Dupilumab Significantly Reduces Hospitalization Rates in Patients With Atopic Dermatitis

Dupilumab treatment was associated with reduced all-cause and atopic dermatitis (AD)–related hospitalization rates among patients with AD, according to study findings published in The Journal of Allergy and Clinical Immunology: In Practice.

Among patients with AD, incidence of refractory disease, severe flares, and infections have been linked with significantly increased hospitalization rates and costs. In fact, researchers note that about 1 in 5 patients, including children and adults, who have had an AD-related hospitalization experience an all-cause hospital readmission within the next year.

“Treatment options for moderate-to-severe AD include various systemic immunosuppressants, some of which may increase the risk of infection and serious infection requiring hospitalization,” they added.

With dupilumab having demonstrated efficacy and safety among adults, adolescents, and young children 6 months and older with moderate-to-severe AD, the study authors sought to explore whether rates of hospitalizations may be ameliorated by the drug.

They conducted a post hoc analysis of pooled data from 7 placebo-controlled, phase 2 or 3 randomized controlled trials involving adult patients with moderate-to-severe AD. Participants were treated with dupilumab 300 mg every 2 weeks or weekly (n = 1841) vs placebo (n = 1091), with or without topical corticosteroids, for 12, 16, or 52 weeks.

The primary outcomes assessed included hospitalization rates (all-cause and AD-related), length of AD-related hospitalizations, and time to first hospitalization.

From the study cohort, 77 hospitalization events were identified (31 in the dupilumab group), of which “AD exacerbation” was the most common reason for hospitalization and was lower in the combined dupilumab vs control groups.

Compared with the control group, patients with moderate-to-severe AD in the combined dupilumab groups exhibited a 62% risk reduction for all-cause hospitalizations (3.8 vs 9.0 events per 100 patient-years [PY]; rate ratio [RR], 0.38; 95% CI, 0.23-0.62; P < .001), a 79% risk reduction for AD-related hospitalizations (1.0 vs 4.1 events per 100 PY; RR, 0.21; 95% CI, 0.09-0.51; P < .001), and a 30.3-day reduction per 100 PY for overall duration of AD-related hospitalizations (8.6 vs 38.9 days per 100 PY; RR, 0.10; P = .06)

Moreover, the individual dupilumab dose regimen groups also showed lower rates for the assessed outcomes vs the control group:

• 49% risk reduction and 71% risk reduction for all-cause hospitalization in the dupilumab 300 mg every 2 weeks and once-weekly groups, respectively, vs placebo (every 2 weeks: 5.8 vs 9.0 events per 100 PY; RR, 0.51; 95% CI, 0.27-0.95; P = .033; weekly: 2.7 vs 9.0 events per 100 PY; RR, 0.29; 95% CI, 0.15-0.55; P < .001)
• 60% risk reduction and 91% risk reduction for AD-related hospitalizations in the dupilumab 300 mg every 2 weeks and once weekly groups, respectively, vs placebo (2.0 vs 4.1 events per 100 PY; RR, 0.40; 95% CI, 0.15-1.08; P = .07; 0.4 vs 4.1 events per 100 PY; RR, 0.09; 95% CI, 0.02-0.40; P = .002)
• 28.0-day and 31.6-day reduction per 100 PY for duration of AD-related hospitalizations in the dupilumab 300 mg every 2 weeks and once weekly groups, respectively, vs placebo (10.9 vs 38.9 days per 100 PY; RR, 0.45; 95% CI, 0.07-3.09; P = .42: 7.3 vs 38.9 days per 100 PY; RR, 0.02; 95% CI, 0.00-0.16; P < .001)
  

“These analyses show that the efficacy of dupilumab translates into a benefit of reduced hospitalizations, overall and those related to AD,” said the study authors. “Although all-cause hospitalizations may include events that have no relationship to the drug or AD, a reduction of all-cause hospitalizations provides additional information relevant to the safety profile of dupilumab.”

Reference

Silverberg JI, Rubini, Pires MC, et al. Dupilumab treatment reduces hospitalizations in adults with moderate-to-severe atopic dermatitis. J Allergy Clin Immunol Pract. Published online January 12, 2022. doi:10.1016/j.jaip.2021.11.034