Off-label use of dupilumab for pediatric patients with atopic dermatitis: A multicenter retrospective review

Igelman, Sean; Kurta, Anastasia O.; Sheikh, Umar A.; McWilliams, Ashley; Armbrecht, Eric S.; Cullison, Stephanie R. Jackson; Kress, Douglas W.; Smith, Anna; Castelo‐Soccio, Leslie; Treat, James R.; Boothe, William D.; Diaz, Lucia Z.; Levy, Moise L.; Patel, Avni; Lee, Lara Wine; Fraile-Alonso, María Carmen; Antaya, Richard J.; Shah, Sonal D.; Kittler, Nicole W.; Arkin, Lisa M.; Siegfried, Elaine C.

doi:10.1016/j.jaad.2019.10.010

Cited by 54 publications

(58 citation statements)

References 5 publications

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“…Dupilumab injection was safe in our case report without adverse effects [12] [13]. On the first visit, the patient presented with dominant erythematoedematous type of steroidal addiction and with started withdrawal, papulopustular type predominated as reported in the literature [5].…”

Section: Discussionmentioning

confidence: 63%

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Dupilumab Injection in the Management of Steroid-Induced Rosacea: A New Case Report

Abdulwahhab¹,

Mehair²

2021

JCDSA

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Background: Topical corticosteroids (TCS) are used frequently for various inflammatory skin conditions. The prolonged daily and inappropriate use of TCS may cause adverse effects such as erythema, atrophy, and telangiectasia. Steroid rosacea or addiction is a distinct adverse effect of inappropriate use of TCS. It occurs most commonly in adult women applying mid-or high-potency TCS to the face. Dupilumab is an interleukin 4 (IL-4) receptor α-antagonist approved for treatment Moderate-to-Severe Atopic Dermatitis in childhoods and adults. The role of dupilumab injection in steroid-induced rosacea management is rarely discussed. Aim: To document a new case presentation of atopic dermatitis on high potency topical facial steroid addiction for a duration of 4 years in a young female patient who was successful treated with dupilumab injection and withdrawal therapy. Case Report: A 32-year-old female patient with a history of atopic dermatitis presented with a history of worsening pruritic facial rashes for a one-month duration and on high potency TCS (Clobetasol Propionate ointment 0.05%) since 4 years ago with multiple treatments failure of steroidal withdrawal treated successfully in combination with dupilumab injection. Conclusion: Dupilumab injection considers effective and inducing rapid resolution of signs and symptoms of steroid-induced rosacea in patients with a history of atopic dermatitis in combination with withdrawal therapy without a rebound effect.

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Section: Discussionmentioning

confidence: 63%

“…Dupilumab has recently been approved for the treatment of childhood and adult patients with moderate-to-severe atopic dermatitis [12]. It's an interleukin 4 (IL-4) receptor α-antagonist that inhibits IL-4 and IL-13 signaling through blockade of the shared IL-4 α subunit.…”

Section: Introductionmentioning

confidence: 99%

Dupilumab Injection in the Management of Steroid-Induced Rosacea: A New Case Report

Abdulwahhab¹,

Mehair²

2021

JCDSA

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“…It is the only systemic treatment currently licensed to treat severe AD in children aged 6–11 years and moderate-severe AD in adolescents and adults by the US Food and Drug Administration [ 6 , 7 ]. Its efficacy and safety profiles have been demonstrated in several studies and have been consistent among these age groups (see the electronic supplementary material) [ 1 , 8 – 13 ].…”

Section: Introductionmentioning

confidence: 87%

“…Increasing use of dupilumab for atopic dermatitis [ 1 ] in younger and younger children has stimulated new questions about immunization. Immunization is the process of acquiring protective immunity from the vaccine agent and should be distinguished from “vaccination,” which is the act of administering a vaccine.…”

Section: Introductionmentioning

confidence: 99%

Recommendations for Vaccination in Children with Atopic Dermatitis Treated with Dupilumab: A Consensus Meeting, 2020

et al. 2021

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Dupilumab is the only biologic therapy currently approved in Europe and the United States for severe atopic dermatitis in patients 6 years of age or older. Off-label use is rationalized in younger children with severe atopic dermatitis. Decisions about vaccination for children on dupilumab are complex and depend on both the child’s current treatment and the type of vaccination required. To achieve consensus on recommendations for vaccination of pediatric patients with atopic dermatitis treated with or planning to start dupilumab, a review of the literature and a modified-Delphi process was conducted by a working group of 5 panelists with expertise in dermatology, immunology, infectious diseases and vaccination. Here, we provide seven recommendations for vaccination of pediatric patients with atopic dermatitis treated with or planning to start dupilumab. These recommendations serve to guide physicians’ decisions about vaccination in children with atopic dermatitis treated with dupilumab. Furthermore, we highlight an unmet need for research to determine how significantly dupilumab affects cellular and humoral immune responses to vaccination with live attenuated and inactivated vaccines. Supplementary Information The online version contains supplementary material available at 10.1007/s40257-021-00607-6.

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“…Erythematous, scaling patches with characteristic punched-out appearing erosins of eczema herpeticum are seen F I G U R E 2 Clinical appearance 6 months prior to treatment with dupilumab mean maintenance dose was 5.1 mg/kg every 2 weeks, both higher than in adolescent trials. 4 Similarly, in a case series of six pediatric patients with recalcitrant atopic dermatitis, patients weighing fewer than 40 kg were given a 300 mg loading dose with 150 mg biweekly maintenance doses, and patients weighing 40 kg or more were given a 600 mg loading dose with 300 mg maintenance doses. This resulted in higher weight-based dosing than in the previous study, but all the patients tolerated treatment well and showed similar resolution of symptoms.…”

mentioning

confidence: 99%

Successful and rapid clearance of severe, treatment‐resistant atopic dermatitis with dupilumab in a 3‐year‐old

Dakin

Haas

2020

Dermatologic Therapy

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Dupilumab is a monoclonal antibody which selectively inhibits the α-subunit of IL-4 and IL-13, which are involved in the pathogenesis of atopic dermatitis. It is the only targeted systemic treatment FDA approved to treat moderate-to-severe atopic dermatitis in adolescents and adults. 1 As systemic treatment for severe atopic dermatitis in children under 6 years of age is lacking, off-label use of dupilumab is

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Off-label use of dupilumab for pediatric patients with atopic dermatitis: A multicenter retrospective review

Cited by 54 publications

References 5 publications

Dupilumab Injection in the Management of Steroid-Induced Rosacea: A New Case Report

Dupilumab Injection in the Management of Steroid-Induced Rosacea: A New Case Report

Recommendations for Vaccination in Children with Atopic Dermatitis Treated with Dupilumab: A Consensus Meeting, 2020

Successful and rapid clearance of severe, treatment‐resistant atopic dermatitis with dupilumab in a 3‐year‐old

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