Dupilumab Shows Superiority in Reducing Upper Respiratory Infections in Patients With AD

Over a 5-year period, patients treated with dupilumab exhibited a significantly lower incidence of acute URIs compared to those on non-targeted immunosuppressant therapies. (mi_viri/Adobe Stock)

Patients with moderate to severe atopic dermatitis (AD) frequently resort to immunosuppressants, which, despite their variable efficacy, come with the baggage of adverse effects, including the risk of bacterial and opportunistic infections with prolonged usage. Amidst this landscape, dupilumab (Dupixent)was the first biologic approved for AD treatment over 7 years ago¹, inhibiting signaling of Th2-inflammation drivers IL-4 and IL-13. However, the dearth of long-term population-based studies comparing the safety profiles of systemic immunosuppressants and immunomodulatory therapies for AD has left a crucial gap in understanding the optimal treatment approach.

Presented at the 2024 American Academy of Dermatology Meeting in San Diego, California, a poster detailing a multi-center, longitudinal cohort study utilizing the TriNetX global health records database sought to fill this void by comparing the risk of upper respiratory infections (URIs) in AD patients treated with dupilumab versus those on non-targeted immunosuppressants.²

Study Methodology

The study methodology involved meticulous patient identification using International Classification of Diseases, Tenth Revision (ICD-10) codes for AD and subsequent categorization based on treatment received—dupilumab, methotrexate, and cyclosporine. To ensure robustness, AD patients treated with dupilumab and non-targeted immunosuppressants were matched 1:1 to AD patients without these treatments, employing propensity score matching based on age, sex, race, and other atopic conditions.

Results

Over a 5-year period, patients treated with dupilumab exhibited a significantly lower incidence of acute URIs compared to those on non-targeted immunosuppressant therapies. Furthermore, the risk of URI-related mortality was notably diminished in the dupilumab cohort. These findings resonate with prior research, showcasing dupilumab's efficacy in not only improving skin infections in AD but also mitigating respiratory infections in asthma compared to placebo. However, the study does acknowledge certain limitations inherent to its design, including potential misclassification of ICD10 codes and incomplete medical history within the database. Moreover, the cross-sectional nature of the study impedes the establishment of causal relationships.

Nevertheless, the implications of this research are notable. By demonstrating the superior URI safety profile of dupilumab therapy over systemic immunosuppressants, the study provides valuable insights to clinicians grappling with treatment decisions for moderate to severe AD. In a realm where balancing therapeutic efficacy with safety considerations is paramount, these findings offer a guiding light, paving the way for more informed and patient-centric treatment strategies.

Conclusion

Investigators behind this poster presentation underscored the pivotal role of dupilumab in reshaping the treatment landscape for AD. Beyond its acclaimed efficacy in alleviating skin symptoms, dupilumab emerges as a safer alternative, offering a tangible reduction in the risk of upper respiratory infections—a testament to its transformative potential in improving patient outcomes and enhancing quality of life.

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References

1. FDA approves Dupixent. Drugs.com. March 28, 2017. Accessed March 27, 2024. https://www.drugs.com/newdrugs/fda-approves-dupixent-dupilumab-eczema-4505.html
2. Ma E, Bao A, Cornman H, et al. Dupilumab therapy reduces the risk of acute upper respiratory infections and associated mortality in atopic dermatitis patients: a multi-center cohort study. Poster presented at: 2024 American Academy of Dermatology Annual Meeting; March 8-12, 2024; San Diego, CA