Biologic Prescription Patterns and Biomarker Determinants of First-Line Dupilumab in Danish Adult Patients With Severe Asthma and Comorbid Atopic Dermatitis

TY - JOUR

T1 - Biologic Prescription Patterns and Biomarker Determinants of First-Line Dupilumab in Danish Adult Patients With Severe Asthma and Comorbid Atopic Dermatitis

AU - Soendergaard, Marianne Baastrup

AU - Håkansson, Kjell Erik Julius

AU - Hansen, Susanne

AU - Bjerrum, Anne-Sofie

AU - Schmid, Johannes Martin

AU - Johansson, Sofie Lock

AU - Rasmussen, Linda Makowska

AU - Bonnesen, Barbara

AU - Vijdea, Roxana

AU - von Bülow, Anna

AU - Krogh, Niels Steen

AU - Hilberg, Ole

AU - Thomsen, Simon Francis

AU - Ulrik, Charlotte Suppli

AU - Porsbjerg, Celeste

N1 - © 2025 The Author(s). Clinical & Experimental Allergy published by John Wiley & Sons Ltd.

PY - 2025/7/15

Y1 - 2025/7/15

N2 - Background: Asthma and atopic dermatitis are common type-2 (T2)-driven diseases that often coexist, although different T2 biomarkers indicate disease severity in each condition. Multiple biologics target T2 inflammation, but only dupilumab has been approved for both diseases. Little is known about patients with severe asthma and comorbid atopic dermatitis, particularly regarding how this comorbidity influences the choice of biologic for severe asthma. Methods: We utilised the nationwide Danish Severe Asthma Register to characterise patients with severe asthma and comorbid atopic dermatitis, and describe prescription patterns of biologics in patients with and without comorbid atopic dermatitis. We compared biomarker determinants of first-line dupilumab prescription between the two groups using a multivariate logistic regression model adjusting for age and sex. Results: We identified 1137 patients initiating a biologic for severe asthma, of whom 192 (17%) had comorbid atopic dermatitis. Patients with comorbid atopic dermatitis more often had childhood-onset asthma with an allergic phenotype. The prescription patterns of biologics differed according to comorbid atopic dermatitis status, and patients with comorbid atopic dermatitis were more likely to switch (OR 3.02, p < 0.001). In patients with comorbid atopic dermatitis, elevated IgE was the strongest biomarker determinant of first-line dupilumab prescription (OR 8.77, p < 0.001), whereas in patients without, it was elevated FeNO (OR 1.76, p = 0.03). Conclusion: Biologic prescription patterns in severe asthma vary according to comorbid atopic dermatitis status. In patients with comorbid atopic dermatitis, elevated IgE predicts first-line dupilumab prescription, indicating that the severity of atopic dermatitis influences treatment decisions. Additional research is needed to explore the management of coexisting T2 diseases with biological therapies.

AB - Background: Asthma and atopic dermatitis are common type-2 (T2)-driven diseases that often coexist, although different T2 biomarkers indicate disease severity in each condition. Multiple biologics target T2 inflammation, but only dupilumab has been approved for both diseases. Little is known about patients with severe asthma and comorbid atopic dermatitis, particularly regarding how this comorbidity influences the choice of biologic for severe asthma. Methods: We utilised the nationwide Danish Severe Asthma Register to characterise patients with severe asthma and comorbid atopic dermatitis, and describe prescription patterns of biologics in patients with and without comorbid atopic dermatitis. We compared biomarker determinants of first-line dupilumab prescription between the two groups using a multivariate logistic regression model adjusting for age and sex. Results: We identified 1137 patients initiating a biologic for severe asthma, of whom 192 (17%) had comorbid atopic dermatitis. Patients with comorbid atopic dermatitis more often had childhood-onset asthma with an allergic phenotype. The prescription patterns of biologics differed according to comorbid atopic dermatitis status, and patients with comorbid atopic dermatitis were more likely to switch (OR 3.02, p < 0.001). In patients with comorbid atopic dermatitis, elevated IgE was the strongest biomarker determinant of first-line dupilumab prescription (OR 8.77, p < 0.001), whereas in patients without, it was elevated FeNO (OR 1.76, p = 0.03). Conclusion: Biologic prescription patterns in severe asthma vary according to comorbid atopic dermatitis status. In patients with comorbid atopic dermatitis, elevated IgE predicts first-line dupilumab prescription, indicating that the severity of atopic dermatitis influences treatment decisions. Additional research is needed to explore the management of coexisting T2 diseases with biological therapies.

UR - https://www.scopus.com/pages/publications/105010679640

U2 - 10.1111/cea.70117

DO - 10.1111/cea.70117

M3 - Journal article

C2 - 40662227

SN - 0954-7894

JO - Clinical and Experimental Allergy

JF - Clinical and Experimental Allergy

ER -