(028) Prescription Patterns After the Approval of Dupilumab, Abrocitinib, Baricitinib, and Upadacitinib in Adults with Atopic Dermatitis: A Real-World Evidence from a Multi-Institutional Database in Taiwan

Background: Treatment for atopic dermatitis (AD), a chronic inflammatory disease, often requires employing multiple medications. Clinical practices have evolved with the introduction of novel therapeutics, such as dupilumab and oral Janus kinase inhibitors (JAKis). However, evidence regarding prescription patterns remains limited after these changes and revisions to the National Health Insurance Payment Guidelines (NHIPG) for treating moderate-to-severe AD therapy in 2023.

Objectives: To investigate prescription patterns for adults with AD following the approval of dupilumab and three JAKis: abrocitinib, baricitinib, and upadacitinib. We analyzed the factors affecting prescription patterns between dupilumab and JAKis.

Methods: We conducted a retrospective cohort study encompassing AD patients over 18 newly initiated on dupilumab or JAKis between 2018 and 2023 using a multi-institutional electronic medical database in Taiwan. Owing to the NHIPG revision in 2023, patients from 2018 to 2022 were allocated to Group 1, while those from 2023 formed Group 2. We collated patients' characteristics that might affect prescription, including AD severity, sex, topical steroid and calcineurin inhibitors use, co-medication, and comorbidities. Factors influencing prescription patterns were examined using chi-square tests or t-tests.

Results: A total of 681 patients were enrolled (Group 1: 390, Group 2: 291). Compared to JAKis, dupilumab exhibited a higher prescription rate among patients with moderate-to-severe AD who were already using oral agents, namely methotrexate (Group 1: 35.3% vs. 21.1%, p=0.0097; Group 2: 47.7% vs. 19.9%, p< 0.0001), cyclosporine (Group 1: 50.9% vs. 44.2%, p=0.26; Group 2: 56.2% vs. 42.2%, p=0.0182), or azathioprine (Group 1: 38.0% vs. 20.0%, p=0.0013; Group 2: 44.6% vs. 22.4%, p< 0.0001). In terms of out-of-pocket expenditures for medications, self-pay patients in both Group 1 (97.9% vs. 65.8%; p< 0.0001) and Group 2 (85.1% vs. 42.3%; p< 0.0001) demonstrated a higher rate to opt for JAKis. Regarding specialties, rheumatologists prescribed JAKis more frequently to patients in Group 1 (11.6% vs. 5.4%) and Group 2 (11.2% vs. 5.4%), while no substantial disparity was noticed in dermatologists' prescriptions between dupilumab and JAKis. (Group 1: 90.5% vs 86.3%; Group 2: 92.3% vs. 87.6%).

Conclusions: Several factors, including the approval of new drugs, as well as changes to the NHIPG, have affected AD prescription patterns. A higher rate of taking JAKis has been discerned among self-pay patients and those who have visited rheumatologists. Nevertheless, a more extended observation is required to evaluate other factors impacting prescription trends and the therapeutic efficacy between dupilumab and JAKis in AD patients.