Dupilumab Shows Durable Control in Pediatric Atopic Dermatitis
Key Takeaways
- Among children aged 16 years or younger with moderate-to-severe atopic dermatitis treated at Dutch hospitals, disease control on dupilumab generally persisted during follow-up extending up to three years.
- Dupilumab-associated ocular surface disease was the most frequently reported adverse event.
- Treatment persistence remained high, with most discontinuations occurring early in follow-up.
- The youngest children had greater pruritus and quality-of-life impairment over time, along with more administration-related discontinuation challenges.
Investigators enrolled 309 children aged 16 years or younger who initiated dupilumab for moderate-to-severe atopic dermatitis in aprospective, multicenter cohort at academic and nonacademic hospitals in the Netherlands. Enrollment ran from November 2019 through October 2025. Children were grouped by age: 6 months to 5 years, 6 to 11 years, and 12 to 16 years. Dupilumab was given at label-recommended doses, with reductions when clinically indicated. Investigators assessed the Eczema Area and Severity Index (EASI), Investigator Global Assessment (IGA), pruritus and pain on the Numeric Rating Scale (NRS), quality of life (QoL), adverse events, and drug survival and discontinuation over follow-up extending up to three years.
Most children maintained controlled atopic dermatitis during observation. At three years, mean EASI was 3.4 (95% CI, 2.4–4.5), and mean pruritus NRS was 3.6 (95% CI, 3.1–4.1). Pruritus and QoL scores differed significantly by age group over time: the youngest children consistently reported greater pruritus and more QoL impairment than older children.
Dupilumab-associated ocular surface disease was the most frequently reported adverse event, affecting 113 of 309 children (36.6%). Dupilumab was discontinued by 50 of 309 children (16.2%), while three-year drug survival was 80.1%. Ineffectiveness, adverse events, and administration problems were the principal reasons for stopping treatment. Most discontinuations occurred early in follow-up, and administration problems posed a particular discontinuation challenge for younger children.
These age patterns come from an observational cohort of dupilumab-treated children in the Netherlands, without an untreated or active-treatment comparator. Follow-up duration varied across age groups, limiting direct comparisons of their trajectories.
The authors concluded that longer-term effectiveness and safety were observed with dupilumab in this pediatric clinical setting; younger children also faced greater symptom burden and administration-related challenges.
Clinician Questions
How did follow-up duration differ across pediatric age groups receiving dupilumab for atopic dermatitis?
Among children receiving dupilumab for moderate to severe atopic dermatitis, median follow-up was shortest at ages 6 months to 5 years, longer at ages 6 to 11 years, and longest at ages 12 to 16 years. Shorter observation in the youngest group qualifies interpretation of age-group patterns; these medians do not describe every child’s observation time.
Which factors were associated with a lower risk of stopping dupilumab in children with atopic dermatitis?
In this prospective Dutch cohort of children receiving dupilumab for moderate to severe atopic dermatitis, allergic asthma, allergic rhinitis, and age 6 to 11 years were associated with lower discontinuation risk. These associations do not establish that either allergic condition prevents discontinuation.