Clinical Course of Atopic Dermatitis after Dupilumab Discontinuation: A Multicenter Real-World Study

Abstract

Introduction: Limited data exist on the clinical course of atopic dermatitis (AD) after the discontinuation of dupilumab. This study aims to assess disease progression following dupilumab discontinuation.

Methods: A multicenter, 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 post-discontinuation. Kaplan-Meier analysis estimated 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 'decision (11.1%), and pregnancy or pregnancy's desire (20.7%). Patients with a family history of AD or non-classical 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, and 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. Re-initiation of dupilumab significantly improved EASI and P-NRS scores within 16 weeks.

Conclusion: Discontinuing dupilumab is associated with disease recurrence in some patients, especially those with a family history or non-classical AD. Dupilumab re-initiation is effective, leading to significant clinical improvements and supporting its use after treatment interruption.