(C-016) Characterizing dupilumab-naïve patients with bullous pemphigoid using US administrative claims data

Background: Bullous pemphigoid (BP) is a rare autoimmune disorder, and the patient population has not been well characterized in the real-world setting. Dupilumab has been found to achieve significant improvements in disease remission and symptoms in a BP pivotal study. Case reports/case series also showed its potential to help patients suffering from BP. This descriptive analysis provides information about patients with BP to better understand their characteristics.

Objectives: Describe the demographics, most common comorbidities, and medications used among dupilumab-naïve patients with BP.

Methods: Optum’s de-identified Clinformatics® claims database was used. Patients were included if they had ≥1 inpatient or ≥2 outpatient diagnosis codes of BP (ICD-10 L12.0) within 365 days from January 2017 to March 2023, and were required to be aged ≥1 year, have ≥365 days prior continuous enrollment, and no dupilumab dispensing within 365 days before or on the index date, which was defined as the first date when all the criteria were met. For contextualization, an individually matched control cohort without BP was created based on birth year, sex, and index year. Individuals were followed up until disenrollment, death, dupilumab initiation, a BP diagnosis (control cohort only), or end of data availability, whichever occurred first. Demographics at index date, the most common comorbidities and medications assessed during the follow-up period in the overall and age-stratified subgroups (1- < 18 years, 18- < 65 years, and ≥65 years) of both the BP and control cohorts were described.

Results: A total of 8595 patients with BP were identified. Patients were mostly aged ≥ 65 years (90.9%), and 54.9% were female. Among those ≥ 65 years, the most common comorbidities included essential hypertension, hyperlipidemia, and dyspnea in both the patients with BP and the matched control cohort. However, the prevalence of these conditions was higher in the patients with BP than the control cohort (essential hypertension, 81.6% vs. 64.3%; hyperlipidemia, 61.0% vs. 47.9%; and dyspnea, 40.1% vs. 25.6%). The most used medications among patients with BP included oral prednisone (59.1%), influenza vaccine (49.7%), and triamcinolone topical cream (22.4%).

Conclusions: Patients with BP were mainly elderly, with prednisone being the primary systemic corticosteroid used. A higher prevalence of comorbidities including hypertension and hyperlipidemia was observed in patients with BP compared to those without. This increased comorbidity burden, potentially linked to the known adverse reactions of systemic steroid use, underscores the critical need for developing and implementing targeted treatment strategies to optimize outcomes in patients with BP.