Dupilumab Least Likely to Be Discontinued in AD Patients

Marjolein de Bruin-Weller, MD

New data from an analysis of the European Observation Study in Patients Eligible for Systemic Therapy for Atopic Dermatitis (EUROSTAD) found that among current systemic treatments for moderate to severe atopic dermatitis, dupilumab was the least likely to be discontinued while cyclosporine and corticosteroids were primarily limited to episode flare management.

EUROSTAD is on ongoing observational study intended to describe characteristics of AD patients treated with systemic therapy over time in addition to the management of their disease.

The skin condition affects approximately 2-7% of adults worldwide, with the highest rates observed in Europe.

Investigators led by Marjolein de Bruin-Weller, MD, PhD, University Medical Center Utrecht, Utrecht, the Netherlands, detailed the patient characteristics, outcomes, and the median duration of the use of different systemic therapies from an interim 1-year analysis of EUROSTAD.

The Methods

With EUROSTAD, the intention was to enroll 500 patients at 51 sites across 10 European countries.

Eligible patients were 18 years and older and suited for systemic treatment who had started or switched to a new systemic treatment on day 1 or in the 30 days before enrollment.

Patients were intended to continue for 60 months with follow-up visits every 3-4 months. Despite this, the study would be terminated early due to the COVID-19 pandemic.

As such, the analysis included data at 12 months collected between March 2017 and April 2019.

Patients enrolled in EUROSTAD were analyzed for both clinical and patient-reported outcomes.

Clinicians assessed the disease status using the Investigator’s Global Assessment (IGA) scale and Eczema Area and Severity Index (EASI), while patient reported data included Peak Pruritus Numeric Rating Scale, Patient-Oriented Eczema Measure, Hospital Anxiety and Depression Scale, and sleep quality Visual Analog Scale.

Systemic therapy and changes in treatments were also documented.

The Findings

A total of 308 patients were included in the study with a mean age of 37 years and a mean duration of AD of 25 years.

Among these patients, 288 reported taking systemic medications; 42.7% patients received cyclosporine, 35.3% dupilumab, 28.1% methotrexate, 25.4% oral corticosteroids, 6.8% azathioprine, 6.1% injectable corticosteroids, and 3.4% mycophenolate.

The median duration of treatment was 1.1 months for oral systemic corticosteroids, 3.2 months for injectable corticosteroids, 4.8 months for cyclosporine, 7.3 months for methotrexate, and 14.9 months for dupilumab.

The most frequent reasons for stopping treatment included lack of efficacy, patient decision, adverse events, and disease well controlled.

Investigators noted that the reasons for starting and stopping treatment with cyclosporine and corticosteroids specifically were consistent with their use for acute flare management.

Regarding limitations of the study, they noted that it was an observational study with limited patient numbers and included young participants with high disease burden that did not represent all AD patients.

“However, we feel that real-world data collected in a practice setting, rather than a clinical trial, adds an additional source of data to inform physician treatment choices more reflective of everyday practice,” the team wrote. “EUROSTAD will continue to follow this patient cohort over time, allowing for more insight into ongoing treatment choices and disease course of patients with relatively severe AD in a real-world setting”

The study, "Use of systemic therapies in adults with atopic dermatitis: 12-month results from the European prospective observational study in patients eligible for systemic therapy for atopic dermatitis (EUROSTAD)," was published online in the Journal of Dermatological Treatment.