Measuring Real-World Effectiveness of Dupilumab Using IGA Scores to Reduce Symptom Severity Landing Page

According to results of a real-world effectiveness study, patients with moderate-to-severe atopic dermatitis (AD) achieved meaningful improvements in signs and symptoms based on ­­investigator global assessment (IGA) scores and peak pruritus numerical rating scale (PNRS).

Lead study author Lawrence F Eichenfield, MD, departments of dermatology and pediatrics, University of California, San Diego School of Medicine, San Diego, CA, and colleagues conducted the retrospective, cohort study using data the 0-5 point IGA scores to access AD severity (0=clear; 5=severe) and a 0-10 point PNRS for the severity of AD itch. Data was examined from Modernizing Medicine’s dermatology-specific electronic medical records (EMR), from more than 5000 dermatologists.

Included patients met the following criteria: at least 18-years-old or older when first initiating dupilumab; more than 1 dupilumab prescription between April 1, 2017 and November 30, 2017 (index period); IGA score recorded in the EMR within 3 months prior or 4 months post index date, and an IGA score of ≥3.

Of the 2945 adult patients with more than 1 dupilumab prescription in the index period, 211 patients (7%) had pre- and post-index IGA scores recording in the EMR, and all inclusion criteria was met by 187 patients (6.3%)—who became the final study cohort. Mean age was 42.3 years and patients were 52.3% male.

The final study cohort was observed from April 1, 2016 through March 31, 2018. During that period, nearly one-third of the sample (n=60; 32.1%) achieved a post-index IGA score of 0/1 (clear/minimal). Another third of the patient sample (n=63; 33.7%) achieved a post index score of 2 (mild). Overall, 79.1% of the patients had a post-index IGA score that was at least one point lower than the pre-index score.

In regards to PNRS outcomes, 32 (17.1%) patients in the analytic sample had a PNRS recorded during the index period. Baseline PNRS was 4.59 (±3.79). Post index PNRS for the same patients was 2.19 (±2.76), with a pre-post change in PNRS of –2.41 (±3.8).

Dr Eichenfield and colleagues explained that these real-world results are comparable to results seen in dupilumab clinical trials but note that clinical trials used a 0-4 point scale for IGA instead of the 0-5 point scale in this study, “thus requiring a greater point reduction for a severe patient in the current study to achieve IGA 0/1 than in clinical trials.”

“Clinicians should be encouraged to assess and record these outcomes more routinely in clinical practice,” concluded the researchers.

—Edan Stanley 

Reference:
Eichenfield LF, Armstrong A, Guttman-Yassky E, et al. Real-world effectiveness of dupilumab based on investigator global assessment (IGA) scores and peak pruritus numerical rating scale (PNRS) in an electronic medical records dataset. Poster presented at the 77th Annual Meeting of the Society for Investigative Dermatology (SID); May 8–11, 2019; Chicago, ILP.