Dupilumab impact on psychiatric and sleep disorder risk reduction in atopic dermatitis: A population-based cohort study

Teng-Li Lin; Yi-Hsuan Fan; Kuo-Sheng Fan; Chao-Kuei Juan; Yi-Ju Chen; Chun-Ying Wu

doi:10.1016/j.anai.2024.11.016

Dupilumab impact on psychiatric and sleep disorder risk reduction in atopic dermatitis: A population-based cohort study

Ann Allergy Asthma Immunol. 2024 Nov 28:S1081-1206(24)01707-1. doi: 10.1016/j.anai.2024.11.016. Online ahead of print.

Authors

Teng-Li Lin¹, Yi-Hsuan Fan², Kuo-Sheng Fan³, Chao-Kuei Juan⁴, Yi-Ju Chen⁵, Chun-Ying Wu⁶

Affiliations

¹ Department of Dermatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; PhD Program of Interdisciplinary Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
² Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan.
³ Division of Chest Medicine, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
⁴ Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan.
⁵ Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; Faculty of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. Electronic address: [email protected].
⁶ Faculty of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Translational Research, Taipei Veterans General Hospital, Taipei, Taiwan; College of Public Health, China Medical University, Taichung, Taiwan.

PMID: 39613228
DOI: 10.1016/j.anai.2024.11.016

Abstract

Background: Patients with atopic dermatitis (AD) have a higher risk of developing psychiatric and sleep disorders.

Objective: To compare the risk of psychiatric and sleep disorders in patients with AD treated with dupilumab vs those on conventional drugs (systemic corticosteroids, methotrexate, cyclosporin, and azathioprine).

Methods: This retrospective cohort study used the TriNetX Global Collaborative Network (LLC, Cambridge, MA) and included adult patients with AD newly prescribed dupilumab (DUPI-cohort) or conventional drugs without previous dupilumab exposure (CONV-cohort). Propensity score matching was performed for age, sex, race, comorbidities, and laboratory measures. Risks of various psychiatric disorders, such as anxiety, depressive disorders, adjustment disorders, and attention deficit hyperactivity disorder, including sleep disorders, were compared between cohorts, with hazard ratios determined using Cox regression.

Results: After matching, both the DUPI- and CONV-cohorts included 6114 patients each, with an average age of 44 years and 53% female. The racial distribution in both cohorts was approximately 49% White, 15% Black or African American, and 12% Asian. During the 3-year follow-up, the DUPI-cohort had reduced risks of anxiety (hazard ratio 0.76, 95% CI 0.64-0.89), depressive disorders (0.70, 0.58-0.86), adjustment disorders (0.535, 0.37-0.78), and sleep disorders (0.78, 0.65-0.94), whereas the risk of attention deficit hyperactivity disorder was not significantly affected (0.92, 0.61-1.38). These findings were consistent across age groups, sexes, races, and atopic comorbidities, with a more pronounced effect in Black or African American patients.

Conclusion: Patients with AD prescribed dupilumab exhibited a lower risk of psychiatric and sleep disorders, with the effect being more evident within the Black or African American subgroup.