Increased Frequency of Eosinophilia Examined With Dupilumab in Patients With Atopic Dermatitis

Close-up of eczema, showing an eczematous skin rash on the leg of a middle-aged male. Eczema (atopic dermatitis) is a chronic inflammatory skin disorder characterized by redness, itching, and scaly rashes.
Dupilumab demonstrated similar efficacy to that seen in clinical trials, but higher rates of conjunctivitis and eosinophilia.

Dupilumab is effective for reducing the severity of atopic dermatitis (AD) but may concomitantly increase the risk for eosinophilia, according to study findings reported in the Journal of the American Academy of Dermatology.

Data from a French multicenter retrospective cohort that consisted of consecutive adult patients with moderate to severe AD were included in the analysis. Patient cohorts received dupilumab and data from the SCORAD (Scoring Atopic Dermatitis), EASI (Eczema Area and Severity Index), DLQI (Quality of Life Index), and blood eosinophil (B-eos) counts at baseline and 3-month follow-up were collected.

Efficacy outcomes included the median percent change in SCORAD and EASI scores, mean change in DLQI, and the percentage of patients who achieved improvement on the SCORAD or EASI of 50% to ≥75% from baseline to follow-up. Eosinophilia was defined as B-eos >500 cells/mm3 and hypereosinophilia was defined as B-eos >1500 cells/mm3.

A total of 241 patients from 29 different hospitals were included in the dataset. At a median follow-up of 3.8±3.7 months, treatment with dupilumab was associated with a lower median SCORAD score compared with baseline (median percent change, −52.5±44; 56±27.4 vs 25±21, respectively; P <10-9).

Compared with baseline, lower median scores on the EASI (4.1±6.8 vs 17.9±15.4, respectively; P <10-9) and DLQI (4±8 vs 13±11, respectively; P <10-9) at 3 months were also observed. During treatment, 31.1% of patients had ≥1 event that was considered an AD flare; 20.8% were considered severe exacerbations of AD.

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Approximately 71% of patients experienced ≥1 adverse event during the trial period. The percentage of patients who continued treatment with dupilumab was high at 3 (95.6%) and 6 months (79.7%). Up to 56.5% of patients with at least 1 B-eos count within 6 months of follow-up had blood eosinophilia. A higher percentage of patients at follow-up had eosinophilia than at baseline (57% vs 33.7%, respectively; P <10-6).

Limitations of the study include its single-arm design, retrospective nature, the relatively small number of participants, and the limited follow-up duration.

The researchers concluded, “This real-life study of dupilumab in the treatment of AD in adults showed similar effectiveness results as those observed in clinical trials but showed a higher frequency of conjunctivitis and eosinophilia, which can call into question the continuation of treatment.”

Disclosures: Multiple researchers report receiving fees from Sanofi-Genzyme, Leo-Pharma, and Abvie, among others. For a full list of disclosures, please see the full study text.

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Faiz S, Giovannelli J, Podevin C, et al. Effectiveness and safety of dupilumab for the treatment of atopic dermatitis in a real-life French multicenter adult cohort [published online February 27, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.02.053