Extended-Interval Dosing and Discontinuation of Dupilumab in Atopic Dermatitis: A Real-World Retrospective Study

Abstract

This retrospective study evaluated the clinical courses and treatment patterns of 81 patients with atopic dermatitis (AD) treated with dupilumab at Hiroshima University Hospital. Patients were categorized into six groups based on their clinical outcomes, including those who continued treatment, achieved remission and discontinued, or discontinued due to adverse effects or insufficient efficacy. Of the 81 patients, 38 (47%) continued treatment throughout the study period, and 16 (20%) achieved remission and discontinued treatment without relapse. Analysis of baseline severity using EASI and TARC levels revealed no significant differences between these groups, suggesting that baseline severity does not predict long-term therapeutic outcomes. Regarding concomitant topical therapy, although the potency of topical corticosteroids (TCS) remained unchanged in most patients, the total dosage was significantly reduced by a mean of 71.3%, reflecting a successful transition to proactive therapy or a reduced affected body surface area. Furthermore, this study investigated the feasibility of extending dupilumab dosing intervals. Nearly half of the patients extended their intervals including every 3 weeks (Q3W), Q4W, and up to Q8W by 6 months without exacerbation. By 12 months, 22 of the 40 evaluable patients successfully transitioned to extended intervals up to Q12W. These findings suggest that baseline disease severity does not necessarily predict the long-term clinical course of dupilumab therapy in patients with AD. Although TCS potency is often maintained to ensure stability, the dosage can be drastically reduced. Furthermore, a subset of patients can discontinue or extend the dosing intervals, and the optimal timing for extending intervals is more flexible and can be initiated earlier than currently suggested by previous reports.