Dupilumab Promising in Children and Adolescent With Atopic Dermatitis

Dupilumab was efficacious and well tolerated regardless of sex, age, or race/ethnicity in treatment of adolescent and pediatric atopic dermatitis (AD). These are among the study findings published in The Journal of Allergy and Clinical Immunology: In Practice.

AD affects more than 15% of children and adolescents, disproportionally affecting African American children with more severe symptoms compared with European American children, and impairing quality of life to a greater extent in Hispanic children compared with non-Hispanic children. Persistent disease in adulthood is a common outcome among children and adolescents with AD particularly those with onset after 5 years of age and/or with severe disease, it was noted. Researchers aimed to evaluate adolescents and children with AD treated with dupilumab to characterize adverse events and long-term treatment responses.

They initiated a retrospective observational study reviewing electronic medical records from March 2017 through September 2021 of patients younger than 19 years of age with moderate-to-severe AD treated with dupilumab. Some patients were treated off-label. Measurements showed body surface area (BSA) (49.1±24.0), investigator’s global assessment (IGA) (37.0±11.6), and eczema area and severity index (EASI) (3.4±0.5) before dupilumab treatment. All patients were receiving topical corticosteroids at baseline, 73% topical calcineurin inhibitors, and 51.7% crisaborole.

Before starting dupilumab, almost half of the study cohort received treatment with a systemic immunosuppressant. Almost three-quarters of the cohort had at least 1 atopic comorbidity before starting dupilumab, more than half with allergic rhinitis and/or conjunctivitis, and food allergies, and more than a third of patients had asthma.

Of the 89 patients (56.2% girls; 47.2% European American, 18.1% Hispanic, 15.7% African American, 15.7% Asian American; age of AD onset 4.1±4.2 years; duration of AD 9.3±4.3 years; treatment duration 1.3±0.9 years) 73 had baseline assessments and week 12 through 24 score improvements in BSA (63.1%±29.2%), IGA (39.6%±29.9%), and EASI (59.6%±30.7%) (P <.001 for all). The most typical dosing regimen was 300 mg dupilumab every 2 weeks.

Among the 23 patients treated with dupilumab for at least 1 year, 100% reached EASI-75 and IGA 0/1, and 60.8% reached EASI-90. Researchers noted improvements compared with baseline for BSA (89.1%±10.8%), IGA (72.5%±12.2%), and EASI (89.1%±7.2%), (P <.001 for all).

Higher percent improvement in BSA at weeks 12 through 24 was associated with positive history of atopy (P <.05). Just more than 13% of patients reported adverse events, none serious. Conjunctivitis (5.6%) and joint pain (2.2%) were most common.

Study limitations include the retrospective nature, single-center cohort, and unaccounted for confounders in patient location, prescribers’ assessments, and insurance coverage.

Researchers concluded that, “Dupilumab was well tolerated and effective in treating pediatric and adolescent AD regardless of age, sex, or race/ethnicity.” They also observed a reduction in concomitant AD treatments and, “a significant association between prior history of atopy and greater improvement in body surface area posttreatment.”

Disclosure: A study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Pagan AD, David E, Ungar B, Ghalili S, He H, Guttman-Yassky E. Dupilumab improves clinical scores in children and adolescents with moderate to severe atopic dermatitis: a real-world, single-center study. J Allergy Clin Immunol Pract. Published online June 24, 2022. doi:10.1016/j.jaip.2022.06.014