Different AD clinical courses in patients withdrawing treatment compared to patients continuing therapy.
At timepoint 1 (lockdown phase), disease severity assessment of the whole patient population showed: mean EASI score of 6.8 ±7.7, itch-NRS of 2.6 ±2.2, sleep-NRS of 1.7 ±2.1, and self-assessment of AD severity, AD-NRS of 2.5 ±2.1 (Table 4). During the study period, patients experienced a significant reduction of mean itch-NRS, mean sleep-NRS, and mean AD-NRS scores, achieving lower mean scores at timepoint 3, compared to timepoint 1 (Table S2 and Table S3). This improvement reflected the significant decrease of mean EASI score at timepoint 3 (3.4 ± 4.4) compared to timepoint 1 (6.8 ± 7.7, p<0.0001). Reduction of mean EASI score was observed in both patients continuing treatment and patients interrupting systemic therapy, though at different extent (Table 4). Indeed, mean EASI score changed in the cohort of patients continuing treatment over time (6.6±7.8 at timepoint 1 vs. 2.8±3.4 at timepoint 3), obtaining a 10-fold higher reduction compared to the cohort of patients withdrawing treatment (8.2±7.5 at timepoint 1 vs. 7.3±7.7 at timepoint 3).
Self-assessment of itch, sleep and disease severity did not reveal any marked difference between the two patient subcohorts in terms of score reduction (Table 4).
At timepoint 1, AD improvement was experienced by a higher percentage of patients continuing therapy compared to patients discontinuing treatment (28.8% vs. 15.5%, p<0.001). Stable AD was reported by 60.9% of patients continuing therapy compared to 48.6% of patients interrupting therapy. On the contrary, an increased number of patients discontinuing therapy described worsening of disease compared to patients continuing therapy (35.9% vs. 10.3%). Similarly, AD status perceived by patients continuing or interrupting therapy was significantly different at the following timepoints (p<0.001; Table 4). Comparing patients treated with dupilumab monotherapy, dupilumab combined with other systemic therapies, and immunosuppressive systemic compounds, a reduction of disease severity (EASI score, and NRS scores) was detected at timepoint 3 vs. timepoint 1, as well as a significantly different AD status across the three patient cohorts at each time point (p<0.0001, Table S2). Patients treated with dupilumab monotherapy showed lower disease activity at timepoint 1, with a mean EASI score significantly lower compared to the other patients (p<0.001), and this improvement was sustained thereafter (Table S2).