Practical Management of Patients with Atopic Dermatitis on Dupilumab

Abstract

Introduction Dupilumab is approved to treat moderate-to-severe atopic dermatitis (AD) in several countries in patients as young as 6 years of age. Since its approval, practical issues related to the use of dupilumab for AD have arisen, with particular interest in transitioning from current therapies and managing medication overlap, considerations for special populations of patients with AD, and management of potential adverse events. Methods This article aims to review the literature addressing several practical management issues related to dupilumab use for AD and to provide a framework for clinical decision-making in these circumstances and sub-populations. Each statement was reviewed, revised and voted on by authors to provide their level of agreement and degree of uncertainty for each statement. Results An agreement level > 80% was achieved for all of the statements. Conclusion The expert panel provides statements considering the practical management of patients with AD taking dupilumab to inform clinical decision-making in specific but frequently encountered clinical situations. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00586-w.

Dupilumab Treatment of Atopic Dermatitis in Routine Clinical Care: Baseline Characteristics of Patients in the PROLEAD Prospective, Observational Study

“…PROLEAD patients treated with conventional systemic therapies at last prior visit were generally switched to dupilumab without overlap. Although not widely implemented in this study, previous publications have recommended an overlap as practical management for patients transitioning from conventional systemic treatments to dupilumab, as concurrent treatment with these therapies does not alter either drug’s intrinsic risk profile [ 10 ]. The proportion of patients with previous and concomitant treatment with antihistamines was unexpectedly high, as there is no evidence for the treatment of pruritus in AD patients and they are not recommended by treatment guidelines.…”

“…Dupilumab (Dupixent®) [ 9 ], the first biologic licensed for adults and adolescents with moderate-to-severe AD who require systemic therapy, is also licensed in patients aged ≥ 6 years with severe AD [ 10 ] and in other type 2 inflammatory diseases [ 1 , 11 ]. Dupilumab is a fully human monoclonal antibody that blocks the interleukin (IL)-4 and IL-13 signalling pathways, which are key drivers of type 2 inflammation in AD and other type 2 inflammatory diseases, such as severe asthma and chronic rhinosinusitis with nasal polyps [ 2 , 3 ].…”