Dupilumab Improves Clinical Scores in Children and Adolescents With Moderate to Severe Atopic Dermatitis: A Real-World, Single-Center Study

To characterize treatment responses and adverse events in children and adolescents with atopic dermatitis treated with dupilumab.

Children and adolescents <18 years of age with moderate to severe atopic dermatitis treated with dupilumab from March 2017 to September 2021.

This was a retrospective observational study undertaken at the Icahn School of Medicine at Mount Sinai Department of Dermatology. Three atopic dermatitis clinical scores - body surface area (BSA), Eczema Area and Severity Index (EASI), and Investigator’s Global Assessment (IGA) – were assessed for 1 or more years of treatment. The clinic followed an ethnically diverse population, allowing evaluation of the potential impact of race and ethnicity on treatment response.

Eighty nine patients, 50 females, and 49 males were included. Forty seven percent identified as European American, 18% as Hispanic/Latin American, 16% as Asian American, 16% as African American, 2% as 2 or more races, and 1% as Pacific Islander. Atopy was common with 57% reporting allergic rhinitis and/or conjunctivitis, 50% reporting food allergies, and 33% reporting asthma. Of the initial 89 patients, 73 had received dupilumab for at least 3 months and had baseline and posttreatment scores reported. Mean±SD improvements in BSA, EASI, and IGA were 63.1%±29.2%, 39.6%±29.9%, and 59.6%±30.7%, respectively. All patients who received dupilumab for 1 year or more (N = 23) achieved 75% improvement in EASI and IGA, and 60.8% achieved 90% improvement in EASI. A positive history of atopy was associated with improvement in BSA at weeks 12 to 24. Side effects were reported in 13.5%, with conjunctivitis (5.6%) and joint pain (2.2%) the most common side effects reported. There were no serious side effects. There were no significant associations between clinical improvement or adverse events and demographics (age, sex, race, or ethnicity).

In an uncontrolled, real-world, clinical setting, dupilumab was well-tolerated and effective in treating pediatric and adolescent atopic dermatitis regardless of age, sex, race, or ethnicity, with no serious adverse events reported.

Dupilumab has been shown to be clinically effective and tolerated in multiple controlled trials. This is a clinically helpful study showing the effectiveness and tolerability of dupilumab in a real-world clinical setting. It was used in a pediatric and adolescent clinic with patients of various races and ethnicities, ages, and genders, utilizing clinical tools that we as clinicians use in the clinic. Dupilumab was highly effective and very well tolerated in this diverse but clinically relevant population.