Dupilumab for the treatment of adolescents with atopic dermatitis

ABSTRACT

Introduction

Dupilumab is a treatment option newly licensed for adolescents with moderate to severe atopic dermatitis (AD). It reduces type 2 inflammation by blocking the shared receptor subunit for IL-4/-13. Dupilumab affects three disease mechanisms in atopic dermatitis: the skin barrier, the Th2-cell differentiation and the class switch to IgE. This report is based on a systematic literature search of the PubMed Database.

Areas covered

Dupilumab showed promising results in improving AD signs, symptoms and quality of life in adolescents with moderate to severe AD. The safety profile of dupilumab in adolescents with moderate to severe AD closely resembled the known safety profile of dupilumab in adults with moderate to severe AD. Injection-site reactions and conjunctivitis were the relevant side-effects. Skin infections were less frequently observed compared to placebo.

Expert commentary

Dupilumab was approved by the Food and Drug Administration in March 2019 and by the European Medicines Agency in August 2019 for the treatment of adolescents with moderate to severe atopic dermatitis whose disease is not adequately controlled with topical therapies or when those therapies are not advisable. Since it is the first licensed drug it will likely become the reference drug for adolescents with moderate to severe AD.

KEYWORDS:

• Dupilumab
• IL-4
• IL-13
• atopic dermatitis treatment
• biologics
• monoclonal antibody
• adolescents

Article highlights

Dupilumab for adolescent patients

-Indication:Moderate to severe atopic dermatitis in adolescents inadequately

controlled with topical medications or for whom topical therapies were inadvisable (US indication)

Moderate-to-severe atopic dermatitis in adults and

adolescents 12 years and older who are candidates for systemic therapy (EU indication)

-Function:Inhibits IL-4/IL-13 signaling by blocking the IL-4R-alpha

subunit of the receptor

-Bioavailability:60,7%

-Elimination rate:0.968 mg/L/d

-Approval:FDA approved, EMA approved

-Dose:300 mg weekly (600 mg loading dose): adolescents ≥ 60 kg

200 mg weekly (400 mg loading dose): adolescents < 60 kg

-Side effects:Injection-site reactions, skin infections, conjunctivitis

Declaration of interest

S. Senner has received personal fees for lectures from Lilly. L. Eicher has received personal fees for lectures from L’Oreal. A. Wollenberg has received personal fees for lectures or advisory boards, grants or nonfinancial support from Abbvie, Almirall, Beiersdorf, Bioderma, Chugai, Galapagos, Galderma, Hans Karrer, Leo Pharma, Eli Lilly, L’Oreal, Maruho, MedImmune, Novartis, Pfizer, Pierre Fabre, Regeneron, Santen and Sanofi-Aventis. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Sanofi/Regeneron provided a scientific accuracy review at the request of the journal editor.

Additional information

Funding

There was no funding for this paper.