Successful tapering of dupilumab in patients with atopic dermatitis with low disease activity:a large pragmatic daily practice study from the BioDay registry

BACKGROUND: Limited data is available regarding patient-centered dosing of dupilumab for atopic dermatitis (AD) in daily practice.OBJECTIVES: To evaluate our patient-centered dupilumab dosing regimen in daily practice, to assess prognostic factors for successful tapering and to estimate medication-related cost savings.METHODS: This prospective multicenter study included adult AD patients, participating in the BioDay registry, treated with dupilumab for ≥1.3 years. Interval prolongation was considered in case of dupilumab standard dose for ≥1 year and persistent controlled AD (Eczema Area and Severity Index (EASI)≤7); ≥six months). Primary endpoints were the mean EASI and Numeric Rating Scale (NRS)-pruritus after start of tapering. Prognostic factors for successful tapering were analyzed with logistic regression and a cost saving analysis was performed.RESULTS: A total of 595 patients were included, of which 401 patients (mean EASI 2.5 (SD 2.3)); NRS-pruritus of 2.4 (SD 1.9) at start tapering) prolonged dupilumab interval. In 83.3% of these patients tapering was successful; most patients used dupilumab every 3 or 4 weeks (Q3W/Q4W). A significant small increase was observed for EASI (highest mean 3.5) and NRS-pruritus (highest mean 3.2) (p&lt;0.0001), however scores remained low. Predicting successful tapering showed non-significant odds ratios for all incorporated variables. The estimated cost saving was 3,977,033.98 EUR for 401 patients between January 2019-June 2022.CONCLUSIONS: This study showed successful tapering of dupilumab in 83.3% of AD patients who attempted tapering while maintaining controlled disease and with the majority using Q3W/Q4W. Interval prolongation can be both beneficial for the patient and from a socio-economic perspective.</p