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This section of First Report Managed Care focuses on reporting the latest in health care economics and outcomes research for a variety of treatments and disease states.

Previous clinical trial data proved dupilumab to be effective at improving signs and symptoms of atopic dermatitis (AD) and according to a study examining real-world clinical practice data, dupilumab has a high persistence rate and is well-tolerated by patients.

Jonathan Silverberg, MD, PhD, MPH, associate professor of dermatology at The George Washington University School of Medicine and Health Sciences, Washington, DC, and colleagues conducted the real-world retrospective observational study to better describe dupilumab treatment initiation in a clinical setting in regards to persistence, sociodemographic characteristics, comorbidity, and treatment patterns.

Using data from the US Truven MarketScan claims database from 2016 to 2018, the final study cohort included 1647 patients aged 18-years and older, who reported ≥1 dupilumab dispensation between March 28, 2017 and January 31, 2018, were continuously enrolled in a health plan for the duration of the study period, and had received an AD diagnosis on the index date or during the baseline period. Patients were an average of 42.2 years old, 50.1% male, 49.9% female, and primarily enrolled in a commercial insurance plan (94.7%).

At baseline, 51.3% patients reported ≥1 atopic comorbidity, with allergic rhinitis (33.7%) and asthma (26.8%) being the most prevalent. Additionally, at baseline, 81.1% of included patients were also treated with topical corticosteroids, systemic corticosteroids (71.9%), or systemic immunosuppressants (24.7%). The most prevalent non-AD related concomitant treatments 12 months prior to baseline included antibiotics, pain medication, sleep medication, and anxiolytics.

“Over a mean (SD) follow-up of 287.5 (106.2) days, dupilumab persistence (95% confidence interval [CI]) at 6 and 12 months was 92.2% (90.9% to 93.6%) and 78.5% (75.9% to 81.1%), respectively,” found the researchers. For patients who discontinued treatment, 66.9% reinitiated dupilumab within a 4-month period.

“To contextualize our results, 12-month persistence for the most commonly used first-line biologic treatment for psoriasis (adalimumab), using an 8-week grace period between previous and subsequent fill date, was 53.4%; 12-month persistence with dupilumab in AD is much higher (78.5% and 84.7% using a 30-day and 45-day grace period, respectively),” said the researchers.

These high persistence rates suggest that dupilumab is well-tolerated and patients are satisfied with its effectiveness. However, the researchers note that “future studies are needed to determine predictors of persistence with dupilumab.”

Limitations of the study included the potential for misclassification of persistence due to assumptions regarding injection frequency and grace period, the final cohort included early adopters of dupilumab, and unavailable discontinuation reasons.

—Edan Stanley

References:

  1. Silverberg JI, Guttman-Yassky E, Gadkari A, et al. Real-world persistence with dupilumab among adults with atopic dermatitis (AD). Poster presented at: The Society for Investigative Dermatology (SID) 77th Annual Meeting; May 8–11, 2019; Chicago, IL.
  2. Silverberg JI, Guttman-Yassky E, Gadkari A, et al. Real-world persistence with dupilumab among adults with atopic dermatitis (AD). Oral presentation at: The Society for Investigative Dermatology (SID) 77th Annual Meeting; May 8–11, 2019; Chicago, IL.
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