Dupilumab versus tralokinumab in atopic dermatitis: A propensity score adjusted comparison from BioDay

IF 9.2 2区医学 Q1 DERMATOLOGY

Journal of the European Academy of Dermatology and Venereology Pub Date : 2026-07-31 Epub Date: 2026-04-13 DOI:10.1111/jdv.70442

Lian F. van der Gang, Nicolaas P. A. Zuithoff, Inge M. Haeck, Veroniek E. M. Harbers, Simone Stadhouders-Keet, Klaziena Politiek, Albert J. Oosting, Anneke M. T. van Lynden-van Nes, Hoo-Yin Lam, Anne-Moon van Tuyll van Serooskerken, Shiarra M. Stewart, Antoni Gostynski, Annebeth Flinterman, Berit Velstra, Wouter R. H. Touwslager, Francine C. van Erp, Marie L. A. Schuttelaar, Marjolein S. de Bruin-Weller, Marlies de Graaf

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Abstract

Background

Dupilumab and tralokinumab for atopic dermatitis (AD) target the type 2 axis through different mechanisms of action, which may lead to variation in effectiveness and safety. Head-to-head trials, however, are lacking.

Objectives

To compare the real-world effectiveness and safety of dupilumab and tralokinumab in AD.

Methods

This prospective cohort study enrolled biologic−/Janus kinase inhibitor-naïve AD patients (≥12 years) from the BioDay registry who initiated dupilumab or tralokinumab between November 2021 and September 2024. Visits were scheduled at baseline, 4 weeks and every 3 months up to 52 weeks. Effectiveness outcomes included Eczema Area and Severity Index (EASI), weekly mean pruritus Numeric Rating Scale (NRS), treat-to-target thresholds (EASI ≤ 7; NRS-pruritus ≤ 4, with patients discontinuing treatment considered non-responders) and drug survival. Adverse events (AEs) were assessed at each visit. Inverse probability of treatment weighting (IPTW) was used to balance treatment groups.

Results

In total, 750 patients were included (643 dupilumab; 107 tralokinumab). After IPTW, baseline characteristics were well balanced. During follow-up, dupilumab patients had lower EASI scores than tralokinumab patients, although differences were not consistently statistically significant (p = 0.10). NRS-pruritus scores were significantly lower with dupilumab at all visits (p < 0.0001), mean differences did not exceed the 2-point clinical relevance threshold. The probability of achieving EASI ≤ 7 and NRS-pruritus ≤ 4 was higher with dupilumab (both p < 0.0001), with risk differences of 34.7% and 40.2% at 52 weeks, respectively. After 52 weeks, dupilumab drug survival was 92.6% vs. 70.6% for tralokinumab. Ocular surface disease incidence was similar (HR 1.0, 95% CI 0.6–1.6, p = 0.94) between treatments, leading to discontinuation of dupilumab in n = 23 (3.4/100 PY) and tralokinumab in n = 5 (5.4/100 PY).

Conclusions

In this real-world comparison, dupilumab provided superior effectiveness compared with tralokinumab. In responders continuing treatment, EASI and NRS-pruritus differences were small. More substantial differences were observed when treatment targets EASI ≤ 7 and NRS-pruritus ≤ 4, and discontinuation rates were taken into account.

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杜匹单抗与曲洛单抗治疗特应性皮炎：来自BioDay的倾向评分调整比较

背景：治疗特应性皮炎（AD）的Dupilumab和tralokinumab通过不同的作用机制靶向2型轴，这可能导致有效性和安全性的差异。然而，目前还缺乏面对面的试验。目的：比较dupilumab和tralokinumab治疗AD的实际有效性和安全性。方法：这项前瞻性队列研究招募了生物/Janus激酶inhibitor-naïve AD患者（≥12岁），这些患者来自BioDay注册中心，在2021年11月至2024年9月期间开始使用dupilumab或tralokinumab。随访时间为基线、4周和每3个月，直至52周。疗效指标包括湿疹面积和严重程度指数（EASI）、每周平均瘙痒数值评定量表（NRS）、治疗-目标阈值（EASI≤7；NRS-瘙痒≤4，患者停止治疗视为无反应）和药物生存期。在每次访问时评估不良事件（ae）。采用治疗加权逆概率（IPTW）来平衡各治疗组。结果：总共纳入750例患者（643例dupilumab； 107例曲罗单抗）。IPTW后，基线特征平衡良好。在随访期间，dupilumab患者的EASI评分低于tralokinumab患者，尽管差异不具有统计学意义（p = 0.10）。在所有就诊中，杜匹单抗的nrs -瘙痒评分显著降低(p)。结论：在这个真实世界的比较中，杜匹单抗与曲罗单抗相比提供了更好的疗效。在持续治疗的应答者中，EASI和nrs瘙痒差异很小。当治疗目标EASI≤7和nrs -瘙痒≤4时，观察到更实质性的差异，并考虑停药率。

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来源期刊

Journal of the European Academy of Dermatology and Venereology 医学-皮肤病学

CiteScore

10.70

自引率

8.70%

发文量

874

审稿时长

3-6 weeks

期刊介绍： The Journal of the European Academy of Dermatology and Venereology (JEADV) is a publication that focuses on dermatology and venereology. It covers various topics within these fields, including both clinical and basic science subjects. The journal publishes articles in different formats, such as editorials, review articles, practice articles, original papers, short reports, letters to the editor, features, and announcements from the European Academy of Dermatology and Venereology (EADV). The journal covers a wide range of keywords, including allergy, cancer, clinical medicine, cytokines, dermatology, drug reactions, hair disease, laser therapy, nail disease, oncology, skin cancer, skin disease, therapeutics, tumors, virus infections, and venereology. The JEADV is indexed and abstracted by various databases and resources, including Abstracts on Hygiene & Communicable Diseases, Academic Search, AgBiotech News & Information, Botanical Pesticides, CAB Abstracts®, Embase, Global Health, InfoTrac, Ingenta Select, MEDLINE/PubMed, Science Citation Index Expanded, and others.