Abstract:

Objective To evaluate the short-term efficacy of dupilumab in the treatment of moderate to severe atopic dermatitis (AD) in children and the recurrence after drug withdrawal. Methods A retrospective study was conducted, including children with moderate to severe AD who visited the dermatology outpatient department from January 2024 to March 2025 and completed 16 weeks of dupilumab treatment. Dupilumab was administered according to the standard protocol based on age and weight. The Atopic Dermatitis Score (SCORAD), Eczema Area and Severity Index (EASI), ItchyQuant, and Patient-Oriented Eczema Measure (POEM) scores of the children were compared at baseline and at weeks 4, 8, 12, and 16 of treatment. Follow-up was conducted for 12 weeks after drug withdrawal in children who completed 16 weeks of treatment to assess recurrence. Results A total of 41 children with moderate-to-severe atopic dermatitis (AD) were enrolled, including 22 boys and 19 girls, with a median age of 8.00 (5.50-10.00) years. Statistically significant differences were observed in SCORAD, EASI, ItchyQuant, and POEM scores between baseline and weeks 4, 8, 12, and 16 of dupilumab treatment (all P<0.001). Pairwise comparisons revealed that, compared with baseline, SCORAD and EASI scores decreased significantly at weeks 8, 12, and 16 (all P<0.001); ItchyQuant and POEM scores decreased significantly at weeks 4, 8, 12, and 16 (all P<0.001). At week 16 of treatment, 35 (85.37%), 22 (53.66%), 10 (24.39%), and 1 (2.44%) children achieved EASI-50, EASI-75, EASI-90, and EASI-100, respectively. A total of 33 children were followed up for 12 weeks after treatment discontinuation. Overall comparisons of SCORAD, EASI, ItchyQuant, and POEM scores between the last treatment (week 16) and weeks 4, 8, and 12 after discontinuation showed statistically significant differences (all P<0.001). Pairwise comparisons indicated that at 12 weeks after discontinuation, SCORAD, EASI, ItchyQuant, and POEM scores were significantly increased compared with the last treatment (P<0.001). Despite significant rebound, SCORAD, EASI, ItchyQuant, and POEM scores at 12 weeks after discontinuation remained significantly lower than baseline levels (all P<0.001). According to different criteria for clinical deterioration, 8 children (24.24%) had an EASI increase ≥50% from the time of discontinuation with EASI≥7 points; 10 children (30.30%) had an ItchyQuant increase≥3 points from the time of discontinuation with ItchyQuant≥4 points; and 12 children (36.36%) had a POEM increase≥4 points from the time of discontinuation with POEM≥8 points. Conclusions Sixteen weeks of dupilumab treatment significantly improved skin lesions and pruritus symptoms in children with moderate-to-severe AD; however, a certain risk of relapse exists 12 weeks after treatment discontinuation.

Key words: dupilumab, atopic dermatitis, recurrence, child