Dupilumab Drug Survival Rates Superior to Those for Upadacitinib and Tralokinumab in Atopic Dermatitis: Large-Scale, Real-World Data
A first large-scale comparison of length of treatment with advanced AD therapies also identified reasons for discontinuation and examined prior use of biologics and JAK inhibitors.
Dupilumab for treatment of individuals with moderate-to-severe atopic dermatitis (AD) demonstrated higher drug survival (DS) rates at 12 and 24 months compared with upadacitinib and tralokinumab, in that order, according to findings of a new retrospective multicenter analysis published online February 6 in the Journal of the European Academy of Dermatology and Venerology.
The comparative study of individuals aged 12 years and older diagnosed with AD across 16 dermatology centers throughout western Europe is one of the first large-scale real-world investigations of DS across treatments for AD, research on which is described as “scarce” by first author Tiago Torres, MD, PhD, professor of dermatology at the Instituto de Ciências Biomédicas Abel Salazar, University of Porto and colleagues. DS is defined for the study as “duration of time an individual remains on treatment before discontinuation” a measure Torres et al stress is important to understand long-term effectiveness, safety and adherence of a specific treatment. The rapid progress in research and development of biologic agents and Janus kinase (JAK) inhibitors, for example, and the potential for an ever-broader range of treatment options choice to increase mean that comparative outcomes will become increasingly important.2
Cohort members were treated with 1 of the 3 medications between October 2017 and March 2023, according to the study. Across medication groups the mean participant age was 42.2 years and mean disease duration was 22 years. Researchers documented 2,038 treatment courses of which 75.9% were for dupilumab, 15.8% for upadacitinib, and 8.3% for tralokinumab. At 12 and 24 months, the team reported, DS rates were, respectively:
- Dupilumab: 92.9% and 86.3%
- Upadacitinib: 90.2% and 78.7%
- Tralokinumab: 78.1% and 66.8%
After multivariate analysis, Torres et al confirmed, dupilumab remained superior for DS.
DS and Previous Therapy. Among participants naïve to both biologics and JAK inhibitors, the rankings for DS remained the same, led at the 12- and 24-month points by dupilumab (93.1% and 86.6%), followed by upadacitinib (92.0% and 89.2%) and tralokinumab (84.6% and 66.0%).
Participants treated with tralokinumab were more likely to have previously received a JAK inhibitor (7.1% vs 2.0% for dupilumab and 2.2% for upadacitinib; P <.001), while prior treatment with a biologic was highest in the upadacitinib cohort (44.1% vs 0.7% for dupilumab and 28.7% for tralokinumab; P <.001).
Discontinuation.The primary reason for discontinuation was perceived lack of efficacy, according to the authors, with more participants treated with tralokinumab claiming the failure (11.2%) compared with dupilumab (5.6%) or upadacitinib (2.8%). Adverse event-related discontinuation was highest for upadacitinib (5.6%) compared with dupilumab (3.4%) and tralokinumab (2.9%). Torres et al also found an increased risk of treatment discontinuation across drugs associated with male sex.
At study baseline, the mean Eczema Area and Severity Index (EASI) scores were highest for participants treated with dupilumab (24.3 ± 14.3) compared with tralokinumab (21.6 ± 10.9) and upadacitinib (17.1 ± 11.5) (P <.001), according to the study.
The researchers also documented the prevalence of atopic comorbidities, ie, allergic rhinitis, asthma, allergic conjunctivitis and food allergy and reported the lowest baseline rate in the dupilumab-treated cohort (30.8%) and highest among those treated with upadacitinib (54.3%); the rate of comorbidity for tralokinumab-treated participants was 38.8% (P <.001)
Among the study’s limitations the authors point to the retrospective design, sample heterogeneity, and smaller number of participants receiving tralokinumab at 12 months. They conclude, however, that the “study highlights the high survival rates of all drugs after 2 years of treatment.”
