Improving atopic dermatitis (AD) symptoms with dupilumab may decrease the need for attention-deficit/hyperactivity disorder (ADHD) management, according to a research letter published in Journal of the American Academy of Dermatology.
Researchers conducted a retrospective cohort study of validated International Statistical Classification of Diseases, Tenth Revision (ICD-10) codes using the TriNetXResearch Network database. They evaluated de-identified patients with ADHD and AD across 78 health care organizations from 2002 to 2022.
There were a total of 56,525 patients with concurrent diagnoses of ADHD and AD, of whom 754 were treated with dupilumab, and 55,771 were never treated with dupilumab. First diagnosis of ADHD and AD was defined as the index event for the nonexposed cohort. The initiation of dupilumab was defined as the index event for the exposed cohort, with follow-up for 1 to 5 years following the index event. The primary endpoint was use of nootropics and psychostimulants.
Following dupilumab exposure among all patients with AD vs those never on dupilumab, it was observed that a significant decrease in the 1- to 5-year incidence of nootropic and psychostimulant use for ADHD (relative risk [RR], 0.85; 95% CI, 0.75-0.96), and stratified by sex (women’s RR, 0.99; 95% CI, 0.84-1.16); (men’s RR, 0.75; 95% CI, 0.63-0.89).
Researchers noted nootropic and psychostimulant use decreased among all patients with ADHD and AD following initiation of dupilumab vs prior to initiation of dupilumab (RR, 0.72; 95% CI, 0.62-0.82), and stratified by sex (women’s RR, 0.77; 95% CI, 0.62-0.95); (men’s RR, 0.67; 95% CI, 0.54-0.84).
Study limitations include the retrospective study design, unevaluated treatment response to dupilumab, and possible misclassification by ICD codes.
Researchers concluded “Currently, no data supports dupilumab use for treatment of behavioral disorders. AD’s chronicity is associated with pruritus. Chronic itching is linked to insomnia and cognitive behavioral issues. Dupilumab improves both itch and sleep disturbances.”
Yildirim AM, Pradhan T, Zinn ZA. Dupilumab treatment for atopic dermatitis is associated with decreased utilization of psychostimulants for attention deficit hyperactivity disorder: a retrospective cohort study. J Am Acad Dermatol. Published online January 31, 2023. doi:10.1016/j.jaad.2023.01.025