitis (34.7%), and asthma (26.5%).
During the 12 months or more prior to dupilumab initiation, patients were commonly treated with a variety of therapies for their AD. The most common treatments were topical corticosteroids (81.6%), followed by systemic corticosteroids (72.5%) and systemic immunosuppressants (22.8%). Furthermore, 45.0% of patients were given pain medications, 14.95% sleep medications, and 54.1% other psychotropic drugs.
“In AD, psychological distress can reach levels that are clinically relevant and may be so severe that drug treatment and even psychiatric hospitalization may be warranted,” the authors explained. “Moreover, the use of these medications is likely related to sleep problems and pain, which are common complaints among patients with AD.”
On average, patients were followed for an average of 314.5 days after they initiated dupilumab. Persistence was 91.9% (95% CI, 90.7%-93.2%) at 6 months and 77.3% (95% CI, 75.0%-79.7%) at 12 months. A total of 329 patients discontinued dupilumab, but 78.8% actually reinitiated treatment within 116.2 days, on average, of the date of discontinuation. When the analysis allowed for a 45-day grace period, the overall persistence rate was 92.4% (95% CI, 91.2%-93.6%) at 6 months and 83.2% (95% CI, 81.2%-85.2%) at 12 months.
The study population included patients who were early initiators of dupilumab, which may indicate that they had more severe disease. The authors noted that this may reduce the generalizability of the results—persistence may be different in a more diverse population of patients.
“When comparing with 12-month persistence with biologics used to treat psoriasis, the high level of persistence with dupilumab at 12 months suggests that dupilumab is well tolerated and that patients are satisfied with its effectiveness and frequency of administration for the management of their AD,” the authors concluded.
Silverberg JI, Guttman-Yassky E, Gadkari A, et al. Real-world persistence with dupilumab among adults with atopic dermatitis. Ann Allergy Asthma Immunol. 2020;S1081-1206(20)30517-2. doi:10.1016/j.anai.2020.07.026