692 Real-world effectiveness of dupilumab based on Investigator Global Assessment (IGA) and peak Pruritus Numerical Rating Scale (PNRS) scores

Abstract

The real-world effectiveness of dupilumab in AD based on the IGA and PNRS measures was assessed via Modernizing Medicine’s Electronic Medical Assistant dermatology-specific medical records for patients age≥18, ≥1 dupilumab prescription between 01APR17-30NOV17 and with recorded IGA and PNRS scores ≤3months pre- and ≥4months post- dupilumab initiation. Pre- vs. post-dupilumab improvements in IGA and PNRS were evaluated in patients with baseline IGA≥3 and PNRS≥3 (moderate-to-severe AD), respectively. Of 211 and 89 patients with recorded IGA and PNRS scores, respectively, 187(88%) with IGA≥3 and 61(69%) with PNRS≥3 were analyzed. Mean (SD) age was 42.3(±17.3) and 46.9(±16.8) years, 51% were male in both groups, and 44% and 43% were White, in the IGA≥3 and PNRS≥3 groups, respectively. Treatments 1-year pre-dupilumab for IGA≥3 and PNRS≥3 were, respectively: topical corticosteroids 69% and 85%, topical calcineurin inhibitors 19% and 25%, oral/injectable steroids 39% and 59%, systemic immunosuppressants 25% and 31%, phototherapy 11% and 8%, PDE-4 inhibitors 27% and 25%. Baseline IGA distribution was: 35% for IGA3, 54% for IGA4 and 11% for IGA5. Post-dupilumab, in IGA≥3 32% of patients achieved IGA0-1; 58% and 79% achieved IGA improvements ≥2-points and ≥1-point, respectively. Baseline PNRS distribution for patients with PNRS≥3 was: 47% for PNRS3-6, 53% for PNRS7-10. Post-dupilumab, in PNRS≥3 PNRS improved by [mean (SD),%change] -3.6(±3.5),-54% (p<.0001); 66% had ≥3-point PNRS improvement. A majority of moderate-to-severe AD patients treated with dupilumab in routine clinical practice achieved clinically meaningful improvements in AD signs and itch. Improvements observed in real-world clinical practice were comparable to those seen in dupilumab trials.