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A-STAR register, comparing dupilumab and methotrexate in atopic dermatitis: Carsten Flohr, EADV 2023

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Published Online: Oct 13th 2023

A-STAR is the The UK-Irish Atopic Eczema Systemic Therapy Register, an observational study investigating short and long-term safety and efficacy of systemic immuno-modulators for people with atopic dermatitis. The register also assesses the ‘real life’ cost of eczema treatments, comparing therapeutic costs with efficacy.

touchDERMATOLOGY caught up with Prof. Carsten Flohr (Guy’s & St Thomas’ NHS Foundation Trust, London, UK) to discuss participants, treatments and outcome measures of the A-STAR register and the comparative efficacy and safety findings.

This information is provided solely by Touch Medical Media and is independent of any sponsorship or affiliation with the European Academy of Dermatology & Venereology (EADV).

Comparing the treatment effectiveness and safety of dupilumab and methotrexate in paediatric and adult atopic dermatitis: results from the A-STAR register‘ was presented at EADV 2023, Berlin, 11-14 October 2023 #EADVCongress.


  1. What impact has dupilumab had on the treatment paradigm for atopic dermatitis since its approval? (0:12)
  2. Could you give us a brief overview of the participants, treatments and outcome measures of the A-STAR register? (0:42)
  3. What were the aims and design of your analysis of the A-STAR register? (1:09)
  4. What were the comparative efficacy and safety findings of your study? (1:57)
  5. What were the key take home messages from your study? (2:50)

Disclosures: Carsten Flohr has nothing to disclose in relation to this video interview.

Support: Interview and filming supported by Touch Medical Media Ltd. Interview conducted by Victoria Jones and Katey Gabrysch.

Filmed in coverage of the EADV Annual Meeting.

Click here for more content on atopic dermatitis & for further EADV 2023 highlights visit here.


What impact has dupilumab had on the treatment paradigm for atopic dermatitis since its approval?

It’s been a game changer.

I mainly look after children, so turning lives around in a big way. We see a lot of anxiety and depression in our patients with severe atopic dermatitis. A drug like dupilumab is a Godsend for a lot of patients, but there is a group of patients, approximately 20 % or so who do not respond adequately to the dupilumab, therefore, there is still a need for other medications as well.

Could you give us a brief overview of the participants, treatments and outcome measures of the A-STAR register?

A-STAR, stands for the UK-Irish Atopic Eczema Systemic Therapy Register, which runs in the UK and Ireland, which I coordinate. The registry recruits adults and children at any age, if they have started a systemic medication. For example, that could be a conventional drug like cyclosporine or methotrexate, or a newer treatment such as dupilumab or tralokinumab, or one of the JAK-inhibitors.

What were the aims and design of your analysis of the A-STAR register? 

A-STAR has several aims. The first one is to study the short and long term effectiveness of the medications that our patients are on. That’s the conventional like methotrexate cyclosporine, as well as the new ones, like dupilumab, we already mentioned, or the JAK inhibitors, we’re interested in adverse events. So what sort of side effects people have on these medications, some rare ones like cancer will be important as time goes on and the participant numbers in A-STAR go up, and there’s some more short term adverse events like conjunctivitis, which you see in the patient’s on dupilumab we’re interested in. And then, we’re doing a comprehensive health economic assessment as well just to see what the cost is per improvement that patients are experiencing on the various drugs.

What were the comparative efficacy and safety findings of your study?

It’s important to remember that A-STAR is a real world registry, and that the drugs we compared to dupilumab versus cyclosporin versus methotrexate are not used at the same time within the treatment pathway.

Because of the NICE stipulation in the UK that you have to travel through a conventional immunomodulator drug first (e.g. cyclosporin and methotrexate) before we can entertain a new one like dupilumab, the data that we showed on Wednesday as the EADV, and that suggested that dupilumab works almost as well as cyclosporin, has to be seen in that context. So that dupilumab improvement was actually seen in patients who already had either methotrexate or cyclosporin, and that’s really impressive to see that you see that degree of improvement still in people who were struggling on the conventional immunosuppressive drugs.

What were the key take home messages from your study?

Even in patients who were not systemic naïve, they start dupilumab in the UK context, another healthcare context, whether the drug like cyclosporin and methotrexate has been used first, and people don’t respond to that drug adequately, you still see an significant impact, positive impact, of dupilumab on those patients atopic dermatitis.

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