RECENT findings suggest that dupilumab, a monoclonal antibody treatment for atopic dermatitis (AD), may significantly reduce the risk of atopic march in children. Atopic march describes the progression from AD to other allergic conditions such as asthma and allergic rhinitis. While dupilumab’s efficacy in treating AD is well-documented, its potential to prevent the atopic march has been less clear. Researchers analysed the impact of dupilumab on the atopic march in paediatric patients.
This retrospective cohort study compared 2,192 children newly treated with dupilumab to an equal number receiving conventional immunomodulatory therapies. Data were sourced from the TriNetX US Collaborative Network and covered the period from 2011 to 2024.
The study revealed that the 3-year cumulative incidence of atopic march progression was significantly lower in the dupilumab group (20.09%) compared to the conventional therapy group (27.22%). Children treated with dupilumab showed a 32% reduction in the risk of atopic march progression (hazard ratio [HR] = 0.68; 95% confidence interval [CI], 0.55-0.83). Furthermore, the dupilumab cohort exhibited a reduced risk of developing asthma (HR = 0.60; 95% CI, 0.45-0.81) and allergic rhinitis (HR = 0.69; 95% CI, 0.54-0.88).
The study also found that the protective effects of dupilumab were consistent across different age groups. Preschoolers on dupilumab experienced the greatest reduction in atopic march progression (HR = 0.537; 95% CI, 0.381-0.756), followed by school-aged children (HR = 0.635; 95% CI, 0.466-0.865) and adolescents (HR = 0.639; 95% CI, 0.44-0.927). However, the reduction in asthma risk was significant only for preschool-aged children (HR = 0.427; 95% CI, 0.247-0.738).
The authors concluded that dupilumab offers a protective effect against the progression of the atopic march in paediatric AD patients, potentially altering the clinical approach to managing AD and preventing subsequent allergic conditions. However, the authors called on further research with extended follow-up, and proof-of-concept is required, highlighting the need to validate these findings in more diverse populations and over more extended periods. This study underscores dupilumab’s potential beyond treating atopic dermatitis, marking a significant step towards holistic allergy prevention in pediatric care.
Laith Gergi, EMJ
Reference
Lin TL et al. Reduced atopic march risk in pediatric atopic dermatitis patients prescribed dupilumab versus conventional immunomodulatory therapy: a population-based cohort study. J Am Acad Dermatol. 2024:S0190-9622(24)00788-6.
