Background: Dupilumab is the first biologic registered for the treatment of moderate-to-severe atopic dermatitis (AD) and efficacy was shown in phase III clinical trials (primary outcome at week 16 was reached in 38% of patients). Currently, there is limited daily practice data on dupilumab available, especially when combined with systemic immunosuppressants.
Objective: To evaluate dupilumab treatment in daily practice in AD patients.
Methods: In this observational cohort study we prospectively included all adult AD patients treated with dupilumab in two University Hospitals in The Netherlands. Concomitant systemic immunosuppressive treatment was monitored. Physician-reported and patient-reported outcome measures (PROMs) of patients with ≥12 weeks of follow-up were analysed. We used a linear mixed-effects model to determine changes in scores during follow-up.
Results: Ninety-five patients were included of which 62 patients used systemic immunosuppressants at baseline, which were continued during dupilumab treatment in 43 patients. From baseline to 16 weeks of treatment, the estimated mean Eczema Area and Severity Index score (0 - 72) decreased from 18.6 (95%CI 16.0 - 21.4) to 7.3 (95%CI 5.4 - 10.0), and the estimated mean PROMs showed a decrease of 41 - 66%. Investigator Global Assessment 0 or 1 (clear/almost clear) was reached in 38% of the patients. Five patients discontinued dupilumab treatment due to side effects or ineffectiveness. Eye symptoms and orofacial (non-ocular) Herpes Simplex Virus (HSV) reactivation were reported in 62% and 8% of the patients, respectively.
Conclusion:Dupilumab treatment in daily practice shows a clinically relevant improvement of physician-reported scores and PROMs, which is in line with efficacy data from clinical trials. Besides frequently reported eye symptoms and orofacial (non-ocular) HSV reactivation, there were no apparent safety concerns.