The use of dupilumab in children and adolescents with severe atopic dermatitis (AD): a systematic review and meta-analysis

The big idea:

• Dupilumab is a treatment for moderate to severe AD in adults and children aged 12 years and older, and severe AD in children aged 6 months to 11 years. 

• Dupilumab is a type of biologic drug called a monoclonal antibody → these target specific proteins or receptors in the body, blocking the proteins from binding to their receptors, to regulate the immune response or interfere with disease processes. 

• Such biologic drugs have fewer potential side effects than immunosuppressive drugs for eczema, as they specifically target parts of the immune system causing eczema rather than suppressing the whole immune system.

What the study asked:

To assess the efficacy and safety of dupilumab in the treatment of atopic dermatitis in children aged 6 months to 18 years old. 

Explanations of key terms: 

• Investigator global assessment (IGA): 

  • Scale used to assess the overall severity of lesions at a given time. 

  • Scored from 0 (clear) to 4 (severe) based on four clinical features of AD lesions: Erythema, induration/papulation, lichenification, and exudation/crusting, and takes into account the extent of the disease.

• Eczema Area and Severity Index (EASI): 

  • Scoring system that rates the area and severity of eczema in four regions of the body, with a total range of 0 - 72 points

  • EASI-50 means > 50% reduction in severity; EASI-75 means > 75% reduction

• Treatment-Emergent Adverse Event (TEAE): 

  • Any undesirable symptom, sign, or disease that appears or worsens after initiating a study treatment (drug, device, or procedure), lasting from the first dose until a specified follow-up time. 

What the study did:

• A systematic review of the medical research literature available online using Medline, Embase, ClinicalTrials, and Google Scholar databases. 

• Three randomised clinical trials were selected for the study’s review, involving 3 different age groups: 

  • 6 months to 6 years

  • 6-11 years

  • 12-18 years

• In these trials, dupilumab doses ranging from 100 to 300 mg were injected subcutaneously (below the skin) every 2 weeks or 4 weeks or 16 weeks, and follow-up time ranged from 16 to 28 weeks. These were compared against placebos.

What the study found:

For 493 patients submitted to dupilumab and 495 to the placebo group, there was: 

1. a 20% improvement in IGA scores

2. a 39% improvement in EASI-75 scores

3. a 45% improvement in EASI-50 scores

4. there was no difference in the risk of TEAEs with dupilumab treatment compared with placebo

• This revealed a significant difference between the dupilumab and placebo in the research population – where the effectiveness of dupilumab was demonstrated through scales relating to clinical improvement, enhanced quality of life, and lesion improvement. 

• Furthermore, the study found no significant difference in the adverse effects between dupilumab and placebo, reinforcing the safety of dupilumab for use in children and adolescents.

What this means for eczema:

Dupilumab is a safe and effective treatment option for children and adolescents with moderate to severe AD who do not respond to conventional treatments, and significantly improve their quality of life by reducing disease severity and associated impacts. 

Links:

Study: https://pmc.ncbi.nlm.nih.gov/articles/PMC11918844/

References: https://eczema.org/information-and-advice/treatments-for-eczema/dupilumab/