Dupilumab Survival Compared to Upadacitinib, Tralokinumab in Atopic Dermatitis

New findings suggest that drug survival among patients with atopic dermatitis at the 12 and 24-month marks is higher for dupilumab, followed by upadacitinib and then tralokinumab, although biologic- and JAK-naïve individuals saw comparable drug survival rates with dupilumab and upadacitinib.1

These data represent the conclusion of new research conducted to expand upon available large-scale and real-world data on rates of drug survival, specifically across various atopic dermatitis drugs. Tiago Torres, from the department of dermatology at the Centro Hospitalar Universitário de Santo António Porto in Portugal, authored this study along with a team of investigators.

“Drug survival (DS), defined as the duration of time a patient remains on treatment before discontinuation, is an important measure of long-term effectiveness, safety and adherence to a certain drug,” Torres et al. wrote. “However, large-scale real-world studies comparing DS across different treatments for [atopic dermatitis] remain scarce.”1,2

Analyzing Differences Between Rates of Drug Survival

In their evaluation of drug survival rates in individuals diagnosed with atopic dermatitis, the investigative team looked at the rates of dupilumab, tralokinumab, and upadacitinib, with an international, retrospective trial design. There were 16 dermatology centers in which this research took place, including such countries as Canada, Greece, and Portugal.

The team assessed rates of drug survival through the use of the Kaplan–Meier estimator and proportional hazards Cox regression models. They included in their research individuals who were aged 12 years and older that had been given atopic dermatitis therapy in the time period between October 2017 - March 2023.

Among the 2,038 treatment courses that the investigators analyzed, it was noted that 75.9% of the patients evaluated had been treated with dupilumab, 15.8% with upadacitinib, and 8.3% with tralokinumab. At the point of baseline, the research team highlighted those included in the study’s dupilumab arm were shown to have Eczema Area and Severity Index (EASI) scores that were substantially higher (24.3 ± 14.3) than scores in either the tralokinumab arm (21.6 ± 10.9) or upadacitinib arm (17.1 ± 11.5; P < .001).

Previous utilization of JAK inhibitors were noted by the investigators as more frequent among those in the tralokinumab group, with 7.1% reporting JAKi administration versus 2.0% in the dupilumab group and 2.2% in the upadacitinib group (P < .001). In the upadacitinib cohort, it was reported by the team that a greater proportion of subjects had previously been given biologic therapies, with 44.1% as opposed to the 0.7% and 28.7% rates in the dupilumab and tralokinumab cohorts (P < .001).

The analysis further demonstrated that the group with the greatest prevalence of atopic comorbidities were the upadacitinib arm with 54.3%, then tralokinumab with 38.8%, and finally dupilumab with 30.8% (P < .001). In their findings on cessation of treatment, it was noted that 11.4% of those given dupilumab had discontinued, followed by 19.4% of those given tralokinumab, and 11.8% of those given upadacitinib.

The investigators determined that the main reason behind cessation had been the perceived loss of efficacy, with 5.6% of those discontinuing dupilumab reporting this reason, 11.2% for tralokinumab, and 2.8% for upadacitinib. It was also noted that discontinuation was undertaken due to adverse events among 3.4% for the dupilumab arm, 2.9% for tralokinumab, and 5.6% for upadacitinib.

When the research team highlighted any other factors that had led to medication discontinuation, examples included loss to follow-up and pregnancy and conjunctivitis, with the latter reason exclusively impacting the dupilumab group.

By the 12- and 24-month follow-up interactions, the team reported the highest drug survival rates for dupilumab, with rates of 92.9% and 86.3%, respectively. Second to dupilumab was the survival rate of upadacitinib, with 90.2% and 78.7% and both time points, respectively.

Lastly, tralokinumab had a survival rate of 78.1% and 66.8% at the 12- and 24-month follow-ups, respectively. Following the investigators’ multivariate analysis, dupilumab was confirmed as having maintained superior rates.

The 12- and 24-month drug survival rates among individuals deemed biologic- and JAK inhibitor-naïve remained highest for dupilumab, with rates of 93.1% and 86.6%, respectively. The rates of upadacitinib were 92.0% and 89.2% and tralokinumab’s survival rates were comparatively lower, with 84.6% and 66.0%, respectively. In other notable findings, the analysis suggested that male gender had been significantly linked to an increase in discontinuation likelihood.

“Although limited by its retrospective design, sample heterogeneity and the small number of patients remaining on tralokinumab after 12 months, our study highlights the high survival rates of all drugs after 2 years of treatment,” they wrote.1

References

1. Torres, T., Yeung, J., Chiricozzi, A., et al (2025). Drug survival of dupilumab, tralokinumab and upadacitinib in patients with atopic dermatitis: An international, real-world comparative study. J Eur Acad Dermatol Venereol. https://doi.org/10.1111/jdv.20581.
2. van den Reek JMPA, Kievit W, Gniadecki R, Goeman JJ, Zweegers J, van de Kerkhof PCM, et al. Drug survival studies in dermatology:principles, purposes, and pitfalls. J Invest Dermatol. 2015; 135(7): 1–5.