Dupilumab for children and adolescents with atopic dermatitis: An Asian perspective

Abstract

Atopic dermatitis (AD) is a common, chronic, recurrent inflammatory skin disease. Poorly controlled AD can lead to reduced quality of life (QoL) and psychosocial impairment. Dupilumab is the first approved monoclonal antibody targeting type 2 inflammation, for adolescent and adult patients with moderate‐to‐severe AD. We performed a retrospective analysis of the efficacy and safety of dupilumab in a cohort of Asian children and adolescents with moderate‐to‐severe AD. Clinical response was documented with investigator global assessment (IGA) and eczema area and severity index (EASI) scores. Improvement in QoL was assessed using child dermatology life quality index (CDLQI) or Teenager's quality of life (T‐QoL), and caregivers' QoL was assessed using dermatitis family impact (DFI) questionnaire. Twelve patients were recruited, aged between 6 to 18 years of age (mean 13.3 years), with mean duration of AD of 9.8 years. At baseline, the mean IGA score was four and the mean EASI was 48.2. The mean T‐QoL and DFI scores at baseline were 18.7 and 19.6, respectively. After 12 to 16 weeks of treatment, the mean IGA score decreased to 2.2. The mean EASI decreased to 19.3 with mean reduction of 28.9. The mean T‐QoL decreased to 7.5 with mean reduction of 11.2, and the mean DFI decreased to 8.6 with mean reduction of 11. Adverse events included mild conjunctivitis in two patients and paradoxical head and neck erythema in one patient. Our study supports dupilumab as an effective and safe treatment option for Asian children and adolescents with moderate‐to‐severe AD.

Multicenter Canadian case series of pediatric patients less than 12 years of age with moderate‐to‐severe atopic dermatitis treated with dupilumab

“…Compared to other case series, 7–11 our patients had experienced more difficult‐to‐treat AD based on the number of previous systemic therapies (Tables 1 and 2); however, similar EASI improvements were achieved. In another case series, patients received systemic corticosteroids (44%), cyclosporine (25%), and methotrexate (7%) 9 while, in our cohort, more patients received methotrexate (45%) and fewer patients received systemic corticosteroids (35%) and cyclosporine (18%).…”

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

“… 21 , 23 , 24 EASI‐75 was achieved by 42.0%–66.7% of the patients. 21 , 22 , 23 , 24 In the current study, the proportions of patients that achieved EASI‐50 and EASI‐75 after 16–28 weeks were 75.4%–78.7% and 42.6%–49.2%, respectively, which were within the range of the other daily practice studies. Other clinical outcomes used in the published daily practice studies differ from our study, making them difficult to compare.…”

“… 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. 21 , 22 , 23 , 24 In the current study, the proportions of patients that achieved EASI‐50 and EASI‐75 after 16–28 weeks were 75.4%–78.7% and 42.6%–49.2%, respectively, which were within the range of the other daily practice studies.…”

“…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.…”

Dupilumab induces a rapid decrease of pruritus in adolescents: A pilot real‐life study

“…Our real-life experience confirms data reported in literature about effectiveness of dupilumab in adolescent. [7][8][9] We observed a marked reduction in the median values of pruritus assessed by SCORAD and ppNRS, in association with an improvement of skin involvement. The decrease of pruritus recorded at week 4 was slightly lower than the one we had detected in adult patients (37.5 vs. 50%) in a much larger cohort.…”