Comparative effects of dupilumab versus disease-modifying anti-rheumatic drugs on future sequelae and comorbidities in patients with atopic dermatitis
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Presented at: Society for Investigative Dermatology 2025
Date: 2025-05-07 00:00:00
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Summary: Purpose: Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with an increased risk of cardiovascular disease, lymphoma, osteoporosis, and infections. However, data remain limited on how treatment with dupilumab influences the risk of these comorbidities compared to traditional systemic therapies. Methods: For this retrospective cohort study, the TriNetX database was used to identify patients with AD from 98 healthcare organizations across the United States. Patients were classified into those who had received dupilumab and those who had received systemic therapies including cyclosporine, mycophenolate mofetil, methotrexate, or azathioprine. Propensity score matching was used to balance baseline differences. Results: After matching, 5,434 pairs of AD patients treated with dupilumab and matched controls treated with traditional systemic therapy were included. Dupilumab initiators had a lower risk of death (HR 0.76; 95%CI 0.61-0.96; P=0.021), major adverse cardiovascular events (HR 0.68; 95%CI 0.54-0.85; P=0.001), ischemic heart disease (HR 0.8, 95%CI 0.65-0.95, P= 0.013), respiratory infections (HR 0.74; 95%CI 0.64-0.87; P=0.0001), sepsis (HR 0.47; 95%CI 0.34-0.63; P=0.0001), and osteoporosis (HR 0.66; 95%CI 0.53-0.83; P=0.0001). There was no difference in the risk of lymphoma (HR 1.13; 95%CI 0.77-1.66; P=0.53). The dupilumab group had a higher risk of conjunctivitis (HR 1.30; 95%CI 1.11-1.51; P=0.001). Conclusion: This study supports the effectiveness of dupilumab in reducing AD-related comorbidities and suggests that dupilumab may be a preferred systemic treatment option for patients with AD. Further research is needed to understand the mechanisms underlying the differential comorbidity risks associated with dupilumab compared to other systemic treatments. Kevin Ma<sup>1, 2</sup>, Natalie Braun<sup>1, 2</sup>, Joseph Ebriani<sup>1</sup>, Natalie Baker<sup>1, 2</sup>, Ghida El-Banna<sup>1</sup>, Bryan L. Peacker<sup>1, 2</sup>, Steven Chen<sup>1, 2</sup> 1. Department of Dermatology, Massachusetts General Hospital, Boston, MA, United States. 2. Harvard Medical School, Boston, MA, United States. Clinical Research: Epidemiology and Observational Research