O06 Association between novel systemic immunomodulatory medications and achievement of super response in patients with moderate-to-severe atopic eczema: results from the UK–Irish Atopic Eczema Systemic Therapy Register (A-STAR)

Abstract Previous post hoc analyses of randomized controlled trial data demonstrated that more patients with atopic eczema (AE) on Janus kinase (JAK) inhibitors achieve ‘super response’ (defined as total or nearly total clearance of AE) compared with dupilumab. However, there is a lack of head-to-head comparisons between conventional and novel systemic medications in patients with AE achieving super response in a real-world setting. The aim of this analysis was to explore the association between systemic medications used in patients with AE and patients achieving super response in the UK–Irish Atopic Eczema Systemic Therapy Register (A-STAR). A-STAR is a multicentre prospective observational register in the UK and Ireland aimed at evaluating the real-world effectiveness and safety of systemic treatments in AE. Patients in A-STAR who initiated conventional systemics (oral or subcutaneous methotrexate or ciclosporin), dupilumab or a JAK1 inhibitor (abrocitinib or upadacitinib) were included in this analysis. The outcomes assessed were Eczema Area and Severity Index (EASI), Peak Pruritus Numerical Rating Scale (PP-NRS) and Children’s Dermatology Life Quality Index or Dermatology Life Quality Index (C/DLQI). Patients were stratified by the medications prescribed at baseline. Super response was defined as achieving ≥ 90% improvement in EASI (EASI 90), PP-NRS of 0 or 1 (PP-NRS 0/1) and C/DLQI of 0 or 1 (C/DLQI 0/1) at any timepoint during the follow-up (censored at 500 days). Cox regression was used to assess the association between systemic medication exposure and time to achieve super response. Methotrexate was used as a reference medication. Hazard ratios and 95% confidence intervals were estimated. Risk estimates were adjusted for baseline EASI, C/DLQI, PP-NRS, ethnicity, age, sex, education level, age of AE onset, number of prior systemic treatments, concomitant oral corticosteroids and Fitzpatrick skin type. In total 649 patients were included in the analysis. The medications used were methotrexate (n = 157), ciclosporin (n = 48), dupilumab (n = 299) and JAK1 inhibitors (n = 88). The patients’ mean age was 28.7 years (SD 15.6), the mean (SD) baseline EASI was 18.2 (12.3), mean (SD) baseline PP-NRS 6.5 (2.5) and mean (SD) baseline C/DLQI 14.4 (8.1). The results for the Cox regression are summarized in the Table. Using methotrexate as the reference, both dupilumab and JAK1 inhibitors were associated with significantly more patients achieving super response in crude and adjusted models. In conclusion, treatment with dupilumab and JAK1 inhibitors is associated with a higher proportion of patients with AE achieving super response, compared with methotrexate, despite these treatments being mainly used after failure of conventional systemic medication.TableAssociation between novel systemic immunomodulatory medications and achieving super response in patients with moderate-to-severe AE. Data are expressed as the hazard ratio (95% confidence interval) CrudeAdjustedMethotrexate1 (reference)1 (reference)Ciclosporin2.25 (0.59–8.52)2.79 (0.56–13.9)Dupilumab2.20 (1.04–4.69)3.03 (1.23–7.46)JAK1 inhibitors2.75 (1.58–8.36)5.89 (2.09–16.6)