Dupilumab Shows Higher 2-Year Drug Survival Than Other Targeted Therapies for Atopic Dermatitis

Real-world data from a large Dutch registry suggest that dupilumab is associated with higher 2-year drug survival compared with other biologics and Janus kinase inhibitors (JAKi) used to treat adults with atopic dermatitis (AD), according to findings published in Allergy.

In an analysis of treatment episodes from the prospective BioDay registry, investigators found that dupilumab demonstrated superior overall drug survival across biologic- and JAKi-naïve and treatment-experienced patient subgroups, with discontinuation most commonly driven by lack of effectiveness rather than adverse effects.

The open-label, multicenter analysis included adults aged 18 years or older with AD who were treated in routine clinical practice with dupilumab, tralokinumab, abrocitinib, baricitinib, or upadacitinib between January 2021 and October 2024. The study period was selected to ensure that at least one alternative targeted therapy to dupilumab was available.

Drug survival, defined as time to treatment discontinuation, was used as a real-world proxy for treatment effectiveness and safety. Kaplan–Meier analyses and multivariable Cox regression models were used to compare therapies and identify predictors of discontinuation. Patients who discontinued treatment because of pregnancy wish, well-controlled disease, or loss to follow-up were censored.

A secondary analysis examined dupilumab treatment episodes dating back to 2017 to assess how the availability of alternative targeted therapies influenced drug survival over time.

Key Results: Drug Survival at 1 and 2 Years

The analysis included 865 dupilumab, 227 tralokinumab, 144 abrocitinib, 106 baricitinib, and 241 upadacitinib treatment episodes.

Among biologic- and JAKi-naïve patients, 2-year drug survival rates were:

• Dupilumab: 77.3%
• Tralokinumab: 47.6%
• Abrocitinib: 27.1%
• Baricitinib: 42.8%
• Upadacitinib: 63.5%

Drug survival was consistently lower among biologic- or JAKi-experienced patients, with 2-year survival rates of 68.1% for dupilumab, 49.6% for tralokinumab, 27.8% for abrocitinib, 22.4% for baricitinib, and 49.4% for upadacitinib.

Comparative Effectiveness and Predictors of Discontinuation

Multivariable analyses demonstrated significantly higher overall drug survival for dupilumab compared with tralokinumab, abrocitinib, baricitinib, and upadacitinib in most comparisons. The difference between dupilumab and upadacitinib was not statistically significant among treatment-naïve patients after correction for multiple testing.

Across the cohort, treatment discontinuation was most frequently attributed to ineffectiveness, accounting for 20.6% of treatment episodes, followed by adverse effects in 13.7%. At the time of discontinuation for ineffectiveness, nearly all patients had persistent moderate disease activity based on Eczema Area and Severity Index scores greater than 7 and/or Numeric Rating Scale scores for pruritus greater than 4.

Adverse effects leading to discontinuation differed by drug class. Ocular surface disease was most commonly reported with biologics, whereas infections were the most frequent adverse events associated with JAK inhibitors.

Higher baseline pruritus scores and concomitant immunosuppressant use were associated with shorter dupilumab drug survival. Older age was associated with longer drug survival among patients treated with baricitinib.

Impact of New Targeted Therapy Availability

In the secondary analysis, the introduction of additional targeted therapies was associated with a significant decline in dupilumab drug survival. Despite this reduction, dupilumab maintained higher overall drug survival compared with other targeted therapies across most patient subgroups.

Investigators noted that treatment availability itself appeared to influence drug survival outcomes, suggesting that both physician and patient preference play a role in real-world treatment persistence.

The findings provide comparative real-world evidence on treatment persistence among biologics and JAK inhibitors used for moderate-to-severe AD. According to the authors, drug survival analyses may help inform personalized treatment selection as the number of targeted therapies continues to expand.

Reference: van der Gang LF, Boesjes CM, Zuithoff NPA, et al. Drug survival in atopic dermatitis: Comparison of biologics and JAK inhibitors in the BioDay registry. Allergy.