More favourable treatment responses and higher drug persistence have been observed with dupilumab than with tralokinumab in moderate-to-severe atopic dermatitis, according to a recent analysis of Dutch registry data.
Real-world evidence is increasingly important in guiding treatment for moderate-to-severe atopic dermatitis (AD), where multiple biologics are now available, but direct comparative trials are lacking.
A prospective, multicentre cohort study published in the Journal of the European Academy of Dermatology and Venereology addressed this gap by comparing the effectiveness and safety of dupilumab and tralokinumab in 750 biologic- and Janus kinase (JAK) inhibitor-naive patients, using data from the BioDay registry.
Patients were aged 12 years or older with moderate-to-severe AD, of whom 643 received dupilumab and 107 tralokinumab. They were followed up for 52 weeks, with outcomes assessed at baseline, four weeks and every three months thereafter.
Primary outcomes included absolute Eczema Area and Severity Index (EASI) and weekly mean pruritus numeric rating scale (NRS) scores, alongside treat-to-target thresholds of EASI ≤ 7 and NRS ≤ 4. Safety outcomes included adverse events, serious adverse events and treatment discontinuation.
Dupilumab pruritus scores and adverse events
Dupilumab was associated with consistently lower pruritus scores than tralokinumab at all follow-up visits (P < 0.0001), although mean differences (0.8–1.4 points) did not meet the predefined threshold for clinical relevance.
EASI scores were also lower with dupilumab, but differences were not consistently statistically significant over time (P=0.10).
Differences were more pronounced when treatment targets were considered. At 52 weeks, the probability of achieving the EASI and NRS treat-to-target thresholds was significantly higher with dupilumab, with adjusted risk differences of 34.7% and 40.2%, respectively.
These findings reflect both symptom control and the higher discontinuation rates with tralokinumab, which were classified as non-response.
Dupilumab showed increased treatment persistence, with a 52-week drug survival rate of 92.6% compared with 70.6% for tralokinumab. Discontinuation due to ineffectiveness was more common with tralokinumab (18.7% vs 5.4%).
Adverse events occurred at similar rates across groups, with ocular surface disease the most frequently reported event, but incidence did not differ significantly between treatments (hazard ratio [HR] 1.0; 95% CI 0.6–1.6; P=0.94).
Hair loss was reported more frequently with tralokinumab, although interpretation was limited by incomplete subtype classification. Serious adverse events were rare and not considered related to treatment.
Similar safety but superior effectiveness
Some study limitations needed to be acknowledged, including the observational design and potential residual confounding despite statistical adjustment. Small sample sizes for tralokinumab and adolescents also led to wider confidence intervals and limited subgroup analyses, respectively.
Considering the overall findings, the authors concluded that, although dupilumab and tralokinumab have similar safety profiles, dupilumab might provide better real-world effectiveness, especially when considering treatment goals and discontinuation rates.
Further prospective studies, including comparisons with other biologics and JAK inhibitors, as well as cost-effectiveness analyses, were advocated by the authors to better inform clinical decision-making.
Reference
van der Gang LF et al. Dupilumab versus tralokinumab in atopic dermatitis: a propensity score adjusted comparison from BioDay. J Eur Acad Dermatol Venereol 2026;Apr 13:doi:10.1111/jdv.70442.
This article was originally published by our sister publication Hospital Healthcare Europe.
