Dupilumab Most Common Treatment for Atopic Dermatitis Among New Systemic Therapy Users

Maria Schneeweiss, MD

New findings suggest that dupilumab was the most widely used agent among new users of a systemic treatment for atopic dermatitis (AD), surpassing all conventional systemic drug use.

From its introduction in 2017 until the end of the study in 2021, the rate of use increased from 71.6% to 83.7%. The study data additionally show 92% of patients who started dupilumab in 2020-2021 had received no other systemic treatments before.

“Our study found that a majority of patients who initiated dupilumab, were still receiving dupilumab at 90 days and beyond,” wrote study author Maria Schneeweiss, MD, Division of Pharmacoepidemiology, Department of Medicine and Department of Dermatology, Brigham and Women’s Hospital and Harvard Medical School. “This is in line with clinical trials that showed that patients experienced improvement in symptoms with dupilumab, starting at 8 weeks, with maximum effect around 12 weeks.”

Dupilumab is a human monoclonal IgG4 antibody that binds interleukin (IL)-4 receptor alpha and the first systemic drug approved for treatment of AD. Although clinical trials have reported significant improvement with its use, there is a lack of real-world data to examine how dupilumab is being utilized in the context of off-label systemic medications.

The goal of the current study was to describe patterns of prescribing, switching and discontinuing systemic AD drugs, before and after the approval of dupilumab and to understand factors associated with dupilumab prescription.

Investigators used commercial United States insurance claims data to identify patients with AD over 18 years of age who had filled at least 1 prescription for a topical agent (topical corticosteroid, calcineurin inhibitor, or PDE-4 inhibitor) in the time period beginning 365 days before starting a systemic treatment for AD. Two cohorts were thus created, including the systemic therapy cohort and the dupilumab cohort.

They additionally used logistic regression to determine factors associated with dupilumab prescription in patients who initiated a systemic therapy for AD between March 2017 and February 2018 (dupilumab approval) and between March 2019 and February 2020 (two years after dupilumab approval).

The number of patients with AD who initiated systemic therapy was 219 in the 2015-2016 cohort to 1,358 after dupilumab approval in 2019-2020.

Among the 536 patients who initiated systemic therapy for AD in 2017-2018, methotrexate use dropped to 9.7%, making dupilumab the most prescribed initial therapy (62.1%), with an additional 10% starting the therapy in combination with a systemic glucocorticoid.

Data show the proportion of patients who filled a prescription for dupilumab alone was 66.2%, 60.8%, and 54.4% at 90, 180, and 365 days after cohort entry. The proportion of patients who discontinued all systemic treatment at one year was 35%.

Two years after approval, dupilumab continued to be the most prescribed treatment with 78% using dupilumab alone and an additional 5.8% using it in combination with systemic glucocorticoids. The proportion of patients who discontinued treatment at one year was 36%, according to the data.

The use of dupilumab as the initial systemic therapy for AD increased from 62% to 78% between the year it was approved in 2017-2018 to 2 years after its approval in 2019-2020. Individuals under 60 years of age were more likely to be prescribed dupilumab, as were those previously treated with topical steroid-sparing AD agents.

The study, “Use patterns of systemic immunomodulators in the United States before and after dupilumab approval in adults with atopic dermatitis,” was published in Pharmacoepidemiology & Drug Safety.