Real-life management of atopic dermatitis patients with an inadequate response to on-label use of dupilumab.

In patients with moderate to severe atopic dermatitis (AD) showing an inadequate response to dupilumab 300mg/2weeks, few real-life studies reported the response to alternative regimen maintaining dupilumab. To assess and analyze the response to an increased dose of dupilumab or its combination with cyclosporin A (CsA), methotrexate (MTX), or itraconazole (ITRA), all adult AD patients from 7 French University Hospitals were retrospectively included if they achieved an inadequate response to dupilumab 300mg/2weeks and were subsequently treated with an increased dose of dupilumab (300mg every 7 or 10 days), or a combination of dupilumab 300mg/2weeks with CsA, MTX or ITRA. The response after 3 months, along with epidemiological, clinical, and therapeutic baseline characteristics, were collected. Overall, 68.75% of the 48 included patients achieved an improved response, including 45.8% of complete response (CR). No strategy proved significantly better. Patients showing an initial no response never achieved a further CR versus 52.4% of patients with an initial partial response (p = 0.025). Digestive intolerance and tachycardia led to MTX and ITRA discontinuation in 3 patients. Increasing the dose of dupilumab or combining it with CsA, MTX, or ITRA could be alternative and safe options, to be evaluated in further medico-economic studies.

© 2024 The Authors.

R Strizzolo reports no competing interest. J Seneschal reports the following competing interests: Principal investigator or consultant or speaker for AbbVie, Almirall, Lilly, Sanofi, LeoPharma, Pierre Fabre, Pfizer; support for attending meetings from AbbVie. A Soria reports the following competing interests: Consultant or speaker for Novartis, Sanofi, LEO Pharma, Abbvie, Lilly, Pfizer and Bioprojet D Staumont-Sallé reports the following competing interests: Investigator, consultant and/or speaker for AbbVie, Almirall, Amgen, Astra-Zeneca, Eli Lilly, Galderma, Leo Pharma, Novartis, Pfizer, Sanofi-Regeneron, UCB. S Barbarot reports the following competing interests: principal investigator, speaker and consultant: Astrazeneca, Almirall, Sanofi-Genzyme, Abbvie, Galderma, Alexion, Novartis, Janssen, Leo-Pharma, Pfizer, Eli Lilly, UCB Pharma, Chiesi. M Viguier reports the following competing interests: travel fees, speaker, consultant and/or board member for Lilly, Abbvie, Janssen-Cilag, Galderma, Boehringer Ingelheim, Novartis, UCB, Nordic, Medac, Bristol Myers Squibb. M Jachiet reports the following competing interests: investigator, consultant and/or speaker for AbbVie, Eli Lilly, Galderma, Leo Pharma, Pfizer, Sanofi-Regeneron. A Nosbaum reports the following competing interests: investigator, consultant and/or speaker for AbbVie, Leo Pharma, Pfizer, Sanofi, Lilly, Medac. A Clément reports the following competing interests: principal investigator, speaker and/or consultant for LeoPharma, Sanofi-Regeneron, Abbvie, Lilly, Janssen. M Tauber reports the following competing interests: principal investigator, speaker and/or consultant for LeoPharma, Sanofi-Regeneron, Abbvie, Lilly, Medac, Almirall, Jenssen, Pfizer. S Mallet reports the following competing interests: principal investigator or sub investigator for Lilly, Sanofi, LeoPharma, consulting fees from Lilly, Sanofi, LeoPharma, Pfizer, speaker for Lilly, Sanofi, LeoPharma, Pfizer, support for attending meetings Lilly, Sanofi, LeoPharma, participation on advisory board: Sanofi, LeoPharma, Pfizer. A Du-Thanh reports the following competing interests: principal investigator, speaker and consultant for LeoPharma, Sanofi, Pfizer, Abbvie, Lilly.