High loading-dose of dupilumab resulted in rapid disease control in pediatric patients with atopic dermatitis

Abstract

BackgroundThe real-world experience of dupilumab in Chinese is limited, and the initial loading dose has not yet been deeply explored in patients aged <6 years.ObjectiveTo explore the efficacy and safety of dupilumab in Chinese patients with moderate-to-severe atopic dermatitis and investigate the effect of higher loading dose for disease control in patients aged <6 years.MethodsA total of 155 patients were divided into three groups according to age: <6 years, 6-11 years, and >11 years. Among patients aged <6 years, 37 patients received a high loading dose of 300 mg for body weight <15kg or 600 mg for body weight ≥15kg, and another 37 patients received a standard loading dose of 200 mg for body weight <15kg or 300 mg for body weight ≥15kg. Multiple physicians and patient-reported outcome measures were evaluated at baseline and 2, 4, 6, 8, 12, and 16 weeks after dupilumab treatment.ResultsThe proportion of patients showing an improvement of ≥75% in the Eczema Area and Severity Index was 68.0% (17/25), 76.9% (10/13), and 62.5% (25/40) in the aged <6, 6-11, and >11 years groups, respectively, at week 16. After increasing the loading dose, 69.6% (16/23) of patients aged <6 years achieved 4-point improvement in Pruritus Numerical Rating Scale at week 2, compared with 23.5% (8/34) of patients receiving standard loading dose (P < 0.001). Obesity (odds ratio=0.12, 95% confidence interval: 0.02-0.70) was predictive of a poor response to dupilumab treatment, while female (odds ratio=3.94, 95% confidence interval: 1.26-12.31) predicted good response at week 16. The change of serum C-C motif ligand 17(CCL17/TARC) could reflect the response to dupilumab (r = 0.53, P = 0.002 in EASI) among patients aged <18 years. No major adverse events were reported during the treatment.ConclusionsDupilumab was effective and well-tolerated in Chinese patients with atopic dermatitis. The increased loading dose helped achieve rapid pruritus control in patients aged <6 years.

A Review of Dupilumab in the Treatment of Atopic Dermatitis in Infants and Children

“…Real-world research and phase III clinical trials have shown that, compared to the placebo group, dupilumab significantly improved NRS scores and Quality of Life (QoL)-related scores. 30–32 , 36 , 52–54 In addition, pediatric patients treated with dupilumab had good adherence and dosing persistence, which is consistent with adult results. In the 52-week open-label extension study (LIBERTY AD PED-OLE), patient adherence and medication persistence were good, with 253 of 294 patients continuing to be treated and only 11 patients dropping out of the trial due to lack of efficacy.…”

“…The researchers speculated that this may be related to loading dose/ weight. 36,37 Long-term efficacy of dupilumab was also confirmed in real-world studies. In a multicentre, retrospective real-world study, a total of 91 patients aged 6-11 years completed 52 weeks of treatment, and compared to baseline, patients showed significant decreases in EASI scores, CDLQI scores, and NRS scores, in addition to the proportion of patients who achieved EASI50, EASI-75, and EASI-90, which was 95.6%, 86.8%, and 42.9%, respectively.…”

An updated reappraisal of dupilumab in children and adolescents with moderate–severe atopic dermatitis

“…A Chinese real‐world experience studied the efficacy and safety of a 16‐week dupilumab course (using also high loading doses) in 155 children 72 . The study classified children into three age groups (<6, 6–11, and >11 years).…”

Adipokines in atopic dermatitis: the link between obesity and atopic dermatitis

“…Nonetheless, approved biologic therapies such as dupilumab may not suffice for all patients [ 6 ]. Recent research indicates that overweight and obesity may predict a suboptimal response to dupilumab treatment [ 7 , 8 ]. Adipokines hold potential as novel, precise therapeutic targets.…”