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IMPORTANCE: Limited data are available on the long-term effectiveness and safety of dupilumab for atopic dermatitis (AD) in daily practice. OBJECTIVE: To evaluate clinical effectiveness and reasons for discontinuation of dupilumab treatment in children, adults, and older adults with AD with up to 5 years of treatment in daily practice. DESIGN, SETTING, AND PARTICIPANTS: This prospective multicenter cohort study was conducted using the BioDay registry (4 academic and 10 nonacademic hospitals in the Netherlands) to identify patients with AD of all ages who were treated with dupilumab between October 2017 and December 2022. MAIN OUTCOMES AND MEASURES: Clinical effectiveness was evaluated by the Eczema Area and Severity Index (EASI), Investigator Global Assessment (IGA), and numeric rating scale (NRS) for pruritus, stratified by children (<18 years), adults (18-64 years), and older adults (≥65 years). In addition, time to response, treatment responders, EASI subscores, second treatment episodes, and thymus- and activation-related chemokine and eosinophil levels were assessed. For patients who discontinued dupilumab, the reason for discontinuation was evaluated. RESULTS: In total, 1286 patients with AD (median [IQR] age, 38 [26-54] years; 726 [56.6%] male) were treated with dupilumab, including 130 children, 1025 adults, and 131 older adults. The median (IQR) follow-up time was 87.5 (32.0-157.0) weeks. Most patients maintained controlled AD, with EASI of 7 or lower and NRS for pruritus of 4 or lower varying between 78.6% and 92.3% and 72.2% and 88.2% for up to 5 years of treatment, respectively, while up to 70.5% of all patients prolonged the dosing interval to mostly 300 mg every 3 or 4 weeks. Mean EASI and NRS for pruritus were 2.7 (95% CI, 1.2-4.2) and 3.5 (95% CI, 2.7-4.3), respectively, after 5 years of treatment. Statistically significant differences between age groups were found over time for EASI and IGA; however, differences were rather small (week 52: EASI, 0.3-1.6; IGA, 0.12-0.26). No statistically significant differences between age groups were found for NRS for pruritus. Median thymus- and activation-related chemokine levels considerably decreased from 1751 pg/mL (95% CI, 1614-1900 pg/mL) to 390 pg/mL (95% CI, 368-413 pg/mL) after 6 months of treatment and remained low. Median eosinophil levels temporarily increased up to week 16, with a subsequently statistically significant decrease over time. In total, 306 patients (23.8%) discontinued dupilumab after a median (IQR) of 54.0 (29.0-110.00) weeks, with adverse events among 98 patients (7.6%) and ineffectiveness among 85 patients (6.6%) as the most frequently reported reasons. Forty-one patients (3.2%) restarted dupilumab, and most of these patients recaptured response. CONCLUSIONS AND RELEVANCE: In this cohort study with up to 5 years of follow-up, dupilumab maintained its clinical effectiveness, while two-thirds of patients tapered to a dosing interval of every 3 or 4 weeks. Treatment was discontinued in 23.8% of patients mainly due to adverse events and/or ineffectiveness.

Hintergrund:Das chronische Handekzem (CHE) ist eine sehr häufige Hauterkrankung in der europäischen Bevölkerung. Es verursacht Juckreiz und Schmerzen und beeinträchtigt in schwereren Fällen die Funktion der Hände bei der Arbeit und im Privatleben erheblich. Ziele:Perspektiven von Menschen zu erforschen, die mit CHE leben, und deren Probleme, Wünsche und Ziele zu verstehen. Method:en: Wir folgten einem qualitativen Ansatz und führten themengeführte Interviews in fünf europäischen Ländern durch. Wir verwendeten eine Template-Analyse, um wiederkehrende Themen bei Patienten mit CHE zu identifizieren. Ergebnisse:Wir befragten 60 Patienten in sieben ambulanten dermatologischen und arbeitsmedizinischen Kliniken in Kroatien, Dänemark, Deutschland, den Niederlanden und Spanien. Es wurden fünf Hauptthemen identifiziert: (1) Wissen über die Krankheit und ihren Verlauf, (2) präventives Verhalten, (3) Therapie des Handekzems, (4) Auswirkungen auf den Alltag und (5) Einstellungen gegenüber dem CHE und der Gesundheitsversorgung. Die Teilnehmer fühlten sich nicht gut über CHE informiert, insbesondere über die Ursachen, Auslöser und Behandlungsmöglichkeiten. Vorbeugende Maßnahmen wurden als mehr oder weniger wirksam, aber auch als umständlich empfunden. Die Erfahrungen mit der Therapie waren vielfältig. Die Behandlungszufriedenheit hing von den erreichten Ergebnissen und der wahrgenommenen Unterstützung durch die Behandlungsteams ab. Die Teilnehmer fanden es wichtig, ernst genommen zu werden, praktische Ratschläge zu erhalten, zusätzliche Behandlungen oder Untersuchungen auszuprobieren, neue Hoffnung zu schöpfen und berufliche Perspektiven zu haben. Sie wünschten sich, dass andere die körperliche und emotionale Belastung durch das CHE besser verstehen könnten. Patientenunterstützungsgruppen wurden nicht erwähnt. Die Teilnehmer fanden es wichtig, zu lernen, mit dem Ekzem umzugehen, und das Leben mit CHE zu akzeptieren. Schlussfolgerungen:Aufgrund der lästigen Symptome, der hohen Sichtbarkeit und der Beeinträchtigung der Hände bei der Arbeit und im Privatleben hat das CHE eine hohe emotionale und soziale Wirkung. Manche Menschen benötigen möglicherweise Unterstützung, um den Umgang mit dem CHE und dessen Prävention zu erlernen. Patienten wünschen sich Informationen über Ursachen und Auslöser. Sie schätzen Ärzte, die ihnen zuhören und immer wieder nach Lösungen suchen. © 2023 Die Autoren. Journal of the European Academy of Dermatology and Venereology, veröffentlicht von John Wiley & Sons Ltd im Auftrag der European Academy of Dermatology and Venereology.

IMPORTANCE: Long-term data on dupilumab drug survival in patients with atopic dermatitis (AD) are scarce. Furthermore, little is known about the factors associated with drug survival of dupilumab in AD. OBJECTIVE: To describe the drug survival of dupilumab in patients with AD and to identify associated predictors. DESIGN, SETTING, AND PARTICIPANTS: This cohort study was based on data from the multicenter prospective daily practice BioDay registry, in which 4 university and 10 nonuniversity hospitals in the Netherlands participated. Analysis included patients (age ≥18 years) participating in the BioDay registry with a follow-up of at least 4 weeks. The first patient treated with dupilumab was recorded in the BioDay registry in October 2017; data lock took place in December 2020, and data analysis was performed from October 2017 to December 2020. MAIN OUTCOMES AND MEASURES: Drug survival was analyzed by Kaplan-Meier survival curves and associated characteristics by using univariate and multivariate Cox regression analysis. RESULTS: A total of 715 adult patients with AD (mean [SD] age, 41.8 [16.0] years; 418 [58.5%] were male) were included with a 1-year, 2-year, and 3-year overall dupilumab drug survival of 90.3%, 85.9%, and 78.6%, respectively. Characteristics associated with shorter drug survival owing to ineffectiveness were the use of immunosuppressant drugs at baseline (hazard ratio [HR], 2.64; 95% CI, 1.10-6.37) and being a nonresponder at 4 weeks (HR, 8.68; 95% CI, 2.97-25.35). Characteristics associated with shorter drug survival owing to adverse effects were the use of immunosuppressant drugs at baseline (HR, 2.69; 95% CI, 1.32-5.48), age 65 years or older (HR, 2.94; 95% CI, 1.10-7.87), and Investigator Global Assessment score of very severe AD (HR, 3.51; 95% CI, 1.20-10.28). CONCLUSIONS AND RELEVANCE: This cohort study demonstrated a good overall 1-year, 2-year, and 3-year dupilumab drug survival. Patients using immunosuppressive therapy at baseline and those with an absence of treatment effect at week 4 tended to discontinue treatment owing to ineffectiveness more frequently. Using immunosuppressant drugs at baseline, older age, and Investigator Global Assessment score of very severe AD were characteristics associated with an increased risk for discontinuation owing to adverse effects. These data provide more insight and new perspectives regarding dupilumab treatment in AD and can contribute to the optimization of patient outcomes.

Health literacy (HL) is essential for patients with multiple atopic diseases to improve their health, given the complexity of their disease and treatment regimens.