Dupilumab is the first monoclonal antibody (anti IL-4, anti IL-13) approved for adult and pediatric (≥6 years old) patients with moderate-to-severe atopic dermatitis.

In this real-world retrospective analysis in the clinical practice setting, 4 adult patients were included, with severe atopic dermatitis and poor response to treatment with topical corticosteroids, tacrolimus, pimecrolimus and cyclosporine (2mg/kg with a max dosage of 5mg/kg) for at least 4 consecutive weeks. Dupilumab was administered in these patients with a starting dosage of 600mg, followed by 300mg every 2 weeks for at least 12weeks.

Before the initiation of the treatment, they had to submit a DLQI (Dermatology Life Quality Index) and SCORAD (SCOring of Atopic Dermatitis), BSA (Body Surface Area) and IGA (Investigator's Global Assessment (IGA) Scale) were measured.

Results

In our series of patients: 3 patients were men (75%) and 1 woman (25%), their mean age was 31 years old (18-47years old), the onset of disease was at the mean age of 1,2 years of age (3 months min- 3 years old max), 3 out of 4 (75%) patients had coexisting asthma and all 4 (100%) of them had allergic rhinitis. Their mean DLQI was 21,5 (18,5 min–26 max), mean SCORAD 65,5 (58 min-75 max), mean BSA 57,5% (45%min -75% max), mean IGA 3,75 (3 min-4 max) before the initiation of treatment.

Patients were evaluated in week 12 of treatment with Dupilumab and SCORAD, BSA and IGA were measured again and also a DLQI was resubmitted by the patients.

The results in week 12 were: mean SCORAD 41,5 (35 min-48 max) with a significant decrease -24 after the treatment, mean BSA 32% (min 18%-max 45%) with decrease -25,5%, mean IGA 2 with almost 50% improvement after the treatment and mean DLQI 16 (min 12-max 20) ,-5 points compared to the results before the treatment.

Concerning the side effects of the drug, only one patient presented with conjunctivitis in both eyes after the first 2 injections, he was treated with dexamethasone+chloramphenicol drops for at least 7 days and the symptoms subsided and continued his treatment with dupilumab. The rest of the patients showed no side effects. 

Dupilumab showed excellent therapeutic efficacy with a tolerable safety profile. Even though the series are small in number, all patients showed remarkable improvement in their burden of disease from the very first injections and this reached a peak at week 12 of treatment.