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Lookup NU author(s): Professor Nick ReynoldsORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© The Author(s) 2024.Background The main conventional systemic treatments for atopic dermatitis (AD) are methotrexate (MTX) and ciclosporin (CyA). Dupilumab was the first novel systemic agent to enter routine clinical practice. There are no head-to-head randomized controlled trials or real-world studies comparing these agents directly. Network meta-analyses provide indirect comparative efficacy and safety data and have shown strong evidence for dupilumab and CyA. Objectives To compare the real-world clinical effectiveness and safety of CyA, dupilumab and MTX in AD. Methods We compared the effectiveness and safety of these systemic agents in a prospective observational cohort study of adult and paediatric patients recruited into the UK–Irish Atopic eczema Systemic TherApy Register (A-STAR). Treatment effectiveness measures included Eczema Area and Severity Index (EASI), Patient-Oriented Eczema Measure (POEM), Peak Pruritus Numerical Rating Scale (PP-NRS), Dermatology Life Quality Index (DLQI) and children’s DLQI (cDLQI). The minimum duration of treatment was 28 days and follow-up was 12 months. Adjusted Cox-regression analysis was used to compare the hazard ratios of achieving EASI-50, EASI-75 and EASI-90 over time, and linear mixed-effects models were used to estimate changes in efficacy scores. Treatment safety was assessed by examining adverse events (AEs) at follow-up visits. Results We included 488 patients (311 adults and 177 children/adolescents) on dupilumab (n=282), MTX (n=149) or CyA (n=57). CyA and MTX were primarily used as the first-line treatment, while dupilumab was mainly a second-line systemic treatment as per UK National Institute of Clinical and Care Excellence (NICE) recommendations. EASI-50, EASI-75 and EASI-90 were achieved more rapidly in the dupilumab and CyA groups compared with MTX. After adjustment for previous severity, the reduction in EASI, POEM, PP-NRS and DLQI was greater for patients treated with dupilumab compared with MTX. In patients with severe disease the reduction in EASI, POEM and PP-NRS was even greater with CyA. The incidence rates of AEs were similar across groups (734, 654 and 594 per 10 000 person-month on CyA, dupilumab and MTX, respectively). Conclusions This real-world comparison of CyA, dupilumab and MTX in AD suggests that dupilumab is consistently more effective than MTX and that CyA is most effective in very severe disease within 1 year of follow-up.
Author(s): Alexander H, Malek R, Prieto-Merino D, Gribaleva E, Baden M, Beattie P, Brown S, Burton T, Cameron S, Coker B, Cork MJ, Hearn R, Ingram JR, Irvine AD, Johnston GA, Lambert A, Lunt M, Man I, Newell L, Ogg G, Patel P, Wan M, Warren RB, Woolf R, Yiu ZZN, Reynolds N, Ardern-Jones MR, Flohr C
Publication type: Article
Publication status: Published
Journal: British Journal of Dermatology
Year: 2024
Volume: 191
Issue: 6
Pages: 988-999
Print publication date: 01/12/2024
Online publication date: 24/07/2024
Acceptance date: 06/07/2024
Date deposited: 05/12/2024
ISSN (print): 0007-0963
ISSN (electronic): 1365-2133
Publisher: Oxford University Press
URL: https://doi.org/10.1093/bjd/ljae287
DOI: 10.1093/bjd/ljae287
Data Access Statement: The data underlying this article will be shared on reasonable request to the corresponding author.
PubMed id: 39044673
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