Successful tapering of dupilumab in patients with atopic dermatitis with low disease activity: a large pragmatic daily practice study from the BioDay registry

Abstract

Background Limited data is available regarding patient-centered dosing of dupilumab for atopic dermatitis (AD) in daily practice. Objectives To evaluate our patient-centered dupilumab dosing regimen in daily practice, to assess prognostic factors for successful tapering and to estimate medication-related cost savings. Methods This prospective multicenter study included adult AD patients, participating in the BioDay registry, treated with dupilumab for ≥1.3 years. Interval prolongation was considered in case of dupilumab standard dose for ≥1 year and persistent controlled AD (Eczema Area and Severity Index (EASI)≤7); ≥six months). Primary endpoints were the mean EASI and Numeric Rating Scale (NRS)-pruritus after start of tapering. Prognostic factors for successful tapering were analyzed with logistic regression and a cost saving analysis was performed. Results A total of 595 patients were included, of which 401 patients (mean EASI 2.5 (SD 2.3)); NRS-pruritus of 2.4 (SD 1.9) at start tapering) prolonged dupilumab interval. In 83.3% of these patients tapering was successful; most patients used dupilumab every 3 or 4 weeks (Q3W/Q4W). A significant small increase was observed for EASI (highest mean 3.5) and NRS-pruritus (highest mean 3.2) (p<0.0001), however scores remained low. Predicting successful tapering showed non-significant odds ratios for all incorporated variables. The estimated cost saving was 3,977,033.98 EUR for 401 patients between January 2019-June 2022. Conclusions This study showed successful tapering of dupilumab in 83.3% of AD patients who attempted tapering while maintaining controlled disease and with the majority using Q3W/Q4W. Interval prolongation can be both beneficial for the patient and from a socio-economic perspective.

Extending dupilumab dosing intervals in atopic dermatitis: A prospective observational study in a South European tertiary hospital

“…Our persistence rate of 77.8% aligns with other real-world studies. 1,3 Although a minimum of 12 months of therapy with dupilumab before spacing is common, we had success in a patient after just 9 months. 1,3 The immunological basis for tapering dupilumab has been demonstrated: Q4W dosing maintains undetectable IL-4Rα despite a decrease in serum dupilumab concentrations.…”

“…1,3 Although a minimum of 12 months of therapy with dupilumab before spacing is common, we had success in a patient after just 9 months. 1,3 The immunological basis for tapering dupilumab has been demonstrated: Q4W dosing maintains undetectable IL-4Rα despite a decrease in serum dupilumab concentrations. 5 Tapering can also be performed to manage refractory adverse effects such as PFE or conjunctivitis.…”

“…Recently, the possibility of extending intervals to every 3 (Q3W) or 4 weeks (Q4W) has been discussed, with clinical and pharmaco-economic benefits. [1][2][3][4] We conducted a prospective observational study at an AD referral centre to evaluate the persistence rate of tapering dupilumab. Patients with moderate-to-severe AD treated with Q2W dupilumab were tapered to Q3W or Q4W based on clinical decision.…”

Dose tapering of dupilumab in patients with persistently controlled atopic dermatitis: a Spanish multicenter cohort study

“…1,2 Dupilumab, a monoclonal antibody against IL-4 receptor a, is approved for adults with AD at a loading dose of 600 and 300 mg every 2 weeks (Q2W). [1][2][3][4][5] Currently, there is no consensus about dupilumab dose reduction in well-controlled disease, though real studies suggest it might maintain efficacy. 1,[3][4][5] The objective of this retrospective cohort study was to describe the characteristics of AD patients on dupilumab doses spaced for controlled disease.…”

“…[1][2][3][4][5] Currently, there is no consensus about dupilumab dose reduction in well-controlled disease, though real studies suggest it might maintain efficacy. 1,[3][4][5] The objective of this retrospective cohort study was to describe the characteristics of AD patients on dupilumab doses spaced for controlled disease. BMI, body mass index; IQR, interquartile range.…”