Patient‐centered dupilumab dosing regimen leads to successful dose reduction in persistently controlled atopic dermatitis. Issue 11 (29th July 2022)

• Record Type: Journal Article
• Authors: Spekhorst, Lotte S.; Bakker, Daphne; Drylewicz, Julia; Rispens, Theo; Loeff, Floris; Boesjes, Celeste M.; Thijs, Judith; Romeijn, Geertruida L. E.; Loman, Laura; Schuttelaar, Marie‐Louise; van Wijk, Femke; de Graaf, Marlies; de Bruin‐Weller, Marjolein S.
• Is Part Of: Allergy. Volume 77:Issue 11(2022)
• Page Start: 3398
• Page End: 3407
• Publication Date: 2022-07-29
• Subjects: atopic dermatitis -- daily practice -- dose reduction -- dupilumab -- patient‐centered dosing regimen; Allergy -- Periodicals; 616.97
• DOI: 10.1111/all.15439
• Languages: English
• ISSNs: 0105-4538

Abstract

Abstract: Background: At present, no real‐world studies are available on different dupilumab dosing regimens in controlled atopic dermatitis (AD). The aim of this study was to clinically evaluate a patient‐centered dupilumab dosing regimen in patients with controlled AD and to relate this to serum drug levels and serum biomarkers. Methods: Ninety adult AD patients from the prospective BioDay registry were included based on their dupilumab administration interval according to a predefined patient‐centered dosing regimen. Group A ( n = 30) did not fulfill the criteria for interval prolongation and continued using the standard dupilumab dosage (300 mg/2 weeks), group B ( n = 30) prolonged dupilumab interval with 50% (300 mg/4 weeks), and group C ( n = 30) prolonged dupilumab interval with 66%–75% (300 mg/6–8 weeks). AD severity score, patient‐reported outcomes, serum dupilumab levels, and serum biomarkers were analyzed over time. Results: Disease severity scores did not significantly change over time during the tapering period in any of the groups. In groups B and C, the Numeric Rating Scale (NRS)‐pruritus temporarily significantly increased after interval prolongation but remained low (median NRS‐pruritus≤4). Median dupilumab levels remained stable in group A (standard dosage), but significantly decreased in groups B and C (24.1 mg/L (IQR = 17.1–45.6); 12.5 mg/L (IQR = 1.7–22.3)) compared with the levels during the standard dosage (88.2 mg/L [IQR = 67.1–123.0, p < .001]). Disease severity biomarker levels (CCL17/CCL18) remained low in all study groups during the whole observation period. Conclusions: This study showed that dose reduction was successful in a subgroup of patients with controlled AD by using a patient‐centered dosing regimen. These patients showed stable low disease activity and low severity biomarkers over time. Abstract : Dose reduction was successful in a subgroup of controlled AD patients by using a patient‐centered dupilumab dosing regimen. Despite significantly lower dupilumab levels, the EASI‐score and disease severity biomarkers (TARC/CCL17 and PARC/CCL18) in groups B (Q4W) and C (Q6W/Q8W) remained low and stable. These findings are the first step toward personalized dupilumab treatment for controlled AD patients in clinical practice.Abbreviations: AD, atopic dermatitis; EASI, eczema area and severity index; PARC (CCL18), pulmonary and activation‐regulated chemokine; PROMs, patient‐reported outcome measures; Q2W, every two weeks; Q4W, every four weeks; Q6W, every six weeks; Q8W, every eight weeks; TARC (CCL17), thymus and activation‐regulated chemokine