D3.417 - Dupilumab in pediatric patients with severe atopic dermatitis

Atopic dermatitis (AD) is a chronic systemic inflammatory disease with skin manifestations. AD is charactirized by inflammatory erythematous skin lesions, skin-barrier defect and intense pruritus. T2 immune response is the predominant endotype in AD and in this immune response IL-4 and IL-13 are the main cytokine involved in the patogenesis of the disease. Dupilumab is an IgG4 human monoclonal antibody that binds to the subunit of the IL-4 receptor shared by IL-4 and IL-13 receptor complexes, thus inhibiting both IL-4- and IL-13-mediated pathways. Dupilumab is currently the only biological with approval for the treatment of AD.

Based on the EAACI guidelines for the treatment of AD, in our clinic, in patients who met the criteria, biological therapy with Dupilimab was initated. There are currently 7 patients with AD on Dupilumab therapy. The age of patients undergoing therapy varies from 8 to 16 years, of which 5 are female and 2 are male. Each of the above-mentioned patients has sensitization to some of the most common inhalantory allergens and, with it, symptoms of allergic rhinitis. Three of the patients have food allergies, while the other patients had food allergies in early childhood that they now tolerate and consume normally. Each patient was initially treated with antihistamines, topical corticosteroids and adequate skin care, but disease control was not achieved and biological therapy was initiated. The main tool for disease activity was SCORing Atopic Dermatitis (SCORAD) and Eczema Area and Severity Index (EASI). Each of the patients was monitored as a patient with a severe form of atopic dermatitis, i.e. scores of SCORAD >50 and EASI >50. 57,1% of patients had total IgE that was above the limits of reference values, i.e. > 500 IU/ml. As of right now, after an average duration of therapy of 6 months with Dupilumab, an improvement in the clinical picture is seen. The disease activity was again interpreted by using SCORAD, which was <20, and EASI, which was <20.

In every patient who was being monitored under the diagnosis of severe atopic dermatitis, the severity of the disease was initially assessed by SCORAD and EASI. Following the administration of six doses of biological therapy, the severity of the disease was reassessed using the above scores. Each of the patients had a significant drop in SCORAD and EASI.

These findings support the efficacy of dupilumab as a targeted biological treatment that effectively controls inflammation and improves skin lesions and patient quality of life. Furthermore, the use of standardized scoring systems such as SCORAD and EASI proved to be reliable tools for monitoring disease progression and therapeutic response.