Dupilumab Versus Cyclosporine for the Treatment of Moderate-to-Severe Atopic Dermatitis in Adults: Indirect Comparison Using the Eczema Area and Severity Index

Abstract

Dupilumab is approved for uncontrolled moderate-to-severe atopic dermatitis (AD); cyclosporine is approved for severe AD for ??1 year. The efficacy/effectiveness of these treat?ments was compared indirectly. Regression models used pooled patient-level data to estimate response (Eczema Area and Severity Index (EASI) EASI-50/EASI-75 at weeks 12?16 and 24?30) to dupilumab 300 mg every 2 weeks (CHRONOS [NCT02260986]) or cyclosporine (University Medical Center). Models were adjusted for sex, baseline EASI, and thymus and activation-regulated chemokine level. A total of 106 patients received dupilumab (+ topical cortico?steroids; + TCS), and 57 received cyclosporine (+ TCS). Among University Medical Center patients, estimated EASI-50 responders were, dupilumab vs. cyclosporine, 91% vs. 77% (p?=?0.038; weeks 12?16), and 96% vs. 67% (p?<?0.0001; weeks 24?30); EASI-75 responders were 78% vs. 56% (p?=?0.016; weeks 12?16) and 80% vs. 47% (p?<0.001; weeks 24?30). Among CHRONOS patients, estimated EASI-50 responders were 90% vs. 74% (p?<0.038; weeks 12?16) and 92% vs. 53% (p?<?0.0001; weeks 24?30); EASI-75 responders were 75% vs. 52% (p?=?0.016; weeks 12?16) and 74% vs. 40% (p?<0.001; weeks 24?30), respectively. These results suggest a higher relative efficacy of dupilumab vs. cyclosporine.