Frequency and clinical features of disease flares in patients with atopic dermatitis treated with dupilumab.

Abstract

Background: Dupilumab, an interleukin 4 (IL-4) receptor α-antagonist approved for the treatment of atopic dermatitis, is considered effective in preventing disease recurrences. However, the incidence and characteristics od atopic dermatitis flares during treatment with dupilumab in a real-life setting have not been described in the literature.

Objective: This study aims to evaluate the prevalence of disease flares in patients in treatment with dupilumab and to describe the features of flares in our study population.

Methods: We conducted a retrospective observational study in which we collected demographic and clinical data on adult patients with a diagnosis of severe atopic dermatitis in treatment with dupilumab for a minimum of six months, who reached EASI75 within six months of treatment initiation.

Results: Ninety-nine patients were enrolled. Recurrences were recorded for 38.4% of patients and 7.1% developed a second recurrence. The EASI at recurrence was always lower than the EASI before treatment initiation. The localization of disease at head and neck before treatment was associated to the same localization of disease at the first recurrence (p = 0.011). The risk of recurrence was associated to the baseline EASI score (p = 0.005). The presence of dupilumab-related conjunctivitis was significantly associated to recurrences (p = 0.02).

Conclusions: Treatment with dupilumab does not exclude the risk of a relapse, which can be estimated around 50% within a timespan of three years. In the most cases, flares should not be regarded as treatment failures, and can be easily managed with additional treatment.