Drug Survival and Predictors of Systemic Treatment Outcome in Atopic Dermatitis: Data From a Nationwide Swedish Cohort

Abstract

Real-world data on the drug survival of established and emerging treatment options in atopic dermatitis provide a comprehensive measure of the efficacy and tolerability of these interventions, which may enable improvements in clinical management. This study aimed to describe the drug survival, with associated predictors, of treatment with abrocitinib, baricitinib, cyclosporine, dupilumab, methotrexate, tralokinumab, and upadacitinib among patients with atopic dermatitis in Sweden who were recruited into the multicentre prospective SwedAD cohort between January 2017 and April 2024. A total of 1,194 patients were included with a total of 1,486 treatment episodes. The 2-year drug survival probability was 14.2% for baricitinib (treatment episodes, n = 30), 12.2% for cyclosporine (n = 40), 79.7% for dupilumab (n = 1,026), 45.4% for methotrexate (n = 260), and 46.0% for upadacitinib (n = 89). Two-year follow-up data were not available for abrocitinib (n = 23) or tralokinumab (n = 18). All drugs were compared with the most used conventional systemic treatment at study baseline, methotrexate, using Cox regression. Only dupilumab showed a significantly lower hazard rate of drug discontinuation. In conclusion, dupilumab therapy demonstrated longer drug survival than methotrexate in atopic dermatitis. The impact of national treatment guidelines and time since drug approval should be considered when interpreting the results.

Fig. 1

Drug survival, all treatments.