The IL-4/IL-13 blocker dupilumab leads to rapid symptom control and itch reduction in children with severe atopic dermatitis (AD), as was demonstrated in the phase 3 LIBERTY AD PEDS study .
Previous trials have already shown that dupilumab is effective in adults and adolescents ≥12 years with moderate-to-severe AD inadequately controlled with topical prescription therapies. However, there is also an ongoing medical need for younger children with severe AD. Prolonged use of topical steroids can potentially damage the skin barrier resulting in thinning of the skin. Untreated, moderate-to-severe AD can not only impact a child’s physical development, but can have psychological sequelae, placing a substantial burden on parents and caregivers .
The double-blind phase 3 LIBERTY AD PEDS study aimed to assess the efficacy and safety of dupilumab in children with severe AD aged ≥6 to <12 years (minimum weight 15 kg). All children had an Investigator’s Global Assessment (IGA) score of 4. They were randomised to subcutaneous dupilumab every 2 weeks in 2 dosages according to body weight (100 mg if baseline weight <30 kg and 200 mg if ≥30 kg; n=122), dupilumab every 4 weeks (300 mg regardless of weight; n=122), or placebo (n=123) for 16 weeks. From week 2 onward, all patients initiated standardised treatment with medium-potency topical corticosteroids. The primary endpoint of the study was the percentage of participants with almost clear or clear skin according to the IGA score (0/1 score). In addition, the percentage of patients with an improvement of the Eczema Area and Severity Index (EASI) score by 75% was assessed.
At week 16, 29.5% of the patients with dupilumab treated every 2 weeks, 32.8% of the patients treated every 4 weeks, and 11.4% of patients in the placebo group reached IGA 0/1. EASI 75 improvement was 67.2%, 69.7%, and 26.8%, respectively. Dupilumab led to a significant improvement of pruritus, assessed as mean percent change in the Peak Pruritus Numerical Rating Scale (P<0.001 for all comparisons).
“Dupilumab was well tolerated and the safety profile was consistent with the profile we know from adults and adolescents,” said Prof. Amy S. Paller (Northwestern University, Feinberg School of Medicine, USA). Serious adverse events and adverse event-related treatment discontinuations were rare. Injection-site reactions and conjunctivitis were more common with dupilumab than with placebo.
In conclusion, dupilumab together with topical steroids led to a clinically meaningful and statistically significant improvement in AD signs and symptoms in children <12 years with severe AD.
For more articles on Type 2 Inflammation, see our independent webportal inflammation-type2.org.
- Paller A, et al. Late-breaking abstract, AAD Virtual Meeting Experience, 12-14 June 2020.
- Fennessy M, et al. J Epidemiol Community Health. 2000;54:581–9.
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Table of Contents: AAD 2020
Letter from the Editor
AAD 2020 Highlights Podcast
IL-17A and IL-17F blockade remarkably effective in psoriasis
Good response and pruritus reduction in AD with novel selective JAK1 inhibitor
Novel IL-23 blocker risankizumab highly effective and tolerable in psoriasis
IL-13 blocker tralokinumab effective in AD
Tape stripping – a painless way to distinguish AD and psoriasis?
IL-4/IL-13 blocker dupilumab effective in children with severe AD
Pembrolizumab leads to higher toxicity risk in obese melanoma patients
Can gene expression help to pick the right biologic to treat psoriasis in cancer patients?
Omalizumab for cancer-induced dermatoses
Psoriasis – What Is Hot?
Psoriasis therapy for children and pregnancies
Biologic psoriasis treatment to lower cardiovascular risk?
A new topical PDE-4 inhibitor effective in psoriasis
Systemic Therapies for Dermatologists
How to manage cutaneous side effects of immunotherapy
Cannabinoids: a future role in dermatology?
Hidradenitis Suppurativa/Acne Inversa
Biologics in HS – a growing armamentarium
Pearls of the Posters
Selective IL-23 blocker safe in elderly psoriasis patients
Spironolactone safe for androgenetic alopecia in cancer survivors
Baricitinib beneficial in head and neck AD
Continuous terbinafine most effective for toenail onychomycosis
ECLIPSE trial: skin clearance independent of PsA status at baseline
Cannabinoids: a future role in dermatology?