Short-, mid- and long-term efficacy of dupilumab in moderate-to-severe atopic dermatitis: a real-world multicentre Italian study of 2576 patients
Authors: Ferrucci Silvia , Tavecchio Simona , Maronese Carlo Alberto , Balato Anna , Di Brizzi Eugenia Veronica , Ortoncelli Michela , Ribero Simone , Girolomoni Giampiero , Maurelli Martina , Fortina Anna Belloni , Caroppo Francesca , Naldi Luigi , Pezzolo Elena , Nettis Eustachio , Pugliese Francesco , Stingeni Luca , Hansel Katharina , Rubegni Giovanni , Calabrese Laura , Russo Filomena , Gola Massimo , Magnaterra Elisabetta , Rongioletti Franco , Mercuri Santo Raffaele , Paolino Giovanni , Savoia Paola , Veronese Federica , Foti Caterina , Ambrogio Francesca , Scalvenzi Massimiliano , Napolitano Maddalena , Patruno Cataldo , Dastoli Stefano , Corazza Monica , Borghi Alessandro , Calzavara-Pinton Pier Giacomo , Rossi Mariateresa , Offidani Annamaria , Radi Giulia , Bonzano Laura , Ferreli Caterina , Piras Viviana , Satta Rosanna , Sucato Federica , Malagoli Piergiorgio , Gaiani Francesca , Micali Giuseppe , Musumeci Maria Letizia , Fargnoli Maria Concetta , Esposito Maria , Grieco Teresa , Chello Camilla , Casazza Giovanni , Marzano Angelo Valerio 
Published: June 2024

Abstract

Background
The efficacy and safety of dupilumab in atopic dermatitis (AD) have been defined in clinical trials but limited real-world evidence on long-term treatment outcomes is currently available to inform clinical decisions.

Objectives
To describe the long-term effectiveness and safety of dupilumab up to 48 months in patients with moderate-to-severe AD.

Methods
A multicentre, retrospective, dynamic cohort study was conducted to assess long-term effectiveness and safety of dupilumab in patients with moderate-to-severe AD in a real-world setting. Predictors of minimal disease activity (MDA) optimal treatment target criteria [defined as the simultaneous achievement of a 90% reduction in Eczema Area and Severity Index score, itch-numeric rating scale (NRS) score ≤ 1, sleep-NRS score ≤ 1 and Dermatology Life Quality Index ≤ 1] were investigated.

Results
In total, 2576 patients were enrolled from June 2018 to July 2022. MDA optimal treatment target criteria were achieved by 506/2309 (21.9%), 769/1959 (39.3%), 628/1247 (50.4%), 330/596 (55.4%) and 58/106 (54.7%) of those that reached 4, 12, 24, 36 and 48 months of follow-up, respectively. Logistic regression revealed a negative effect on MDA achievement for conjunctivitis and food allergy at all timepoints. Adverse events (AEs) were mild and were observed in 373/2364 (15.8%), 166/2066 (8.0%), 83/1291 (6.4%), 27/601 (4.5%) and 5/110 (4.5%) of those that reached 4, 12, 24, 36 and 48 months of follow-up. Conjunctivitis was the most frequently reported AE during the available follow-up. AEs led to treatment discontinuation in &lt; 1% of patients during the evaluated time periods.

Conclusions
The high long-term effectiveness and safety of dupilumab were confirmed in this dynamic cohort of patients with moderate-to-severe AD, regardless of clinical phenotype and course (persisting or relapsing) at baseline. Further research will be needed to investigate the effect of T helper cell 2 comorbidities and disease duration on the response to dupilumab and other newer therapeutics for AD.