D3.173 - Switching from Dupilumab to Tezepelumab in a Child with Severe Asthma and Atopic Dermatitis: Clinical Considerations and Therapeutic Implications

BACKGROUND: Dupilumab is an anti–IL-4/IL-13 biologic agent. In the pediatric population it is approved for the treatment of severe asthma and moderate to severe atopic dermatitis (AD).

OBJECTIVE: To evaluate the efficacy of Dupilumab in a complex allergic patient.

METHODS AND RESULTS: We report a 2-year follow-up of a 14-year-old patient affected by severe allergic asthma inadequately controlled with asthma maintenance therapy, moderate AD and vernal keratoconjunctivitis (VKC) from the start of Dupilumab treatment in February 2024.

In 2-year follow-up good disease control was obtained for AD, with reduced need for topical corticosteroids. Initially a reduction in asthma exacerbations was observed, yet followed by a relapse in the recurrence of symptoms during the past year. Between June and December 2025 spirometry showed recurrent bronchial obstruction with approximately one episode per month requiring prolonged use of short-acting beta2-agonists. Worsening of symptoms was seen also for VKC, particularly in the left eye, requiring reintroduction of topical cyclosporine from April 2025.

CONCLUSIONS: After 2 years of treatment, Dupilumab proved beneficial for the patient’s moderate AD but showed limited efficacy in controlling severe asthma and secondarily VKC, for which its use is off label. The suboptimal response to Dupilumab may suggest the involvement of inflammatory pathways not fully controlled by IL-4/IL-13 blockade or the presence of a mixed inflammatory phenotype. Current evidence in the literature indicates that, in patients with multiple atopic comorbidities and mixed phenotypes, upstream inhibition with Tezepelumab (anti-TSLP) may provide broader inflammatory control.