High loading-dose of dupilumab resulted in rapid disease control in pediatric patients with atopic dermatitis

Ao Wang; Yuan Zhou; Yang Luo; Yingxia Gao; Jingsi Chen; Wei Li; Xiaoyan Luo; Xu Yao

doi:10.3389/fimmu.2023.1160710

High loading-dose of dupilumab resulted in rapid disease control in pediatric patients with atopic dermatitis

Front Immunol. 2023 Apr 20:14:1160710. doi: 10.3389/fimmu.2023.1160710. eCollection 2023.

Authors

Ao Wang¹, Yuan Zhou¹, Yang Luo¹, Yingxia Gao¹, Jingsi Chen^{2

3}, Wei Li⁴, Xiaoyan Luo^{2

3}, Xu Yao¹

Affiliations

¹ Department of Allergy and Rheumatology, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China.
² Department of Dermatology, Children's Hospital of Chongqing Medical University, Chongqing, China.
³ National Clinical Research Center for Child Health and Disorders, Ministry of Education Key laboratory of Child Development and Disorders, Chongqing, China.
⁴ Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China.

Abstract

Background: The real-world experience of dupilumab in Chinese is limited, and the initial loading dose has not yet been deeply explored in patients aged <6 years.

Objective: To explore the efficacy and safety of dupilumab in Chinese patients with moderate-to-severe atopic dermatitis and investigate the effect of higher loading dose for disease control in patients aged <6 years.

Methods: A total of 155 patients were divided into three groups according to age: <6 years, 6-11 years, and >11 years. Among patients aged <6 years, 37 patients received a high loading dose of 300 mg for body weight <15kg or 600 mg for body weight ≥15kg, and another 37 patients received a standard loading dose of 200 mg for body weight <15kg or 300 mg for body weight ≥15kg. Multiple physicians and patient-reported outcome measures were evaluated at baseline and 2, 4, 6, 8, 12, and 16 weeks after dupilumab treatment.

Results: The proportion of patients showing an improvement of ≥75% in the Eczema Area and Severity Index was 68.0% (17/25), 76.9% (10/13), and 62.5% (25/40) in the aged <6, 6-11, and >11 years groups, respectively, at week 16. After increasing the loading dose, 69.6% (16/23) of patients aged <6 years achieved 4-point improvement in Pruritus Numerical Rating Scale at week 2, compared with 23.5% (8/34) of patients receiving standard loading dose (P < 0.001). Obesity (odds ratio=0.12, 95% confidence interval: 0.02-0.70) was predictive of a poor response to dupilumab treatment, while female (odds ratio=3.94, 95% confidence interval: 1.26-12.31) predicted good response at week 16. The change of serum C-C motif ligand 17(CCL17/TARC) could reflect the response to dupilumab (r = 0.53, P = 0.002 in EASI) among patients aged <18 years. No major adverse events were reported during the treatment.

Conclusions: Dupilumab was effective and well-tolerated in Chinese patients with atopic dermatitis. The increased loading dose helped achieve rapid pruritus control in patients aged <6 years.

Keywords: CCL17/TARC; atopic dermatitis; children; dupilumab; obesity.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Antibodies, Monoclonal, Humanized* / administration & dosage
Child
Dermatitis, Atopic* / therapy
Dose-Response Relationship, Drug
Female
Humans
Male
Retrospective Studies
Treatment Outcome

Substances

dupilumab
Antibodies, Monoclonal, Humanized

Grants and funding

This work was supported by the National Natural Science Foundation of China (82073446, 81803144, 82273522), the CAMS Innovation Fund for Medical Sciences (2021-I2M-1-059), the Nanjing Incubation Program for National Clinical Research Center (2019060001), the Key Project of Social Development in Jiangsu Province (BE2020632), and the National Key R&D Program of China (2022YFC3601800).