Characterization of treatment path in the study population
Overall, 63.2% (1157/1831) and 36.8% (674/1831) of patients were treated in monotherapy or with two or more systemic agents, respectively. Most patients (55.3%, 1013/1576) were treated with \soutdupilumab (86.1%, 1576/1831 patients), 64.3% of them with dupilumab monotherapy, while in 30.8% (563/1831) dupilumab was associated with other systemic agents or phototherapy (Figure S2). Immunosuppressive systemic compounds were used as either monotherapy or combination therapy as showed in Table 3. More frequently, antihistamines (76.2%, 429/563), oral corticosteroids (19.2%, 108/563) and cyclosporine (12.6%, 71/563) were associated with dupilumab as combination therapy. A small percentage of AD patients (13.9%, 255/1831) was exclusively treated with conventional systemic therapies, including phototherapy (Figure S2). Notably, patients treated with dupilumab combined with other systemic therapies had significantly higher rates of concomitant atopic conditions compared to patients treated with dupilumab monotherapy or systemic immunosuppressive compounds (p<0.001; Table S1). Across treatment subgroups, no worsening of atopic comorbid conditions was reported as adverse event.
In a small proportion of patients (53/1831, 2.9%), systemic therapy was modified including a total of 66 therapy modifications consisting of drug dosage adjustment (i.e., tapering down or increasing dose) or lengthening drug administration interval, at least once. The addition to or substitution of the systemic therapy with topical agents, homeopathy, or other non-systemic therapies (i.e., sun exposure), occurred in 937 cases.
In total, 251 patients discontinued treatment. One hundred-ten of 251 patients (43.8%) temporarily suspended therapy that was restarted during the whole observation period, whereas 141 patients continued to manage AD with topical therapies, emollients, homeopathy or other non-systemic therapies.