P172 Compassionate use of dupilumab in infants and young children aged 6 months to 6 years with severe atopic dermatitis: a retrospective case series

Abstract

Therapeutic options for infants and young children with severe atopic dermatitis (AD) refractory to topical and conventional systemic therapies remain limited. Real-world evidence for dupilumab in this population is emerging, but UK-specific observational data in infants and preschool children (< 6 years) are limited. We aimed to evaluate the safety and clinical effectiveness of dupilumab in this population under compassionate use. We conducted a retrospective case series of 10 paediatric patients (5 boys, 5 girls) aged 6 months to 6 years with severe AD treated with dupilumab under compassionate use at a tertiary paediatric dermatology centre. All had an inadequate response to optimal topical therapy and some had conventional systemic immunosuppressants. Disease severity was assessed using Eczema Area and Severity Index (EASI) and body surface area (BSA). Comorbidities, infectious complications and clinical outcomes were systematically reviewed. Baseline disease burden was high (EASI 27–64; BSA up to 90%). Six patients had food allergies, and all had additional comorbidities, including asthma, obstructive sleep apnoea, allergic conjunctivitis, recurrent infections and poor weight gain. The first child received dupilumab on compassionate grounds following multiple hospitalizations for infected eczema and failure of systemic therapies. The youngest patient was referred at 13 weeks of age and commenced dupilumab at 14 months. Eight patients achieved excellent clinical response (EASI < 5). Two treatment failures occurred: one due to secondary loss of response after 3 years and 10 months, and one primary nonresponse. Prior to dupilumab, the patients experienced significant infectious morbidity, including methicillin-resistant Staphylo­coccus aureus colonization, sepsis, cellulitis, staphylococcal scalded skin syndrome, and septic arthritis requiring surgery. Dupilumab was associated with substantial clinical improvement in most infants and young children with severe, treatment-refractory AD. These findings highlight the considerable disease burden in this population and support dupilumab as an effective therapeutic option with meaningful improvement in disease severity.