Impact of dupilumab on the atopic march in pediatric patients

Summary: Abstract Body: Atopic dermatitis (AD) typically initiates the atopic march, where patients progress to developing asthma and allergic rhinitis. Our study examined whether dupilumab, a targeted immunomodulatory medication available since 2017, could prevent progression of the atopic march in pediatric patients <=18 years old. We conducted a retrospective cohort study using administrative claims data from 2017-2021 in the MarketScan Commercial Claims and Encounters Database. We identified 614 patients with AD who received dupilumab and 168 who received a conventional systemic medication (i.e., methotrexate, cyclosporine, azathioprine, or mycophenolate). The primary outcome was incident asthma or allergic rhinitis diagnosis. The cumulative incidence of atopic comorbidities was greater in the conventional systemics group than the dupilumab group (23.9% vs 12.7%; p<0.001). In proportional hazards models adjusted for age, insurance type, and other medications (e.g., topical calcineurin inhibitors), dupilumab was associated with lower risk of asthma or allergic rhinitis (HR 0.59, 95% CI 0.40-0.89) versus conventional systemics. In secondary analyses, we also compared a cohort of 640 patients who received dupilumab to 4,929 patients who received primarily topical corticosteroids, propensity score matched on age, duration of AD, sex, geographical region, other atopic conditions, history of other AD treatments (i.e. topical calcineurin inhibitors, systemic immunosuppressants, systemic corticosteroids, and phototherapy), and maximum topical corticosteroid strength. The cumulative incidence of atopic comorbidities was similar between the dupilumab and topicals groups (12.8% vs 13.5%; p=0.71); in adjusted models, there was no significant difference in incident asthma or allergic rhinitis diagnosis (HR 1.00, 95% CI 0.79-1.26) between the groups. Our findings suggest that dupilumab may mitigate atopic march progression compared to conventional systemics, but future studies that directly account for AD severity are needed to discern if dupilumab has a protective effect compared to primarily topical therapies. Derek A. Tsang¹, Junko Takeshita², Joy Wan¹ 1. Johns Hopkins University, Baltimore, MD, United States. 2. University of Pennsylvania, Philadelphia, PA, United States. Clinical Research: Epidemiology and Observational Research