Dupilumab reduces psychiatric and sleep disorder risk in atopic dermatitis: a population-based cohort study

Abstract

BackgroundPatients with atopic dermatitis (AD) have a higher risk of developing psychiatric and sleep disorders. ObjectiveTo compare the risk of psychiatric and sleep disorders in AD patients treated with dupilumab versus those on conventional drugs (systemic corticosteroids, methotrexate, cyclosporin, azathioprine). MethodsThis retrospective cohort study used the TriNetX Global Collaborative Network and included adult AD patients newly prescribed dupilumab (DUPI-cohort) or conventional drugs without prior dupilumab exposure (CONV-cohort). Propensity score matching was performed for age, sex, race, comorbidities, and laboratory measures. Risks of various psychiatric disorders, such as anxiety, depressive disorders, adjustment disorders, and attention deficit hyperactivity disorder (ADHD), as well as sleep disorders, were compared between cohorts, with hazard ratios (HRs) determined using Cox regression. ResultsAfter matching, both the DUPI- and CONV-cohorts included 6,114 patients each, with an average age of 44 years and 53% female. The racial distribution in both cohorts was roughly 49% White, 15% Black or African American, and 12% Asian. During the 3-year follow-up, the DUPI-cohort had reduced risks of anxiety (HR 0.76, 95% CI 0.64-0.89), depressive disorders (0.70, 0.58-0.86), adjustment disorders (0.535, 0.37-0.78), and sleep disorders (0.78, 0.65-0.94), while the risk of ADHD was not significantly affected (0.92, 0.61-1.38). These findings were consistent across age groups, sexes, races, and atopic comorbidities, with a more pronounced effect in Black or African American patients. ConclusionAD patients prescribed dupilumab exhibited a lower risk of psychiatric and sleep disorders, with the effect being more evident within the Black or African American subgroup.