The following is a summary of “Factors Associated with Dupilumab Response in Atopic Dermatitis: A Systematic Review and Meta-analysis,” published in the September 2024 issue of Allergy and Immunology by Chokevittaya et al.

Dupilumab has been approved for the treatment of moderate-to-severe atopic dermatitis (AD), yet a significant proportion of patients do not respond to this therapy. Understanding the factors that influence dupilumab efficacy is crucial for optimizing treatment outcomes. This systematic review aims to identify and characterize factors associated with dupilumab response in AD. Researchers conducted a comprehensive search of electronic databases, including PubMed/MEDLINE, Embase, Ovid, and the Cochrane Center of Controlled Trials, up to March 2023. 

The primary focus was to determine factors linked to a 75% reduction in the Eczema Area and Severity Index (EASI) score at 12-16 weeks of treatment, as measured by odds ratios (OR) and 95% confidence intervals (CI) using random-effects meta-analysis. The review of 21 studies involving 5,575 patients with AD included three post hoc analyses from phase 3 dupilumab trials, twelve retrospective studies, and six prospective studies. Key factors associated with a favorable response to dupilumab, defined by achieving EASI75 at 12-16 weeks, were identified as being female (OR 2.16, 95% CI 1.38–3.38), younger age (OR 2.81, 95% CI 1.64–4.81), absence of allergic rhinitis (OR 2.64, 95% CI 1.07–6.50), lower body mass index (BMI) (OR 1.97, 95% CI 1.18–3.30), and lower blood eosinophil count (OR 6.47, 95% CI 3.36–12.48), though with very low certainty of evidence. 

Conversely, factors such as age of onset, baseline EASI score, total IgE level, and serum lactate dehydrogenase level were not found to be associated with dupilumab response. These findings suggest that female sex, younger age, lack of allergic rhinitis, lower BMI, and reduced blood eosinophil count are associated with improved dupilumab efficacy in patients with AD. Clinicians should consider these factors when assessing dupilumab therapy for AD in clinical practice.

Source: sciencedirect.com/science/article/abs/pii/S2213219824008870