Different management of immunosuppressive systemic compounds compared to dupilumab
The majority of patients (86.3%, 1580/1831) continued therapy, whereas 13.7% of patients (251/1831) withdrew systemic therapy at least once, with a mean duration of treatment interruption of 56.5 days (±27.2), and a total number of therapeutic course interruptions of 286. Most of treatment interruptions was recorded at timepoint 1 (67.1%, 192/286), whereas in 16.8% (48/286) and 16.2% (46/286) of cases, therapy was withdrawn at timepoint 2 and 3, respectively. Treatment interruptions occurred with similar distribution across the three cohorts of patients treated with systemic immunosuppressive compounds (36.4% of cases with at least one treatment interruption), dupilumab monotherapy (32.9%), or dupilumab combined with other systemic therapies (30.7%). Nevertheless, considering the rate of treatment interruption for each drug, dupilumab was interrupted in only 9.9% (156/1576) of cases, whereas cyclosporine, antihistamines, oral corticosteroids, phototherapy, methotrexate were interrupted in 40.9% (52/127), 39.9% (190/476), 23.4% (34/145), 74.1% (60/81), 23.5% (12/51) of cases, respectively (Table 3).
In 39.9% (114/286) of cases, treatment interruption was due to patient decision, while in 5.6% (16/286) and 30.1% (86/286) of cases, treatment interruption was suggested by the general practitioner and by the dermatologist, respectively. In particular, the interruption of systemic immunosuppressive compounds was more frequently suggested by the dermatologist (40.4%, 42/104), whereas dupilumab monotherapy or dupilumab combined with other systemic therapies were mostly interrupted because of patient decision (53.2% [50/94]; 50% [44/88] respectively) (Table S1). In details, one or more reasons led to the decision of stopping therapy: (i) the inability to maintain drug supply, other non-medical or unspecified causes (58.7%, 168/286 cases); (ii) the occurrence of concomitant comorbid conditions (5.9%, 17/286 cases); (iii) age, over 60 years old (5.2%, 15/286 cases), (iv) close contact with SARS-CoV-2+ subject (2.4%, 7 /286); (v) SARS-CoV-2 infection (2.8%, 8/286); (vi) fear of increased susceptibility to SARS-CoV-2 infection (24.8%, 71/286). Fear of increased susceptibility to SARS-CoV-2 infection caused treatment interruption in 23.4%, 23.9%, and 26.9% of patients treated with dupilumab monotherapy, dupilumab combined with other systemic therapies, and systemic immunosuppressive compounds, respectively.