Patient‐centered dupilumab dosing regimen leads to successful dose reduction in persistently controlled atopic dermatitis

Abstract

Background At present, no real‐world studies are available on different dupilumab dosing regimens in controlled atopic dermatitis (AD). The aim of this study was to clinically evaluate a patient‐centered dupilumab dosing regimen in patients with controlled AD and to relate this to serum drug levels and serum biomarkers. Methods Ninety adult AD patients from the prospective BioDay registry were included based on their dupilumab administration interval according to a predefined patient‐centered dosing regimen. Group A (n = 30) did not fulfill the criteria for interval prolongation and continued using the standard dupilumab dosage (300 mg/2 weeks), group B (n = 30) prolonged dupilumab interval with 50% (300 mg/4 weeks), and group C (n = 30) prolonged dupilumab interval with 66%–75% (300 mg/6–8 weeks). AD severity score, patient‐reported outcomes, serum dupilumab levels, and serum biomarkers were analyzed over time. Results Disease severity scores did not significantly change over time during the tapering period in any of the groups. In groups B and C, the Numeric Rating Scale (NRS)‐pruritus temporarily significantly increased after interval prolongation but remained low (median NRS‐pruritus≤4). Median dupilumab levels remained stable in group A (standard dosage), but significantly decreased in groups B and C (24.1 mg/L (IQR = 17.1–45.6); 12.5 mg/L (IQR = 1.7–22.3)) compared with the levels during the standard dosage (88.2 mg/L [IQR = 67.1–123.0, p < .001]). Disease severity biomarker levels (CCL17/CCL18) remained low in all study groups during the whole observation period. Conclusions This study showed that dose reduction was successful in a subgroup of patients with controlled AD by using a patient‐centered dosing regimen. These patients showed stable low disease activity and low severity biomarkers over time.

Dupilumab dose spacing after initial successful treatment or adverse events in adult patients with atopic dermatitis: A retrospective analysis

“…EASI score did not significantly change over time during the study period in any of the groups 4 . In both B and C groups, P‐NRS temporarily increased after interval prolongation but remained low 4 . In this study the dupilumab dose reduction was introduced after at least 52 weeks of treatment and when the AD was mild (EASI<7) 4 .…”

“…Another recent real‐world study showed that dupilumab dose reduction was successful in a group of patients with controlled AD 4 . In this study, 90 adult AD patients were enrolled and divided in 3 groups: group A ( n = 30) continued using 300 mg dupilumab dosage Q2W, group B ( n = 30) prolonged dupilumab interval Q4W, and group C ( n = 30) prolonged dupilumab interval Q6W or Q8W 4 . EASI score did not significantly change over time during the study period in any of the groups 4 .…”

“…In this study, 90 adult AD patients were enrolled and divided in 3 groups: group A ( n = 30) continued using 300 mg dupilumab dosage Q2W, group B ( n = 30) prolonged dupilumab interval Q4W, and group C ( n = 30) prolonged dupilumab interval Q6W or Q8W 4 . EASI score did not significantly change over time during the study period in any of the groups 4 . In both B and C groups, P‐NRS temporarily increased after interval prolongation but remained low 4 .…”

“…In adults, dupilumab is administered at the scheduled dosage (600 mg as starting dose, followed by 300 mg every 2 weeks [Q2W]) 1,2 . Strategies on long‐term management of patients who achieved a good clinical response (GCR) or patients who experienced dupilumab‐related adverse events (AEs) are scant 3,4 . Previous literature reported that prolonged dose interval was effective and safe in patients with stable disease, also leading to both improvement of patient's adherence and reduction of costs 5 .…”

“…achieved a good clinical response (GCR) or patients who experienced dupilumab-related adverse events (AEs) are scant. 3,4 Previous literature reported that prolonged dose interval was effective and safe in patients with stable disease, also leading to both improvement of patient's adherence and reduction of costs. 5 On the other hand, it has been reported that interval prolongation improved dupilumabassociated conjunctivitis.…”