Evaluation of dupilumab on the disease burden in children and adolescents with atopic dermatitis: A population‐based cohort study

Abstract Background Dupilumab is the first and only biologic agent approved for the treatment of atopic dermatitis (AD) in pediatric patients aged from 6 months to 17 years. The study aimed to evaluate the impact of dupilumab on the occurrence of comorbidities in pediatric patients with AD. Methods In this population‐based cohort study, we utilized electronic health records from multiple healthcare organizations across the United States. Pediatric patients (<18 years of age) with a diagnosis of AD initiating dupilumab were propensity‐score matched 1:1 to those initiating other systemic agents (azathioprine, cyclosporine, methotrexate, mycophenolate mofetil, or systemic corticosteroids). The primary outcomes were new‐onset comorbidities emerging during the study period measured by the risk ratio (RR) and its confidence interval (CI). Subgroup analyses were stratified by age (0–5 years, 6–11 years, and 12–17 years), sex, and race. Results A total of 3575 pediatric patients with AD treated with dupilumab were matched to 3575 patients treated with other systemic agents. The dupilumab cohort was associated with a lowered risk of new‐onset atopic comorbidities (including asthma RR, 0.72; 95% CI, 0.59–0.89 and allergic rhinitis RR, 0.62; 95% CI, 0.52–0.74), infections (e.g., skin and soft tissue infection RR, 0.70; 95% CI, 0.63–0.76 and respiratory tract infection RR = 0.56; 95% CI, 0.51–0.61), psychiatric disorders (e.g., mood disorder RR, 0.52; 95% CI, 0.39–0.70 and anxiety RR, 0.57; 95% CI, 0.46–0.70, sleep disturbance RR, 0.60; 95% CI, 0.47–0.77), neurologic and developmental disorders (e.g., attention deficit hyperactivity disorder RR, 0.54; 95% CI, 0.38–0.75). Furthermore, the positive effects are found to be more pronounced in younger children (aged 0–5 years) with AD. Conclusions Treatment with dupilumab compared to systemic agents resulted in reductions in AD‐related comorbidities in pediatric patients.