Dupilumab Combined With House Dust Mite Allergen Immunotherapy for Atopic Dermatitis: A Systematic Review and Meta-Analysis

IF 4.2 2区医学 Q2 ALLERGY

Clinical and Translational Allergy Pub Date : 2026-08-08 DOI:10.1002/clt2.70194

Jiale Lian, Ling Ren, Jing Liang, Shuping Guo

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引用次数: 0

Abstract

Background

Dupilumab is effective for moderate-to-severe atopic dermatitis (AD), but sustained disease control after treatment discontinuation remains challenging. House dust mite allergen immunotherapy (HDM-AIT) may provide disease-modifying effects in sensitized patients, but the added value of combining HDM-AIT with dupilumab remains unclear.

Objective

To evaluate the efficacy and safety of dupilumab combined with HDM-AIT versus dupilumab monotherapy in patients with AD.

Methods

PubMed, Embase, Web of Science, and Cochrane Library were searched from inception to April 21, 2026. Randomized controlled trials and comparative observational studies evaluating dupilumab plus HDM-AIT versus dupilumab alone were included. Disease severity assessed by EASI or SCORAD was pooled using standardized mean differences (SMDs), Dermatology Life Quality Index (DLQI) using mean differences, and adverse events using risk ratios. Random-effects models were applied. The certainty of evidence was assessed using the GRADE approach.

Results

Four studies involving 138 patients were included, comprising one randomized controlled trial and three comparative observational studies. Combination therapy showed no significant improvement in disease severity at 6 months (SMD = −0.02, 95% CI −0.41 to 0.36; I² = 0%) or 12 months (SMD = 0.53, 95% CI −1.10 to 2.16; I² = 93%). At 18 months, the pooled estimate suggested a possible benefit of combination therapy for disease severity, although the certainty of evidence was very low (SMD = −0.96, 95% CI −1.76 to −0.17; I² = 61%), although evidence was limited. At the follow-up closest to 30 months, the effect favored combination therapy but was not significant (SMD = −1.16, 95% CI −2.56 to 0.24; I² = 87%). No significant differences were observed in DLQI, overall adverse events, or ocular adverse events.

Conclusion

Current evidence regarding dupilumab combined with HDM-AIT for AD remains limited and inconclusive. Although an exploratory signal of improved disease severity was observed at 18 months, the available data did not demonstrate a statistically significant difference in adverse events, and the certainty of evidence was very low for all evaluated outcomes. Further adequately powered randomized controlled trials with standardized protocols, outcome definitions, and long-term follow-up are needed.

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Dupilumab联合屋尘螨过敏原免疫治疗特应性皮炎：系统回顾和荟萃分析。

背景：Dupilumab对中重度特应性皮炎（AD）有效，但停药后持续的疾病控制仍然具有挑战性。屋尘螨过敏原免疫疗法（HDM-AIT）可能对致敏患者提供疾病改善作用，但HDM-AIT联合杜匹单抗的附加价值尚不清楚。目的：评价dupilumab联合HDM-AIT与dupilumab单药治疗AD患者的疗效和安全性。方法：检索PubMed、Embase、Web of Science和Cochrane Library，检索时间为建站至2026年4月21日。随机对照试验和比较观察性研究评估dupilumab联合HDM-AIT与单独dupilumab。EASI或SCORAD评估的疾病严重程度采用标准化平均差异（SMDs），皮肤病生活质量指数（DLQI）采用平均差异，不良事件采用风险比进行汇总。采用随机效应模型。使用GRADE方法评估证据的确定性。结果：纳入4项研究，共138例患者，包括1项随机对照试验和3项比较观察性研究。联合治疗在6个月时（SMD = -0.02, 95% CI -0.41至0.36;I2 = 0%）或12个月时（SMD = 0.53, 95% CI -1.10至2.16;I2 = 93%）疾病严重程度无显著改善。在18个月时，尽管证据的确定性非常低（SMD = -0.96, 95% CI -1.76至-0.17;I2 = 61%），但合并估计表明联合治疗对疾病严重程度可能有益，尽管证据有限。在最接近30个月的随访中，效果倾向于联合治疗，但不显著（SMD = -1.16, 95% CI -2.56至0.24;I2 = 87%）。在DLQI、总体不良事件或眼部不良事件方面没有观察到显著差异。结论：目前关于dupilumab联合HDM-AIT治疗AD的证据仍然有限且不确定。虽然在18个月时观察到疾病严重程度改善的探索性信号，但现有数据并未显示不良事件的统计学显著差异，并且所有评估结果的证据确定性非常低。需要进一步进行具有标准化方案、结果定义和长期随访的充分有力的随机对照试验。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical and Translational Allergy Immunology and Microbiology-Immunology

CiteScore

7.50

自引率

4.50%

发文量

117

审稿时长

12 weeks

期刊介绍： Clinical and Translational Allergy, one of several journals in the portfolio of the European Academy of Allergy and Clinical Immunology, provides a platform for the dissemination of allergy research and reviews, as well as EAACI position papers, task force reports and guidelines, amongst an international scientific audience. Clinical and Translational Allergy accepts clinical and translational research in the following areas and other related topics: asthma, rhinitis, rhinosinusitis, drug hypersensitivity, allergic conjunctivitis, allergic skin diseases, atopic eczema, urticaria, angioedema, venom hypersensitivity, anaphylaxis, food allergy, immunotherapy, immune modulators and biologics, animal models of allergic disease, immune mechanisms, or any other topic related to allergic disease.