Study shows dupilumab efficacious in treating children with atopic dermatitis
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Key Takeaways:
- Dupilumab showed a reduction in atopic dermatitis symptoms in children.
- 10% of children might need alternative therapies due to side effects.
WASHINGTON — Using dupilumab to treat children with moderate to severe atopic dermatitis proved effective, according to a poster presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.
“As a multi-factorial etiology with a combination of environmental and genetic factors that ultimately lead to compromised epidermal function, [atopic dermatitis] affects around 15% of children in the U.K., and 3% to 8% of children have severe disease,” Mozhgan Hosseini-Ashrafi, a medical student from the University of Manchester, said during the presentation.
“It has a big disease burden and a large impact on the quality of life for patients and their daily activities such as playing, dressing and feeding,” she continued. “Current treatments for severe atopic dermatitis such as oral corticosteroids and systemic immunosuppressants have a large profile of adverse events that can also lead to refractory atopic dermatitis and discontinuation.”
The retrospective observational study examined the real-world outcomes and safety of dupilumab (Dupixent; Regeneron, Sanofi) in children with moderate to severe atopic dermatitis that attended a tertiary referral pediatric center at Royal Manchester Children’s Hospital in the U.K. All patients were under the care of pediatric allergist Peter D. Arkwright, MBBS, D Phil, FRCPCH, and consulting pediatric dermatologist Tim H. Clayton, MBCHB, MRCPCH, FRCP.
The study included 72 patients (median age, 14 years; age range, 7-18 years), of whom 88% did not achieve atopic dermatitis control with oral systemic immunosuppressants.
Within this cohort, 16 patients (21%) discontinued dupilumab, primarily due to atopic dermatitis remission (11%; n = 8). Six patients (8%) discontinued dupilumab due to lack of response.
Seventeen patients (26%) experienced adverse events, most commonly conjunctivitis at 17% (n = 12), followed by injection reactions (4%; n = 3) and psoriasiform rash (3%; n = 2).
Eight patients (11%) who had experienced adverse events discontinued dupilumab, including six with ongoing eczema flares, one case of severe allergic conjunctivitis and one patient who had unrelated Wilson’s disease.
The study used skin and quality of life scores to assess results. They used the Investigators Global Assessment, Eczema Area and Severity Index (EASI), and the Dermatology Life Quality Index (DLQI), as well as adverse events and discontinuation rates using descriptive statistics.
“EASI scores decreased by 94% (between 82% and 100%) in all children and remained consistently low over 10 to 15 months follow-up, with EASI scores in the final follow-up of 2 (between 0 and 6),” Hosseini-Ashrafi said.
The study concluded that 1 in 10 children were able to discontinue the drug due to remission and that dupilumab results in a significant reduction in atopic dermatitis to a 1 year follow-up.
“Dupilumab is effective in treating most children with moderate to severe atopic dermatitis with good safety outcomes in the real world,” Hosseini-Ashrafi said. “However, 10% of children may need alternative therapy because of drug ineffectiveness or side effects.”
Hosseini-Ashrafi expressed the need for further study across larger populations to examine the efficacy of dupilumab.
“This study was a single center study and, in the future, it would be beneficial to do a multi-center study throughout the U.K. to further assess safety and efficacy of dupilumab,” she said. “Longer follow-up would also be useful, particularly to explore the rate of reoccurrence of atopic dermatitis following discontinuation of dupilumab due to remission.”