Use patterns of systemic immunomodulators in the United States before and after dupilumab approval in adults with atopic dermatitis

Purpose: The patterns of dupilumab use, the first systemic drug approved for the treatment of atopic dermatitis (AD), is not well understood in the context of off-label systemic medications. Objective: To describe patterns of prescribing, switching and discontinuing systemic AD drugs, before and after the approval of dupilumab and understand variables associated with dupilumab prescription. Methods: Using longitudinal claims data, we identified patients with AD who initiated a systemic therapy (dupilumab, cyclosporine, methotrexate, azathioprine, mycophenolate) from March 2015 to February 2021, with a washout period of 1 year. We used Sankey plots to visualize longitudinal patterns of use at 3, 6, and 12 months and logistic regression to determine associates of dupilumab prescription. Results: The number of patients starting systemic treatment increased from 319 before dupilumab approval to 1358 after. Dupilumab use increased from 72% to 84%. In 2019-2020, 36% of patients discontinued systemic treatment within a year compared to 62% in 2015-2016. 92% of patients who started dupilumab in 2020-2021 had received no other systemic treatment before. Conclusion: Among new users of a systemic treatment for AD, dupilumab was most used treatment by far.

Automated summary

This study described the patterns of prescribing, switching, and discontinuing systemic AD drugs before and after the approval of dupilumab, and identified variables associated with dupilumab prescription. The results showed an increase in the use of dupilumab and a lower proportion of patients discontinuing systemic treatment in 2019-2020 compared to 2015-2016. Among patients starting dupilumab in 2020-2021, 92% had not received any other systemic treatment before.