P153 Tertiary clinic experience of weekly dupilumab in atopic dermatitis

Abstract

Atopic dermatitis is a chronic inflammatory skin condition requiring long-term treatment. Dupilumab, a monoclonal antibody that inhibits interleukin-4 and interleukin-13, is a safe and effective treatment for atopic dermatitis and other type 2 inflammatory conditions. Treatment withdrawal is most often due to inadequate response or side effects, including conjunctivitis and facial erythema. The licensed regimen is a 600-mg loading dose, followed by 300 mg every 2 weeks. In a tertiary severe eczema clinic, we aimed to assess the efficacy and tolerability of weekly dupilumab 300 mg in selected patients with partial response to standard dose. We present a retrospective case review of 13 patients with severe eczema treated with weekly dupilumab 300 mg. The affected patients were 28–66 years old (mean 37.1); 69% were male and 31% female. On average 1.54 (range 0–5) standard treatments were tried prior to dupilumab. All patients were treated with standard 2-weekly dosing prior to dose escalation. Patients experienced improvement in their eczema but reported recurrence of symptoms prior to their next dose. The average treatment duration of weekly dosing was 10 months (range 4–20). One patient had pre-existing ocular surface disease. With escalation to weekly dosing, 54% (seven) met the minimum ≥ 50% improvement in Eczema Area and Severity Index (EASI 50), with 31% (four) and 8% (one) achieving EASI 75 and EASI 90, respectively. Four patients (31%) did not meet the threshold of EASI 50. Patient-Oriented Eczema Measure and Dermatology Life Quality Index improved by an average of 4.3 (range 1–7) and 4.1 (range 1–11) points, respectively. Four patients (31%) reported ocular side effects and two (15%) required ophthalmology review, but they were managed topically and no dose adjustment was required. No patients reported any other side effects. Our case series suggests that an increased dose of dupilumab can offer objective and subjective improvement in eczema. In patients who tolerated standard dosing, increasing to weekly did not cause additional side effects. Although cost is a consideration, in selected patients this may be a successful treatment option.