Dupilumab impact on psychiatric and sleep disorder risk reduction in atopic dermatitis: A population-based cohort study

Abstract

Background: Patients with atopic dermatitis (AD) have a higher risk of developing psychiatric and sleep disorders.

Objective: To compare the risk of psychiatric and sleep disorders in patients with AD treated with dupilumab vs those on conventional drugs (systemic corticosteroids, methotrexate, cyclosporin, and azathioprine).

Methods: This retrospective cohort study used the TriNetX Global Collaborative Network (LLC, Cambridge, MA) and included adult patients with AD newly prescribed dupilumab (DUPI-cohort) or conventional drugs without previous dupilumab exposure (CONV-cohort). Propensity score matching was performed for age, sex, race, comorbidities, and laboratory measures. Risks of various psychiatric disorders, such as anxiety, depressive disorders, adjustment disorders, and attention deficit hyperactivity disorder, including sleep disorders, were compared between cohorts, with hazard ratios determined using Cox regression.

Results: After matching, both the DUPI- and CONV-cohorts included 6114 patients each, with an average age of 44 years and 53% female. The racial distribution in both cohorts was approximately 49% White, 15% Black or African American, and 12% Asian. During the 3-year follow-up, the DUPI-cohort had reduced risks of anxiety (hazard ratio 0.76, 95% CI 0.64-0.89), depressive disorders (0.70, 0.58-0.86), adjustment disorders (0.535, 0.37-0.78), and sleep disorders (0.78, 0.65-0.94), whereas the risk of attention deficit hyperactivity disorder was not significantly affected (0.92, 0.61-1.38). These findings were consistent across age groups, sexes, races, and atopic comorbidities, with a more pronounced effect in Black or African American patients.

Conclusion: Patients with AD prescribed dupilumab exhibited a lower risk of psychiatric and sleep disorders, with the effect being more evident within the Black or African American subgroup.