Biologic Prescription Patterns and Biomarker Determinants of First-Line Dupilumab in Danish Adult Patients With Severe Asthma and Comorbid Atopic Dermatitis.

Abstract

Background: Asthma and atopic dermatitis are common type-2 (T2)-driven diseases that often coexist, although different T2 biomarkers indicate disease severity in each condition. Multiple biologics target T2 inflammation, but only dupilumab has been approved for both diseases. Little is known about patients with severe asthma and comorbid atopic dermatitis, particularly regarding how this comorbidity influences the choice of biologic for severe asthma.

Methods: We utilised the nationwide Danish Severe Asthma Register to characterise patients with severe asthma and comorbid atopic dermatitis, and describe prescription patterns of biologics in patients with and without comorbid atopic dermatitis. We compared biomarker determinants of first-line dupilumab prescription between the two groups using a multivariate logistic regression model adjusting for age and sex.

Results: We identified 1137 patients initiating a biologic for severe asthma, of whom 192 (17%) had comorbid atopic dermatitis. Patients with comorbid atopic dermatitis more often had childhood-onset asthma with an allergic phenotype. The prescription patterns of biologics differed according to comorbid atopic dermatitis status, and patients with comorbid atopic dermatitis were more likely to switch (OR 3.02, p < 0.001). In patients with comorbid atopic dermatitis, elevated IgE was the strongest biomarker determinant of first-line dupilumab prescription (OR 8.77, p < 0.001), whereas in patients without, it was elevated FeNO (OR 1.76, p = 0.03).

Conclusion: Biologic prescription patterns in severe asthma vary according to comorbid atopic dermatitis status. In patients with comorbid atopic dermatitis, elevated IgE predicts first-line dupilumab prescription, indicating that the severity of atopic dermatitis influences treatment decisions. Additional research is needed to explore the management of coexisting T2 diseases with biological therapies.