TY - JOUR
T1 - Dupilumab versus tralokinumab in atopic dermatitis
T2 - A propensity score adjusted comparison from BioDay
AU - van der Gang, Lian F
AU - Zuithoff, Nicolaas P A
AU - Haeck, Inge M
AU - Harbers, Veroniek E M
AU - Stadhouders-Keet, Simone
AU - Politiek, Klaziena
AU - Oosting, Albert J
AU - van Lynden-van Nes, Anneke M T
AU - Lam, Hoo-Yin
AU - van Tuyll van Serooskerken, Anne-Moon
AU - Stewart, Shiarra M
AU - Gostynski, Antoni
AU - Flinterman, Annebeth
AU - Velstra, Berit
AU - Touwslager, Wouter R H
AU - van Erp, Francine C
AU - Schuttelaar, Marie L A
AU - de Bruin-Weller, Marjolein S
AU - de Graaf, Marlies
N1 - Publisher Copyright:
© 2026 The Author(s). Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.
PY - 2026/8
Y1 - 2026/8
N2 - Background: Dupilumab and tralokinumab for atopic dermatitis (AD) target the type 2 axis through different mechanisms of action, which may lead to variation in effectiveness and safety. Head-to-head trials, however, are lacking. Objectives: To compare the real-world effectiveness and safety of dupilumab and tralokinumab in AD. Methods: This prospective cohort study enrolled biologic−/Janus kinase inhibitor-naïve AD patients (≥12 years) from the BioDay registry who initiated dupilumab or tralokinumab between November 2021 and September 2024. Visits were scheduled at baseline, 4 weeks and every 3 months up to 52 weeks. Effectiveness outcomes included Eczema Area and Severity Index (EASI), weekly mean pruritus Numeric Rating Scale (NRS), treat-to-target thresholds (EASI ≤ 7; NRS-pruritus ≤ 4, with patients discontinuing treatment considered non-responders) and drug survival. Adverse events (AEs) were assessed at each visit. Inverse probability of treatment weighting (IPTW) was used to balance treatment groups. Results: In total, 750 patients were included (643 dupilumab; 107 tralokinumab). After IPTW, baseline characteristics were well balanced. During follow-up, dupilumab patients had lower EASI scores than tralokinumab patients, although differences were not consistently statistically significant (p = 0.10). NRS-pruritus scores were significantly lower with dupilumab at all visits (p < 0.0001), mean differences did not exceed the 2-point clinical relevance threshold. The probability of achieving EASI ≤ 7 and NRS-pruritus ≤ 4 was higher with dupilumab (both p < 0.0001), with risk differences of 34.7% and 40.2% at 52 weeks, respectively. After 52 weeks, dupilumab drug survival was 92.6% vs. 70.6% for tralokinumab. Ocular surface disease incidence was similar (HR 1.0, 95% CI 0.6–1.6, p = 0.94) between treatments, leading to discontinuation of dupilumab in n = 23 (3.4/100 PY) and tralokinumab in n = 5 (5.4/100 PY). Conclusions: In this real-world comparison, dupilumab provided superior effectiveness compared with tralokinumab. In responders continuing treatment, EASI and NRS-pruritus differences were small. More substantial differences were observed when treatment targets EASI ≤ 7 and NRS-pruritus ≤ 4, and discontinuation rates were taken into account.
AB - Background: Dupilumab and tralokinumab for atopic dermatitis (AD) target the type 2 axis through different mechanisms of action, which may lead to variation in effectiveness and safety. Head-to-head trials, however, are lacking. Objectives: To compare the real-world effectiveness and safety of dupilumab and tralokinumab in AD. Methods: This prospective cohort study enrolled biologic−/Janus kinase inhibitor-naïve AD patients (≥12 years) from the BioDay registry who initiated dupilumab or tralokinumab between November 2021 and September 2024. Visits were scheduled at baseline, 4 weeks and every 3 months up to 52 weeks. Effectiveness outcomes included Eczema Area and Severity Index (EASI), weekly mean pruritus Numeric Rating Scale (NRS), treat-to-target thresholds (EASI ≤ 7; NRS-pruritus ≤ 4, with patients discontinuing treatment considered non-responders) and drug survival. Adverse events (AEs) were assessed at each visit. Inverse probability of treatment weighting (IPTW) was used to balance treatment groups. Results: In total, 750 patients were included (643 dupilumab; 107 tralokinumab). After IPTW, baseline characteristics were well balanced. During follow-up, dupilumab patients had lower EASI scores than tralokinumab patients, although differences were not consistently statistically significant (p = 0.10). NRS-pruritus scores were significantly lower with dupilumab at all visits (p < 0.0001), mean differences did not exceed the 2-point clinical relevance threshold. The probability of achieving EASI ≤ 7 and NRS-pruritus ≤ 4 was higher with dupilumab (both p < 0.0001), with risk differences of 34.7% and 40.2% at 52 weeks, respectively. After 52 weeks, dupilumab drug survival was 92.6% vs. 70.6% for tralokinumab. Ocular surface disease incidence was similar (HR 1.0, 95% CI 0.6–1.6, p = 0.94) between treatments, leading to discontinuation of dupilumab in n = 23 (3.4/100 PY) and tralokinumab in n = 5 (5.4/100 PY). Conclusions: In this real-world comparison, dupilumab provided superior effectiveness compared with tralokinumab. In responders continuing treatment, EASI and NRS-pruritus differences were small. More substantial differences were observed when treatment targets EASI ≤ 7 and NRS-pruritus ≤ 4, and discontinuation rates were taken into account.
KW - atopic dermatitis
KW - dupilumab
KW - evidence-based medicine
KW - observational study
KW - propensity score
KW - tralokinumab
UR - https://www.scopus.com/pages/publications/105035747990
U2 - 10.1111/jdv.70442
DO - 10.1111/jdv.70442
M3 - Article
C2 - 41969170
SN - 0926-9959
VL - 40
SP - 1359
EP - 1371
JO - JEADV : journal of the European Academy of Dermatology and Venereology
JF - JEADV : journal of the European Academy of Dermatology and Venereology
IS - 8
ER -