Drug Survival, Retention, and Persistence of Dupilumab in Adults and Adolescents with Atopic Dermatitis: A Narrative Literature Review

Abstract

Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin condition that can have a negative impact on a patient's quality of life. Long-term effectiveness is required to manage the symptoms of AD (skin inflammation, eczematous lesions, and itching). Because some of the systemic immunosuppressants used to treat AD have been associated with serious adverse events (AEs), other safer, more effective options, including dupilumab, have been proven effective long-term for treatment of adult and adolescent patients with moderate-to-severe AD. The long-term safety and effectiveness of a drug are usually confirmed in real-world studies by evaluating its performance over time. Measures such as drug survival, drug retention, drug persistence, or retention rates reflect whether treatment may be considered as satisfactory by both patients and physicians, meeting key clinical needs. This review aimed to describe the survival, retention, or persistence of dupilumab therapy in adults and adolescents with moderate-to-severe AD by conducting a PubMed search in March 2023 and screening for relevant publications. Globally, real-world studies with dupilumab have regularly reported high drug survival rates after 1, 2, and 3 years of observation, being consistently at 80-90%, with low rates of treatment discontinuation due to lack of efficacy or AEs. These findings are notably higher than 1- and 2-year drug survival rates of systemic immunosuppressants (including cyclosporine [37% and 20%, respectively] and methotrexate [41% and 33%, respectively]). Overall, real-world data on drug survival have confirmed that dupilumab provides long-term sustained efficacy and acceptable safety in patients with moderate-to-severe AD.

Keywords: Atopic dermatitis; Drug survival; Dupilumab; Persistence; Retention.

Fig. 1

a Dupilumab drug survival in the overall population and in patients who discontinued because of ineffectiveness or adverse effects over 3.5 years in the BioDay registry study in 715 patients with moderate-to-severe atopic dermatitis (AD) [47]. Reproduced with permission from [JAMA Dermatology, Dupilumab drug survival and associated predictors in patients with moderate to severe atopic dermatitis long-term results from the Daily Practice BioDay registry. 2022. 158(9):1048–1056]. Copyright^©(2022) American Medical Association. All rights reserved. b Comparative drug survival rates for systemic and biologic treatments according to Kaplan–Meier analysis at 20 months in 240 patients with AD in a Spanish retrospective study [46]. Reproduced from Pereyra-Rodriguez JJ, Domínguez-Cruz J, Ruiz-Villaverde R, Silvestre JF, Galán M, Curto L, Figueras I, Serra-Baldrich E, Armario-Hita JC. Drug survival of systemic and biological treatments for moderate-to-severe atopic dermatitis in adults: a multicenter retrospective observational study, Br J Dermatol, 2021, 184, 1, 175–176, by permission of Oxford University Press