Use patterns of systemic immunomodulators in the United States before and after dupilumab approval in adults with atopic dermatitis

AbstractPurposeThe patterns of dupilumab use, the first systemic drug approved for the treatment of atopic dermatitis (AD), is not well understood in the context of off‐label systemic medications.ObjectiveTo describe patterns of prescribing, switching and discontinuing systemic AD drugs, before and after the approval of dupilumab and understand variables associated with dupilumab prescription.MethodsUsing longitudinal claims data, we identified patients with AD who initiated a systemic therapy (dupilumab, cyclosporine, methotrexate, azathioprine, mycophenolate) from March 2015 to February 2021, with a washout period of 1 year. We used Sankey plots to visualize longitudinal patterns of use at 3, 6, and 12 months and logistic regression to determine associates of dupilumab prescription.ResultsThe number of patients starting systemic treatment increased from 319 before dupilumab approval to 1358 after. Dupilumab use increased from 72% to 84%. In 2019–2020, 36% of patients discontinued systemic treatment within a year compared to 62% in 2015–2016. 92% of patients who started dupilumab in 2020–2021 had received no other systemic treatment before. Patients <60 years and those who used steroid‐sparing topical treatments were more likely to receive dupilumab.ConclusionAmong new users of a systemic treatment for AD, dupilumab was most used treatment by far.