O05 Drug survival of dupilumab, methotrexate and ciclosporin in patients with atopic eczema: results from the UK-Irish Atopic eczema Systemic TherApy Register (A-STAR)
Elizaveta Gribaleva, Man Fung Tsoi, David Prieto-Merino, Rebecca Carroll, Bolaji Coker, Manisha Baden, Paula E Beattie, Tim Burton, Moira Clark, Sharmela Darne, Nicola Housam, Alan D Irvine, Graham A Johnston, Irene Man, Charlene Murphy, Graham Ogg, Sophia Paget, Nick Reynolds, Mandy Wan, Richard B Warren, Michael R Ardern-Jones, Carsten FlohrAbstract
Drug survival of systemic medications in atopic eczema is a commonly used measure of effectiveness and tolerability informing clinical decision making. This study evaluates the drug survival of methotrexate, ciclosporin and dupilumab in patients in the A-STAR register. Patients who initiated oral (oMTX) and subcutaneous methotrexate (s/c MTX), ciclosporin (CsA) and dupilumab were included. Patients were stratified by treatment received. One-year drug survival was calculated using Kaplan–Meier estimates. oMTX was used as the reference. Adjusted hazard ratios (aHRs) and corresponding 95% confidence intervals (CIs) were estimated using Cox proportional hazard models with covariate adjustment. In total, 1132 drug episodes were included (oMTX 289, s/c MTX 51, CsA 117, dupilumab 675). Baseline characteristics were largely similar among the patients across the treatment groups, except for higher Eczema Area and Severity Index and number of previous systemic therapies in the CsA and dupilumab groups. One-year survival rates of CsA, oMTX, s/c MTX and dupilumab were 34%, 56%, 64% and 83%, respectively. When stratifying the dupilumab cohort by the number of previous conventional systemic treatments (one vs. at least two), there was no statistically significant difference in dupilumab survival between the subgroups. Median time on treatment (interquartile range) was 6.0 months (2.2–11.4) for CsA, 7.4 months (3.0–18.7) for oMTX, 9.6 months (5.0–16.4) for s/c MTX and 16.6 months (6.9–30.6) for dupilumab. Using oMTX as the reference, dupilumab was associated with a lower chance of drug discontinuation (aHR 0.26, 95% CI 0.19–0.36), whereas drug discontinuation was significantly higher in those receiving CsA (aHR 1.53, 95% CI 1.08–2.17). There was no significant difference in drug survival between s/c and oMTX (aHR 0.73, 95% CI 0.41–1.31). Similar trends were observed in adult and paediatric patients. In conclusion, dupilumab demonstrated the highest drug survival, with CsA showing the highest rate of drug discontinuation among the four assessed treatment modalities, fitting in with clinical experience. Further analyses to stratify survival by reasons for discontinuation are underway.