Dupilumab for infants with atopic dermatitis: Friendly administration tips to enhance adherence

Abstract

Atopic dermatitis (AD) is a chronic inflammatory skin disease driven by type 2 immune responses involving cytokines such as IL-4 and IL-13. It is characterized by persistent pruritus and widespread skin lesions that significantly impact the quality of life (QoL) of both affected children and their caregivers. Disease onset typically occurs in childhood, with approximately 60% of cases presenting within the first year and nearly 80% before age six.¹ Early prevention and effective management are therefore crucial, especially considering the limitations of systemic therapies in young children.

In a recent real-world study published in the JEADV, Lasek et al.² report outcomes from the French Early Access Program (EAP) involving 198 children aged 6 months to 5 years with moderate-to-severe AD. Dupilumab, a monoclonal antibody targeting IL-4 and IL-13, was injected every 4 weeks at a dose of 200 mg for children weighing 5–15 kg and 300 mg for those weighing 15–30 kg. Children who reached 15 kg during treatment continued receiving the 200-mg dose.

By 6 months, approximately 84% of patients achieved an Investigator's Global Assessment (IGA) score of 0/1, indicating clear or almost clear skin. Additionally, 94.4%, 75.0% and 44.4% of patients achieved at least 50%, 75% and 90% improvement, respectively, on the Eczema Area and Severity Index (EASI 50/75/90). Meaningful reductions in pruritus were also noted, with about 67.6% of patients reporting a ≥4-point improvement in the Pruritus-Numerical Rating Scale (P-NRS) scores, highlighting the substantial benefit of dupilumab. These clinical improvements were accompanied by gains in QoL, as reflected by reductions in paediatric-specific measures, including the Infants' Dermatitis QoL Index (IDQOL; for children <4 years) and the Children's Dermatology Life Quality Index (CDLQI, for children ≥4 years). Mean score decreases of −6.9 and −8.8, respectively, indicate a substantial reduction in disease-related discomfort and psychosocial burden in this patient group.

The safety profile remained consistent with previous clinical trials,^{3, 4} with low rates of adverse events—primarily mild or moderate—and no new safety concerns identified. Notably, these findings extend beyond the typical 16-week duration of randomized trials, further supporting dupilumab as an effective and well-tolerated treatment for moderate-to-severe AD in very young children. However, caregivers should take special considerations into account.

To optimize adherence and ease the administration process, several strategies can help reduce the stress of injections for children.⁵ These include removing the syringe or prefilled pen from the refrigerator 30–45 minutes before injection to reduce discomfort caused by cold, applying a topical anaesthetic to reduce pain and using distraction techniques such as audiovisual media, toys or tactile objects to divert attention and alleviate anxiety. Having a supportive presence and involving an experienced healthcare professional for the first injection can further increase confidence and comfort for both children and caregivers. Together, these measures aim to improve the overall experience, reduce fear and promote treatment adherence.

Another important consideration before initiating dupilumab is the vaccination schedule. Clinical data on this matter remain limited,⁵ and specific guidelines for the use of live or live-attenuated vaccines in dupilumab-treated patients are still needed.

Despite the significant advances with dupilumab in young children with AD, several questions remain regarding the optimal timing for treatment discontinuation, long-term use, the potential for personalized dosing intervals and the possibility of modifying the natural course of AD. Long-term prospective studies in larger populations will be essential to address these knowledge gaps.

The authors have nothing to report.

Nothing to be disclosed.

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Data sharing is not applicable to this article as no new data were created or analyzed in this study.