Article Text
Abstract
Background and Importance Dupilumab, an IL-4/IL-13 antagonist, and tralokinumab, an IL-13 antagonist, are approved for the treatment of moderate-to-severe atopic dermatitis (AD). Until now, no published studies have compared these treatments in clinical practice.
Aim and Objectives To evaluate and compare the effectiveness and safety of dupilumab and tralokinumab in AD patients in clinical practice.
Material and Methods We conducted a retrospective study in a tertiary hospital. We included AD patients who initiated dupilumab or tralokinumab as the first targeted treatment between 11/2017 and 5/2023.
We collected the following data from electronic medical and pharmacy records: age, sex, Eczema Area and Severity Index (EASI), Peak Pruritus-Numerical Rate Scale (PP-NRS), and adverse effects (AE). Effectiveness endpoints were EASI and PP-NRS at the first follow-up medical visit. Safety endpoints were the number and type of AE during the study period.
Results In total, 78 patients were included in the study. Mean age (±SD) was 40.8 (±17.4) years. Thirty-nine (50.0%) patients were women. Dupilumab group included 61 patients, whereas tralokinumab, 17.
In dupilumab group, mean initial EASI (±SD) was 32.5 (±9.7) and PP-NRS, 8.2 (±1.3). At first follow-up, the mean EASI was 7.1 (±6.0) and PP-NRS 2.7 (±1.8). In the tralokinumab group, mean initial EASI (±SD) was 26.4 (±8.3) and PP-NRS, 7.3 (±1.7). At first follow-up visit, the mean EASI was 2.4 (±4.8) and PP-NRS 1.9 (±2.7). The reduction in EASI and PP-NRS was statistically significant (p<0.001) in both groups. At first follow-up visit, tralokinumab was superior to dupilumab in the reduction of EASI (p=0.005), but not in PP-NRS. However, comparing the normalised reductions of EASI and PP-NRS, there were no significant differences between dupilumab and tralokinumab groups.
AE were reported in 23 (37.7%) dupilumab-treated patients and 5 (29.4%) tralokinumab-treated patients, which were mostly ophthalmologic (52.2% and 60.0%, respectively). Eight (13.1%) dupilumab-treated patients and 2 (11.8%) tralokinumab had to discontinue the treatment due to AE.
Conclusion and Relevance In our cohort, dupilumab and tralokinumab were effective. Our study shows a significant improvement in EASI and PP-NRS in the first follow-up visit. AE data show that close ophthalmologic monitoring is recommended in these patients. Further studies are warranted to validate the differences found between both treatments.
Conflict of Interest No conflict of interest.