Background Limited data exist on the clinical course of atopic dermatitis (AD) after the discontinuation of dupilumab. Objectives To assess disease progression following dupilumab discontinuation. Methods A multicentre, retrospective study was conducted on 208 patients with severe AD who discontinued dupilumab for reasons unrelated to inefficacy. The Eczema Area and Severity Index (EASI), pruritus numerical rating scale (P-NRS), Atopic Dermatitis Control Tool (ADCT) and Dermatology Life Quality Index (DLQI) were used to assess disease activity after discontinuation. Kaplan-Meier analysis was used to estimate the time and probability of disease worsening (defined as EASI > 7.0, EASI increase >= 6.6, P-NRS >= 4, P-NRS increase >= 4, ADCT >= 7, ADCT increase >= 5, or DLQI increase >= 4), as well as the need to restart systemic treatment. Results The main reasons for discontinuing dupilumab were clinical remission or good clinical control (43.3%), patient's decision (11.1%) and pregnancy or desire to become pregnant (20.7%). Patients with a family history of AD or nonclassical phenotypes had a significantly higher likelihood of disease worsening. A significant portion (42.8%) of patients resumed systemic treatment within a median time of 47 weeks. They had a baseline median EASI score of 10.0 and a median P-NRS of 6.0. The probability of resuming systemic treatment was 25% at 31 weeks and 50% at 94 weeks. Reinitiation of dupilumab significantly improved EASI and P-NRS scores within 16 weeks. Conclusions Discontinuing dupilumab is associated with disease recurrence in some patients, especially those with a family history or nonclassical AD. Dupilumab reinitiation is effective, leading to significant clinical improvements and supporting its use after treatment interruption.
Clinical course of atopic dermatitis after dupilumab discontinuation: a multicentre real-world study / Barei, F.; Macchi, S.; Calzari, P.; Ribero, S.; Ortoncelli, M.; Foti, C.; Balato, A.; Di Brizzi, E. V.; Peris, K.; Gori, N.; Ippoliti, E.; Gurioli, C.; Piraccini, B. M.; Trave, I.; Cozzani, E.; Pezzolo, E.; Bonzano, L.; Errichetti, E.; Schettini, N.; Nettis, E.; Gola, M.; Milanesi, N.; Feliciani, C.; De Felici Del Giudice, M. B.; Campanati, A.; Gioacchini, H.; Pisapia, A.; Avallone, G.; Micali, G.; Musumeci, M. L.; Ortega, R.; Manzo Margiotta, F.; Romanelli, M.; Hansel, K.; Stingeni, L.; Patruno, C.; Esposito, M.; Fargnoli, M. C.; De Berardinis, A.; Ferreli, C.; Calabrese, L.; Rubegni, P.; Lazzeri, L.; Grigolato, L.; Galli, B.; Rossi, M.; Maurelli, M.; Girolomoni, G.; Lauletta, G.; Napolitano, M.; Alfano, A.; Gargiulo, L.; Narcisi, A.; Marzano, A. V.; Ferrucci, S. M.. - In: CLINICAL AND EXPERIMENTAL DERMATOLOGY. - ISSN 0307-6938. - 50:11(2025), pp. 2221-2231. [10.1093/ced/llaf275]
Clinical course of atopic dermatitis after dupilumab discontinuation: a multicentre real-world study
Gola M.;Feliciani C.;De Felici Del Giudice M. B.;
2025-01-01
Abstract
Background Limited data exist on the clinical course of atopic dermatitis (AD) after the discontinuation of dupilumab. Objectives To assess disease progression following dupilumab discontinuation. Methods A multicentre, retrospective study was conducted on 208 patients with severe AD who discontinued dupilumab for reasons unrelated to inefficacy. The Eczema Area and Severity Index (EASI), pruritus numerical rating scale (P-NRS), Atopic Dermatitis Control Tool (ADCT) and Dermatology Life Quality Index (DLQI) were used to assess disease activity after discontinuation. Kaplan-Meier analysis was used to estimate the time and probability of disease worsening (defined as EASI > 7.0, EASI increase >= 6.6, P-NRS >= 4, P-NRS increase >= 4, ADCT >= 7, ADCT increase >= 5, or DLQI increase >= 4), as well as the need to restart systemic treatment. Results The main reasons for discontinuing dupilumab were clinical remission or good clinical control (43.3%), patient's decision (11.1%) and pregnancy or desire to become pregnant (20.7%). Patients with a family history of AD or nonclassical phenotypes had a significantly higher likelihood of disease worsening. A significant portion (42.8%) of patients resumed systemic treatment within a median time of 47 weeks. They had a baseline median EASI score of 10.0 and a median P-NRS of 6.0. The probability of resuming systemic treatment was 25% at 31 weeks and 50% at 94 weeks. Reinitiation of dupilumab significantly improved EASI and P-NRS scores within 16 weeks. Conclusions Discontinuing dupilumab is associated with disease recurrence in some patients, especially those with a family history or nonclassical AD. Dupilumab reinitiation is effective, leading to significant clinical improvements and supporting its use after treatment interruption.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
