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In patients with moderate-to-severe atopic dermatitis (AD), dupilumab significantly reduces hospitalization rates and hospitalization length related to AD.

Atopic dermatitis (AD), a chronic inflammatory skin disease, may necessitate inpatient hospitalization for refractory cases, severe flares (exacerbations), and infections. A U.S. study also found that 18.9% of hospitalized individuals with a primary diagnosis of AD or eczema arrived with a skin infection, compared to 4.3% of hospitalized adults without a primary diagnosis of AD or eczema. Significantly elevated hospitalization rates and expenses have been linked with cutaneous infections in AD patients compared to those without skin infections.

This case-control study was published in The Journal of Allergy and Clinical Immunology: In Practice and compared the hospitalization rates between dupilumab-treated and placebo-treated patients with moderate-to-severe AD.
Data from 7 placebo-controlled, phase 2 or 3, randomized controlled trials, including 2,932 patients with moderate-to-severe AD were included. Patients were administered 300 mg of dupilumab every two weeks (q2w) or weekly (qw) against a placebo for 12, 16, or 52 weeks.

Ultimately, it was observed that patients in the dupilumab 300 mg q2w, qw, and combined dupilumab (q2w and qw;) groups had lower rates of all-cause hospitalizations (5.8, 2.7, and 3.8 events, respectively, vs. 9.0 events per 100 patient-years (PY).

In addition, dupilumab-treated individuals demonstrated a trend toward fewer AD-related inpatient days than control patients. Furthermore, the chance of hospitalization was decreased in patients treated with dupilumab compared to patients in the control group.

Even though all-cause hospitalizations may include occurrences unrelated to the medicine or AD, a reduction in all-cause hospitalizations gives additional information pertinent to the safety profile of dupilumab.
For those treated with dupilmab (300mg q2w) , there was a 49% reduction in all-cause hospitalizations and a 60% reduction in AD-related hospitalizations. Furthermore, hospitalization length was reduced from 38.9 days per 100 PY for the control group to 10.9 days per 100 PY for the dupilumab group.

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The authors concluded that the treatment with dupilumab was associated with significant decreases in all-cause and AD-related hospitalization rates and shorter duration of AD-related hospitalization among individuals with moderate-to-severe AD.

Dupilumab likely lowers infectious episodes through local action involving the reduction of inflammation and enhancement of the skin barrier and systemic action involving the downregulation of T-helper type 2-driven inflammation.

Reference:
Silverberg, J. I., Rubini, N. P. M., Pires, M. C., Rossi, A. B., Zhang, A., Chen, Z., . . . Bégo-Le Bagousse, G. (2022). Dupilumab Treatment Reduces Hospitalizations in Adults With Moderate-to-Severe Atopic Dermatitis. J Allergy Clin Immunol Pract, 10(5), 1279-1285.e1271. doi:10.1016/j.jaip.2021.11.034