Concordance Between Patient- and Physician-Reported Improvement With Dupilumab in Atopic Dermatitis

Dupilumab is an FDA-approved biologic widely used in clinical practice for moderate to severe atopic dermatitis (AD). Concordance between physician and patient outcome assessment from medical records is relatively unknown. We examined patient-reported and physician-reported improvement patterns with dupilumab in outpatient dermatology practice. We conducted a single-center, retrospective cohort study of adults with moderate to severe atopic dermatitis who initiated dupilumab between 2017 and 2023. Improvement was abstracted from physician notes in the electronic medical record at each visit as a binary outcome (yes/no). Patient-reported improvement was defined as documentation of symptomatic benefit (e.g., reduced itch, fewer flares), and physician-reported improvement as clinical improvement on physical exam or overall disease control. Visits were grouped into predefined intervals from treatment initiation (0-14, 15-30, 31-60, up to > 365 days). 405 patients contributed 1064 visits (mean age 46.7 years, 55.8% male). Mean treatment duration was 3.2 years, with 59.0% remaining on therapy at study conclusion. Patient-reported improvement was documented in 948/1064 visits (89.1%), and physician-reported improvement was noted in 868/1064 visits (81.6%). Patient-reported improvement rates were 79.7% at 0-14 days and 93.9% at 91-120 days from dupilumab initiation. Patient-physician concordance occurred in 946/1064 visits (88.9%). Treatment persistence was 86.2% at 12 months and 73.1% at 36 months. The most common reasons for treatment discontinuation were inefficacy (23.9%), adverse events (21.1%), and clinical improvement (21.1%). Dupilumab was associated with high rates of patient- and physician-reported improvement and treatment persistence in adults with moderate to severe atopic dermatitis.