Abstract
A low risk of cardiovascular and metabolic outcomes was found in the randomized clinical trials of dupilumab in atopic dermatitis (AD). Dupilumab-associated real-life long-term cardiometabolic risk relative to other systemic agents is yet to be precisely investigated. To assess the risk of cardiometabolic outcomes in patients with AD treated with dupilumab relative to those treated with methotrexate and cyclosporine. A global retrospective cohort study comprised two distinct analyses comparing patients with AD under different treatments: (i) initiators of dupilumab (n = 10,151) versus methotrexate (n = 10,151) and (ii) initiators of dupilumab (n = 6,629) versus TNFi (n = 6,629). Study groups were compared regarding the risk of 8 cardiovascular and 4 metabolic outcomes during the initial three years following drug initiation. Propensity score matching was conducted to optimize inter-group comparability. Compared to methotrexate, dupilumab was associated with a decreased risk of peripheral vascular disease (PVD; hazard ratio [HR], 0.64; 95% confidence interval CI 0.45-0.90; P = 0.011), deep vein thrombosis (DVT; HR, 0.42; 95% CI, 0.26-0.69; P < 0.001), hypertension (HR, 0.67; 95% CI, 0.58-0.79; P < 0.001), type-2 diabetes mellitus (T2DM; HR, 0.53; 95% CI, 0.42-0.68; P < 0.001), and obesity (HR, 0.70; 95% CI, 0.58-0.86; P = 0.001) within the first year of treatment. Relative to cyclosporine, dupilumab conferred a lower risk of hypertension (HR, 0.52; 95% CI, 0.45-0.62; P < 0.001), hyperlipidemia (HR, 0.59; 95% CI, 0.49-0.71; P < 0.001), and T2DM (HR, 0.62; 95% CI, 0.48-0.81; P < 0.001), CONCLUSION: Dupilumab possesses a favorable cardiometabolic safety profile and might be preferred in patients with susceptibility and risk factors of these conditions.
Published Version
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