Study Highlights Reasons for Discontinuation of Systemic Treatments for Atopic Dermatitis

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Approximately 40% of individuals with atopic dermatitis treated with systemic therapy would prefer to discontinue their treatment once their disease has become well-controlled, according to new findings, regardless of the type of medication.¹

These findings and others regarding patient preferences among those who seek to come off of systemic therapies were highlighted in ‘Treatment Preferences among Adult Patients with Atopic Dermatitis,’ an abstract that’s contents were released during the Revolutionizing Atopic Dermatitis Conference Mid-Year Virtual Update on December 8, 2024.

The investigative team was led in part by Catherine Z. Shen, BA. Shen and colleagues noted that new research assessing therapy cessation for this chronic inflammatory skin condition could allow for helpful insights into outcomes.² They noted that looking at disease progression, the likelihood of flares, and the ability to regain control following restarting treatment were all potentially valuable insights.

“Understanding the characteristics of patients on systemic therapy for [atopic dermatitis] who wish to come off treatment, and their reasons for doing would be helpful and could inform the design of future discontinuation studies that seek to answer this question,” Shen and colleagues wrote.¹

Background and Design

The investigative team explored various elements related to patients' treatment preferences and rationale for the discontinuing of systemic therapy. To determine such findings, the team carried out a cross-sectional analysis that was conducted from September 2023 - May 2024 at a tertiary dermatology center.

The researchers provided surveys to individuals who had a confirmed diagnosis of atopic dermatitis who were also undergoing systemic treatment. These surveys included a variety of questions designed to assess respondents' medical histories, demographic categories, use of different medications, severity of disease as measured by the Patient-Oriented Eczema Measure (POEM), and preferences in medication.

The investigators provided specific inquiries to survey respondents about dupilumab treatment in their questionnaire. Their analysis also involved the use of descriptive statistics for the purposes of summarizing the different variables, as well as logistic regression to evaluate factors which impact participants' willingness to discontinue dupilumab therapy.

Overall, the research team's study involved an assessment of 170 participants, with 56.5% being reported as female and 54.7% reported as White. The subjects also had a mean age of 49.4 years.

Additionally, the team highlighted that most of these individuals were being treated with a single systemic therapy and 61.2% were being given dupilumab.

Notable Findings

When they were surveyed about their preferences for treatment, 56.5% of the survey respondents noted a preference to continue with their current medication for the purposes of maintaining disease control. Only 38.8% were shown by the team to have a desire to end their current treatment after their condition had become well-managed.

In terms of preferences for different types, the investigators found that favoring oral options was noted by 53.5% of their study participants given their ease of use. They also reported that only 20% of the subjects preferred injectables, with most citing perceived effectiveness.

In 1 notable finding, the research team found that none of those being given oral therapies had a preference for injectables, yet 48.1% of individuals given injectables noted that they would like to switch to oral therapy.

Among those treated with dupilumab, 34.6% were found by the team to have a preference to continue using their medication, and 50% were shown to have a willingness to stop their medication. When looking at the major reasons for the desire to discontinue, these included achievement of well-controlled disease among 86.5% of subjects and concerns regarding long-term safety among 30.8%.

It was noted by the team that having a history of cancer was associated with subjects' likelihood of discontinuation desire. They also found that, in terms of factors linked to a lower likelihood, being female and having a prior history of seasonal allergies were the standout examples.

The researchers also reported that about 40% of those with atopic dermatitis on systemic drugs maintained a preference to stop their treatment once their disease is well-controlled, regardless of the type of medication.

“Understanding patient perspectives can help improve the shared decision-making process,” they wrote. “Results from our study will be used to inform future, qualitative studies that further evaluate treatment preferences among adults with [atopic dermatitis].”¹

References

1. ^{Shen C, Huang C, Giordano J, Fuxench X. Treatment Preferences among Adult Patients with Atopic Dermatitis. Presented as part of the 2024 Revolutionizing Atopic Dermatitis Mid-Year Virtual Update. December 8, 2024.}
2. ^{O'Mahony, R., et al., Withdrawal of disease-modifying antirheumatic drugs in patients with rheumatoid arthritis: a systematic review and meta-analysis. Ann Rheum Dis, 2010. 69(10): p. 1823-6.}