Characterization of treatment path in the study population
Overall, 63.2% (1157/1831) and 36.8% (674/1831) of patients were
treated in monotherapy or with two or more systemic agents,
respectively. Most patients (55.3%, 1013/1576) were treated with
\soutdupilumab (86.1%, 1576/1831 patients), 64.3% of them with
dupilumab monotherapy, while in 30.8% (563/1831) dupilumab was
associated with other systemic agents or phototherapy (Figure S2).
Immunosuppressive systemic compounds were used as either monotherapy or
combination therapy as showed in Table 3. More frequently,
antihistamines (76.2%, 429/563), oral corticosteroids (19.2%, 108/563)
and cyclosporine (12.6%, 71/563) were associated with dupilumab as
combination therapy. A small percentage of AD patients (13.9%,
255/1831) was exclusively treated with conventional systemic therapies,
including phototherapy (Figure S2). Notably, patients treated with
dupilumab combined with other systemic therapies had significantly
higher rates of concomitant atopic conditions compared to patients
treated with dupilumab monotherapy or systemic immunosuppressive
compounds (p<0.001; Table S1). Across treatment subgroups, no
worsening of atopic comorbid conditions was reported as adverse event.
In a small proportion of patients (53/1831, 2.9%), systemic therapy was
modified including a total of 66 therapy modifications consisting of
drug dosage adjustment (i.e., tapering down or increasing dose) or
lengthening drug administration interval, at least once. The addition to
or substitution of the systemic therapy with topical agents, homeopathy,
or other non-systemic therapies (i.e., sun exposure), occurred in 937
cases.
In total, 251 patients discontinued treatment. One hundred-ten of 251
patients (43.8%) temporarily suspended therapy that was restarted
during the whole observation period, whereas 141 patients continued to
manage AD with topical therapies, emollients, homeopathy or other
non-systemic therapies.