Dupilumab Shows Superior Drug Survival in Pediatric Atopic Dermatitis Treatment

Key Takeaways

• Dupilumab demonstrated higher 1-year, 2-year, and 3-year drug survival rates in pediatric atopic dermatitis than MTX and CsA.
• MTX and CsA had higher discontinuation risks due to ineffectiveness and adverse effects compared to dupilumab.
• Children aged 12 to 17 were more likely to discontinue treatment due to ineffectiveness and adverse reactions.

New research shows dupilumab was superior drug survival compared to methotrexate (MTX) and cyclosporine A (CsA) in pediatric patients with atopic dermatitis (AD), and with lower rates of treatment discontinuation.

The study, published in JAMA Dermatology, conducted across five tertiary centers in the Netherlands from 2013 to 2023, included 502 treatment episodes in 362 children aged 2-17. The analysis revealed that the 1-year, 2-year, and 3-year drug survival rates were 84.1%, 72.3%, and 62.0% for dupilumab; 60.7%, 39.3%, and 25.3% for MTX; and 43.9%, 21.5%, and 10.4% for CsA, respectively.  The primary reason for discontinuation in 35.5% of cases was ineffectiveness this predominantly affected CsA treatments. MTX and CsA had a higher risk of discontinuation due to ineffectiveness (HR = 4.45 and HR = 10.88, respectively) and adverse effects (HR = 4.39 and HR = 3.83, respectively) versus dupilumab. Patients between ages 12 and 17 had an increased likelihood of stopping treatment due to ineffectiveness (HR = 1.55) and adverse effects (HR = 2.39).

"This multicenter daily practice cohort study demonstrated a superior 1-year, 2-year, and 3-year overall drug survival for dupilumab, followed by MTX, with the lowest rates observed for CsA in pediatric patients with AD," the authors concluded. "This study also identified characteristics associated with discontinuation. These results provide insight into drug survival resulting from the effectiveness, safety, and tolerability of these systemic treatments in pediatric patients with AD and contribute to the optimization of patient outcomes."

Source: van der Rijst L, et al. JAMA Dermatology. 2024. Doi:10.1001/jamadermatol.2024.3717