Dupilumab Demonstrates Superior Long-Term Persistence Over Upadacitinib and Tralokinumab in Atopic Dermatitis

Dupilumab demonstrated superior long-term persistence as monotherapy compared to upadacitinib and tralokinumab in a real-world retrospective study of patients with severe atopic dermatitis (AD). The study, which analyzed data from 2015 to 2024, found that 88.7% of patients treated with dupilumab remained on monotherapy at both 12 and 24 months, compared to 66.4% and 16.9% for upadacitinib, and 59.3% and 19.4% for tralokinumab at those respective time points (log-rank P =.001).¹ The findings were presented as a poster at the 2025 American Academy of Dermatology meeting, being held March 7-11, in Orlando, FL.

The profile of adverse events linked with the systemic therapies used to treat AD may compromise their long-term use, and so also the drug survival and effectiveness. Study authors, led by Alba Vidal Ruiz, from the department of dermatology at the Virgen Macarena University Hospital, Seville, Spain, noted that research on the extended use of dupilumab, tralokinumab, and upadacitinib is limited, although the 2 monoclonal antibodies and the oral Janus kinase inhibitor, respectively, “offer promising prospects for sustained disease control.”¹

The study included 59 adults, half of them men, with a mean age of 36.1 years (95% CI, 6.40–65.82) and mean disease duration of 79.2 months (95% CI, 0–160.61). Most participants (66.1%) had concomitant atopic comorbidities, and the mean baseline Eczema Area and Severity Index (EASI) score was 25.6 (95% CI, 0–53.16). Dupilumab was the most frequently prescribed treatment (70%), followed by upadacitinib and tralokinumab, each prescribed in 15% of cases. The median follow-up period was 17.03 months.¹

Kaplan-Meier survival analysis revealed an overall monotherapy survival rate of 75.8% at 12 months and 67.8% at 24 months, with a median monotherapy survival of 104.03 months. The superior persistence of dupilumab in this study exceeded rates reported in previous literature, according to Ruiz and colleagues.¹ The authors cited data from by Pezzolo et al² that documented a 24-month persistence rate for dupilumab of 82.9%. The current study’s higher 88.7% rate may reflect the medication’s favorable safety profile and efficacy, authors wrote.¹

In contrast, persistence rates of upadacitinib were consistent with prior reports,³ which cite a 66.44% persistence rate at 48 weeks. Real-world persistence data on tralokinumab reflect shorter follow-up periods, Ruiz et al said.¹ The rates reported in the current study at 12 months of 59.3% were notably lower than the 85.9% reported at 52 weeks by Pezzolo et al.²

At 12 months, 49.2% of study participants achieved an EASI-50 response, though only 13.6% maintained this response at 24 months. The authors attributed the higher persistence of dupilumab again to its safety profile.¹ Clinical protocol at their university positions dupilumab as first-line for patients with atopic comorbidities, while upadacitinib and traalokinumab are generally reserved as second-line therapies. The authors noted that their findings suggest using tralokinumab or upadacitinib after dupilumab failure may not be an optimal strategy.¹

Ruiz and colleagues acknowledge several limitations to the study, including the retrospective design, which limited the ability to document adverse events and specific reasons for monotherapy discontinuation. They call for further prospective research to confirm their findings.

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References
1. Ruiz AV, Leiro AS, Gotarredona AS, et al. Treatment of atopic dermatitis in real clinical practice: drug survival in monotherapy. Poster presented at: 2025 American Academy of Dermatology Annual Meeting. March 7-11, 2025; Orlando, FL.
2. Pezzolo E, Rossi M, Caroppo F, Bianchelli T, et al. Long‐term drug survival of dupilumab and associated predictors in moderate‐to‐severe atopic dermatitis: A real‐world prospective cohort study. J European Acad Dermatol Venereol. 2023;37(6). doi:10.1111/jdv.18889
3. Dilla T, Valladares A, Lizán L, et al. Persistencia terapéutica: causas, consecuencias y estrategias de mejora. Atención Primaria. 2009 Jun;41(6):342–8. doi:10.1016/j.aprim.2008.09.031