Dupilumab has a longer drug survival compared with cyclosporin in patients treated for moderate to severe atopic dermatitis (AD), researchers reported in a study published in Dermatologic Therapy.
Their retrospective study included 251 patients with moderate to severe AD and who were treated with dupilumab or cyclosporin from January 1, 2019, to April 30, 2020 at an outpatient clinic. A total of 149 patients (mean age, 44.8 ± 18.6; 59.7% men) received dupilumab, and 102 patients (mean age, 42.5 ± 17.5; 56.9% men) received cyclosporin. The investigators sought to analyze drug survival of dupilumab compared with cyclosporin, the reasons for drug discontinuation, and the predictive parameters of drug survival.
At 16 months, 82% of patients who received dupilumab were still taking the drug vs 11% of those treated with cyclosporin. The reasons for withdrawing from dupilumab were primary inefficacy in 4.7% of patients, persistent clinical remission in 7.4%, and cutaneous adverse effects in 2.6%. Older age at diagnosis and shorter AD duration predicted shorter dupilumab survival.
The reasons for cyclosporin withdrawal included adverse effects in 23.5% of patients, persistent clinical remission in 15.6%, and minimal or absent improvement in 11.7%. Adverse events included poor tolerability, elevation of blood pressure, renal dysfunction, and alterations in laboratory tests.
“Dupilumab exhibited a much higher survival compared to cyclosporin, which was burdened with a more frequent and faster withdrawal,” stated the study authors. “Only a limited number of dupilumab patients discontinued treatment due to adverse effects and/or ineffectiveness.”
Cyclosporin had a faster efficacy than dupilumab, with most patients achieving a significant clinical improvement in the first month. After 4 months of treatment, however, the efficacy of the 2 drugs was similar.
The study’s limitations included its retrospective design and the limited sample size.
“Our data support the safety and long-term efficacy of dupilumab in patients with AD,” the researchers commented. “Interestingly enough, the main reason for dupilumab discontinuation was the achievement of a stable clinical remission, and minimal or absent improvement. Patients who interrupted dupilumab had an older age at the diagnosis and shorter disease duration.”
Dal Bello G, Maurelli M, Schena D, Girolomoni G, Gisondi P. Drug survival of dupilumab compared to cyclosporin in moderate-to-severe atopic dermatitis patients [e-pub ahead of print]. Dermatol Ther. doi: 10.1111/dth.13979