Atopic dermatitis may inhibit growth in children, but dupilumab helps

Children with atopic dermatitis (AD) are at greater risk of impaired linear growth, but treatment with dupilumab may lessen the risk, suggests a study.

A team of investigators conducted a retrospective cohort study using the TriNetX US Collaborative Network from January 2018 to December 2023 involving children aged <18 years. They compared children with AD to propensity score-matched non-AD control participants to assess the risk of falling below the 5th, 25th, and 50th height percentiles.

A target trial emulation framework was applied among children with AD to compare growth outcomes between participants who received dupilumab and those treated with conventional systemic immunomodulators. The investigator used Cox proportional hazard models, adjusted for confounders, to estimate the relative risks (RRs) for reduced stature over a 5-year follow-up period.

A total of 745,046 paediatric patients with AD were included in the analysis. Children with AD had a significantly higher risk of reduced height than matched controls (<5th percentile: RR, 1.15, 95 percent confidence interval [CI], 1.12‒1.18; <25th percentile: RR, 1.13, 95 percent CI, 1.08‒1.21; <50th percentile: RR, 1.22, 95 percent CI, 1.20‒1.25).

The increased risks were most pronounced among male children and those aged >6 years. Sleep disturbance and use of corticosteroids were found as potential effect modifiers.

However, treatment with dupilumab resulted in a significantly lower risk of falling below the 5th (RR, 0.69, 95 percent CI, 0.57‒0.84; p<0.001), 25th (RR, 0.70, 95 percent CI, 0.54‒0.91; p<0.001), and 50th (RR, 0.74, 95 percent CI, 0.58‒0.95; p<0.001) height percentiles. This benefit was also particularly evident among male children, those aged >6 years, and those with BMI ≥20 kg/m2.

“These findings highlight the potential growth-preserving benefits of dupilumab in the management of paediatric AD and emphasize the importance of routine growth monitoring in this population,” the investigators said.