Experience using dupilumab for pediatric atopic dermatitis at a tertiary care c enter: Inadequate response and adverse events

Abstract

Background/Objective: Dupilumab is highly effective in treating atopic dermatitis (AD). However, some patients experience difficulties with dupilumab therapy, such as inadequate clinical response, failure to achieve long-term disease control, or adverse events (AEs). Our objective is to assess inadequate response and AEs occurring in children on dupilumab therapy for AD.Methods: This is a retrospective cohort study of children on dupilumab for AD.Collected variables included patient demographics, medical histories, and dupilumab therapy characteristics. Response analysis was conducted in those with ≥3 months of dupilumab therapy: primary poor responders were defined as those whose EASI scores did not decrease by >50%, and secondary poor responders were those who initially responded but had significant AD flares while on therapy. Results:We included 200 patients on dupilumab for AD in our cohort; 192 received ≥3 months of therapy and were included in our response analysis. Twelve children experienced inadequate primary response, and 4 were secondary poor responders.Four of these 16 children discontinued therapy due to inadequate response.The most common dupilumab-associated AEs were facial erythema (n = 24, 12.0%) and injection-site reactions (n = 24, 12.0%). Female sex was significantly associated with experiencing injection-site reactions, and prior hospitalization was significantly associated with HSV infection on dupilumab. Eight patients discontinued therapy due to an AE. Conclusion:A small but significant number of patients experienced treatment difficulties while on dupilumab. The risk of inadequate response to dupilumab and dupilumab-associated AEs should be discussed thoroughly with patients and their families prior to initiation.

Dupilumab in daily practice for the treatment of pediatric atopic dermatitis: 28‐week clinical and biomarker results from the BioDay registry

“…[4][5][6][7][21][22][23][24][25][26][27] The prevalence of reported conjunctivitis was 6.7%-14.8% in clinical trials 5.6%-17.0% in other daily practice studies, which is quite similar to our results (16.4%). [4][5][6][7][21][22][23][24][25][26][27] Ariëns et al found that 34.1% of the adult patients developed conjunctivitis. Based on this study, conjunctivitis seems more common in adults than in children treated with dupilumab for AD in daily practice.…”

“…All of these studies found a significant improvement of AD severity during dupilumab treatment. 21 , 22 , 23 , 24 , 25 , 26 , 27 After 16–24 weeks of treatment, EASI‐50 was achieved by 67.0%–99.3% of the patients. 21 , 23 , 24 EASI‐75 was achieved by 42.0%–66.7% of the patients.…”

Treatment of children from 6 to 11 years old affected by moderate–severe atopic dermatitis with dupilumab: a first perspective from a single‐center real‐life experience in Italy

“…Data exposed have shown a general improvement of disease severity scores and quality of life, even if below the line of LIBERTY AD PEDS. 1 Our population consisted of a majority of children under systemic immunosuppressants and included two patients who developed not only a known AE, 9 namely, facial redness, but also a SAE, which required hospitalization. These observational data should be validated by larger studies.…”

Dupilumab Improves Clinical Scores in Pediatric Patients Aged 2 to <18 Years with Uncontrolled Atopic Dermatitis: A Single‐Center, Real‐World Study

“…In fact, a larger regimen (Table 3) was partly administrated in our cohorts, which might further prove dupilumab a safe choice in pediatric patients, considering the low occurrence of adverse events. Conjunctivitis was the most commonly reported AE, with incidence rates in real-life studies ranging from 4.95% to 12.15% [12,[19][20][21][22][23][24], which was observed in 5.1% patients in our study. In the ≥2 to <6 years old group, one child experienced the injection-site reaction after the 2 nd injection, which resolved by itself.…”