Real-World Use of Dupilumab for Atopic Dermatitis Shows Support

The real-world efficacy of dupilumab for the treatment of atopic dermatitis (AD) found support from results of a meta-analysis published in the Journal of the American Academy of Dermatology. No new safety signals were observed in the literature. The most common adverse event (AE) was conjunctivitis.

The authors reviewed PubMed and Embase for observational studies published from inception through October 2019 on the efficacy and safety of dupilumab in patients with AD. Primary outcomes were mean percentage reduction in Eczema Area and Severity Index (EASI) from baseline and percentage of patients achieving 50%, 75%, and 90% reduction in EASI score (EASI50, EASI75, EASI90, respectively). The study authors also captured AEs and considered events reported by more than 1% of patients in 3 or more studies “common” AEs.

The study authors included data from 22 unique studies in analyses, comprising a pooled cohort of 3303 patients. Studies were from Asia (n=1), Europe (n=13), the Middle East (n=1), and North America (n=7). All studies were of good (n=6) or fair (n=16) quality according to the Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group. A total of 8 studies with 659 patients reported a mean percentage reduction in EASI. The weighted mean reduction was 54.1% (95% CI, 41.1%-67%) after 4 weeks; 71.9% (95% CI, 66.2%-77.6%) after 12 weeks; and 69.6% (95% CI, 60%-79.2%) after 16 weeks.

At week 16, the percentages of patients achieving EASI50, EASI75, and EASI90 were 85.1% (95% CI, 80.3%-89.2%), 59.8% (95% CI. 53.9%-65.7%), and 26.8% (95% CI, 20.2%-33.8%), respectively. All studies reported AEs. The most common AE was conjunctivitis, which occurred in 26.1% (95% CI, 17.8%-35.4%) of the pooled cohort. Blepharitis, keratitis, and overall ocular disease were also frequently reported. Rarer AEs included herpes simplex virus, facial redness, alopecia, and arthralgia.

As study limitations, the authors noted that follow-up was short-term (<20 weeks) in almost all studies. In addition, the majority of studies were conducted in North America and Europe, which may limit data generalizability.

The meta-analysis revealed efficacy rates similar to those reported in other studies. The investigators observed no new safety signals; however, the frequency of conjunctivitis may necessitate close monitoring of the eyes in patients beginning dupilumab. “Real-world data show that dupilumab is a successful and well-tolerated therapy for AD… [but] there is a continuous need for registries to monitor common and uncommon serious AEs,” the investigators wrote.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry.

Please see the original reference for a full list of authors’ disclosures.

Reference

Halling AS, Loft ND, Silverberg JI, Guttman-Yassky E, Thyssen JP. Real-world evidence of dupilumab efficacy and risk of adverse events: a systematic review and meta-analysis [published online August 18, 2020]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2020.08.051