Dupilumab treatment in patients with atopic dermatitis: a comparative cohort study between the Netherlands and Japan shows a discrepancy in patient‐reported outcome measures

Abstract

Background Dupilumab was equally effective among all racial subgroups in clinical trials, but a direct comparison in daily practice is lacking. Objectives To investigate the effectiveness of dupilumab in patients with atopic dermatitis (AD) in the Netherlands and Japan over 80 weeks of treatment. Methods A longitudinal comparative cohort study was conducted in patients with AD who were treated with dupilumab in daily practice. We used linear mixedeffects models to determine changes over time. Results We found statistically significant differences in sex, disease onset, body mass index and therapeutic history between Dutch (n = 208) and Japanese (n = 153) patients. The baseline Eczema Area and Severity Index (EASI) score was higher in Japanese patients (23Á8 vs. 14Á8), while baseline Patient-Reported Outcome Measures (PROMs) were higher in Dutch patients. EASI scores decreased quickly to a level indicating 'mild disease' (EASI < 7), and remained low in both countries. However, PROMs showed different trajectories with better scores in Japan. Conclusions Dupilumab showed significant, comparable and sustained improvement of EASI scores in Japanese and Dutch patients. However, we found striking differences in the effect on PROMs between the countries, with a better outcome in Japanese patients.What is already known about this topic?• In clinical trials, dupilumab was found to be equally effective among all racial subgroups; however, a direct comparison in daily practice between patients with atopic dermatitis (AD) in Japan and the Netherlands is currently lacking.• Although phenotypical and immunological differences between races are described for AD, literature about the racial differences in coping mechanisms and the perception of disease in AD is lacking.What does this study add?• This study showed a significant improvement of disease severity in both Japanese and Dutch patients with AD during dupilumab treatment in daily practice.• In addition to racial disease-specific differences, healthcare system-or culturerelated characteristics might contribute to differences in physician-and patientreported outcome measures (PROMs) between countries.

Impact on health‐related quality of life and symptoms of anxiety and depression after 32 weeks of Dupilumab treatment for moderate‐to‐severe atopic dermatitis

“…In turn, this finding suggests that annoying symptoms of the disease should not be neglected or overlooked even in the face of low EASI and SCORAD scores, confirming the need to consider patient‐reported outcome measures (PROMs) to understand fully the patient's overall experience of the disease. The recent findings about discrepancy in PROMs betterments among culturally different AD populations treated with Dupilumab, in face of comparable improvements in EASI scores, 35 are in line with what is stated here.…”

Similarities and Differences in the Perception of Atopic Dermatitis Burden Between Patients, Caregivers, and Independent Physicians (AD-GAP Survey)

“…Physicians also underestimated the overall impact of AD on their patients’ QoL, with physicians estimating that 12–14% of their patients with moderate-to-severe AD had no QoL impact, compared with only 2–3% of patients indicating no QoL impact. In a previous study, patients reported that physicians sometimes underestimated the physical and emotional impact of AD on their well-being [ 35 ]. This is in line with a meta-analysis of nine studies in adults [ 36 ] and a more recent study that reported that physicians underestimated the QoL of children/adolescents with inflammatory bowel disease [ 14 ].…”

Long-term Remission of Atopic Dermatitis after Discontinuation of Dupilumab

“…In Japan, patients typically pay 30% of their medical expenses. A previous study reported that financial considerations were one of the primary reasons for discontinuation of DUP in Japanese patients ( n = 11/13) ( 2 ). However, the prognosis after discontinuation of DUP is unclear.…”