Retrospective Study Examines Dupilumab Performance in Asian Youth Population

A recent retrospective analysis, conducted in Singapore, looked the efficacy and safety of dupilumab in a group of Asian children and adolescents with moderate‐to‐severe atopic dermatitis (AD).

Poorly controlled AD, a recurrent inflammatory skin disease, can lead to reduced quality of life (QoL) and psychosocial issues. Dupilumab is the first approved biologic targeting type 2 inflammation, for adolescent and adult patients with moderate‐to‐severe AD.

A total of 12 patients were recruited, with 9 adolescents (>12 years) and 3 children (≤12 years). Ten were male patients (78%) and 2 were female patients. The mean duration of treatment was 9.2 months (range 3‐21 months).

Previous treatments included azathioprine (3 patients), cyclosporine (7 patients), methotrexate (5 patients) and mycophenolate mofetil (1 patient); 9 had phototherapy.

The mean duration of AD before starting dupilumab was 9.8 years; patients’ mean age was 13.3 years when they started the therapy.

Comorbidities included 8 (67%) with allergic rhinitis; 3 (25%) with asthma; 3 patients (25%) with allergic conjunctivitis; 1 patient (8%) with retinal detachment; 1 patient (8%) with raised intraocular pressure; 1 patient (8%) with depression; and 2 patients (17%) with attention deficit hyperactivity disorder.

Three patients had serious complications related to chronic AD and/or long‐term use of topical corticosteroids. Two (17%) had adrenal suppression that required long‐term physiological oral hydrocortisone replacement and 1 patient (8%) had growth failure and pubertal delay as a result of chronic poorly‐controlled AD.

Response to dupliumab 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). Caregivers' QoL was assessed using dermatitis family impact (DFI) questionnaire.

At baseline, the mean IGA score was 4 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:

• Mean IGA score fell to 2.2
• Mean EASI fell to 19.3 with mean reduction of 28.9
• Mean T‐QoL fell to 7.5 with mean reduction of 11.2
• Mean DFI decreased to 8.6 with mean reduction of 11.

Adverse events included mild conjunctivitis in 2 patients and paradoxical head and neck erythema in 1 patient.

The authors said the study “supports dupilumab as an effective and safe treatment option for Asian children and adolescents with moderate‐to‐severe AD.”

Reference

Chia SY, Wee LWY, Koh MJA. Dupilumab for children and adolescents with atopic dermatitis: An Asian perspective. Dermatol Ther. 2021;e14933. doi: 10.1111/dth.14933