Real-World Dupilumab Use in Atopic Dermatitis: Persistence and Treatment Gaps Unveiled

Dupilumab shows substantial declines in continuous use over two years in routine practice, indicating many patients with atopic dermatitis will not remain on the biologic as a single long‑term strategy.

Randomized trials report high response rates and durable benefit for many patients, but real‑world persistence diverges from trial retention.

A Journal of Dermatologic Drugs analysis of roughly 5,200 patients found dupilumab persistence of about 74–82% at 12 months across age bands, falling to roughly 56–71% by 24 months; adults experienced the steepest decline.

By two years, many patients had received supplemental systemic agents and topical treatments, suggesting incomplete control on monotherapy for a substantial subgroup.

Evidence of reduced persistence and frequent supplementation supports shifting practice toward scheduled persistence checks, standardized outcome measures, and predefined escalation pathways. Research priorities include clarifying reasons for discontinuation and comparing durability across newer agents.

Key Takeaways:

• Real‑world retention on Dupilumab declines significantly by 24 months; anticipate treatment changes within two years.
• A substantial proportion of patients require systemic or topical adjuncts, indicating monotherapy may not sustain control for all.
• Institute routine persistence monitoring and predefined escalation plans to reduce symptom burden and optimize long‑term outcomes.