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Patient race and specific atopic dermatitis diagnoses are associated with differences in dupilumab prescription patterns.

Atopic dermatitis (AD) is a common chronic inflammatory disease. Treatment with a systemic immunomodulating agent is indicated in moderate-to-severe AD. These systemic agents include cyclosporine, azathioprine, methotrexate, mycophenolate mofetil, and systemic steroids. Dupilumab, a fully human monoclonal antibody, may be more effective and safe for long-term maintenance than other systemic agents. However, the use of dupilumab may be limited by its cost and novelty. 

A study in JMIR Dermatology examined the prescribing patterns of dupilumab for AD in adults.

Study Population

A retrospective, observational study was conducted using data from 6421 AD patients at a large university-affiliated healthcare facility. Of these patients, 249 were prescribed dupilumab. The mean age was 53.2 years, and 57% of the patients were female. The cohort was composed of primarily non-Hispanic (89%) and White (79.3%) patients. Diagnoses included AD (50.8%), vesicular eczema (17.9%), nummular eczema (17.5%), flexural eczema (11.9%), and atopic neurodermatitis (1.9%).   

Patient Characteristics

Among those who received dupilumab, 58.6% of patients were female, and the mean age was 51.4 years. Those who received a prescription had either multiple prescriptions, prescriptions for quantities greater than one, or received refills. Most patients were White (71.9%), followed by Black (13.7%) and other races (5.2%). The most common recent diagnoses were a general diagnosis of AD (85.8%), atopic neurodermatitis (5.6%), flexural eczema (2.2%), nummular eczema (2.2%), or vesicular eczema (4.1%).

Each patient characteristic was assessed using univariate logistic regression with the binary outcome of receiving dupilumab or not receiving it.

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Black Patients and Dupilumab

Black patients were approximately twice as likely to have received dupilumab for AD as White patients (odds ratio: 2.352, 95% confidence interval (CI): 1.58–3.39).

Atopic Neurodermatitis and Dupilumab

Moreover, patients diagnosed with atopic neurodermatitis were almost twice as likely to have received dupilumab than those with a general AD diagnosis (OR: 1.87, 95% CI: 1.01–3.22).

Other Eczema Diagnoses and Dupilumab
Contrarily, patients with other eczema diagnoses, such as nummular eczema, flexural eczema, or vesicular eczema, were less likely to have received dupilumab compared to those with the most recent diagnosis of atopic neurodermatitis.

In conclusion, Black patients and those with atopic neurodermatitis diagnosis were at higher odds (approximately twice as likely) to have received dupilumab compared to White patients and those diagnosed with AD, respectively. Future studies should expand on factors contributing to dupilumab prescription.

Source:

Sivesind, T. E., Oganesyan, A., Bosma, G., Hochheimer, C., Schilling, L. M., & Dellavalle, R. (2023). Prescribing Patterns of Dupilumab for Atopic Dermatitis in Adults: Retrospective, Observational Cohort Study. JMIR Dermatology, 6(1), e41194. https://doi.org/10.2196/41194