Dupilumab Impact on Psychiatric and Sleep Disorder Risk Reduction in Atopic Dermatitis: A Population-Based Cohort Study

To evaluate the risk of developing psychiatric or sleep disorders in patients with atopic dermatitis (AD) treated with dupilumab compared with those treated with other medications.The population comprised patients older than 18 years with at least 2 diagnoses of AD made 30 days apart and without any existing psychiatric or sleep disorders. Data were retrieved from the Global Collaborative Network within the TriNetX database, containing anonymized data for 148 million patients in 17 countries. Patients were separated into 2 groups: one prescribed dupilumab therapy and another prescribed other medications, including systemic corticosteroids or traditional immunomodulators.The groups were matched 1:1 based on age, sex, race, comorbidities, laboratory measures, and previous use of systemic antihistamines. Outcomes included incidence of anxiety, depressive disorders, adjustment disorders, attention-deficit/hyperactivity disorder (ADHD), and sleep disorders. Outcomes were measured after 6 months of therapy to allow for adequate treatment time, and patients were observed for up to 3 years.Compared with the group receiving conventional therapy, the dupilumab group had reduced risks of anxiety (hazard ratio [HR] 0.76, 95% CI 0.64-0.89), depressive disorders (0.70, 0.58-0.86), adjustment disorders (0.54, 0.37-0.78), and sleep disorders (0.78, 0.65-0.94) over a 3-year period. ADHD risk was not significantly affected. Subgroup analyses were performed, stratified by age, sex, race, and other atopic comorbidities. Among Black or African American patients, a greater risk reduction in anxiety was seen in the dupilumab group compared with the unstratified group (HR 0.41 vs 0.76). Similarly, the risk of depressive disorders was lower (HR 0.40 vs 0.70), as was the risk of adjustment disorders (HR 0.23 vs 0.54) and sleep disorders (HR 0.62 vs 0.78), in the Black or African American subgroups.Psychiatric and sleep disorders can cause great distress for individuals with AD. It is postulated that this is related to social stigmatization and significant pruritus. However, interleukin 4 (IL-4) and IL-13, which are targeted by dupilumab, have also been linked to anxiety symptoms. The risk reduction of psychiatric and sleep disorders seen in the dupilumab group in this study highlights unique benefits of therapy, as it may help with quality of life and reducing impairment in activities of daily life.Pediatricians are aware of the negative impact AD can have on patients. With a growing mental health crisis among the pediatric population, reduced risk of psychiatric and sleep disorders for patients with AD, in addition to symptom improvement with dupilumab, would be a desirable outcome. Further investigation is needed to see whether similar benefits for the pediatric population are seen as those for adults in the study.