The use of dupilumab significantly delays disease relapse in patients with moderate-to-severe atopic dermatitis (AD) while having an acceptable safety profile, reports a study.
“Dupilumab is effective and safe for moderate-to-severe AD, with long-term use significantly delaying relapse,” the investigators said.
Seventy-nine AD patients treated with dupilumab from January 2022 to May 2024 were included in this retrospective study. Participants were categorized by response into long-term (600 mg, followed by 300 mg every 2 week until week 52), short-term (600 mg, followed by 300 every 2 weeks for 16 weeks), and tapering group (600 mg, followed by 300 mg every 2 weeks for 16 weeks, then the interval was extended up to every 8 weeks until week 52).
The investigators then assessed Eczema Area and Severity Index (EASI), Atopic Dermatitis Severity Score (ADSS), pruritus Numeric Rating Scale (pNRS), and Dermatology Life Quality Index (DLQI) at baseline, 16, and 52 weeks.
At week 16, all patient groups demonstrated significant improvements in ADSS (46.62 vs 25.22; p<0.001), EASI (15.65 vs 5.94; p<0.001), and pNRS (7.41 vs 3.73; p<0.001). EASI-50 and EASI-70 response rates were 72.15 percent and 44.3 percent, respectively. [J Am Acad Dermatol 2026;94:1454-1460]
Patients in the long-term groups achieved a significantly longer mean relapse-free period than those in the short-term and tapering groups (159.55 vs 66.40 and 48.17 days). Factors affecting relapse included AD subtype, disease duration, and baseline immunoglobulin E.
Four self-limiting adverse events (AEs) occurred, and two ocular-related AEs were reported during follow-up. One patient had optic nerve atrophy after 1 year of treatment discontinuation, and this case has not been previously reported in literature. Whether this event is related to dupilumab use remains to be determined and requires long-term observation, according to the investigators.
“Another patient experienced immune deviation, which may be associated with immune system regulation, genetic susceptibility, or antimicrobial peptides,” they added. [Dermatitis 2020;31:e36-e37]
Standard treatment
At present, no standardized guideline exists for how to maintain therapy or when to stop using dupilumab after achieving treatment goals. [Pharmaceuticals 2024;17:117]
“Further research is needed to define optimal maintenance dosing intervals following therapeutic response, as various studies report inconsistent intervals,” the investigators said. [Pharmaceuticals 2024;17:117; Int Immunopharmacology 2023;125:111137; Dermatitis 2025;36:e286-e289]
“Our follow-up results suggest that continued use of the standard dupilumab regimen can effectively delay disease relapse in patients with moderate-to-severe AD,” they added.
Some patients even had relapse-free periods extending beyond 300 days. Notably, the recurrence time was earlier in the decline group than the short-term treatment group. Such observation may have been driven by different pharmacological characteristics between these strategies, with the decreasing group being exposed to subtherapeutic drug concentrations during dose reduction, the investigators said.
“We speculate that this low concentration and fluctuating drug level may not be enough to completely inhibit the inflammation of underlying disease, resulting in an unstable state and more likely to cause disease recurrence,” they said.
Furthermore, “clinicians may inadvertently assign patients with more severe or refractory conditions to a diminishing regimen,” potentially resulting in increased inherent risk of early recurrence in the group itself, according to the investigators.
“Further studies using randomized design are needed to confirm this phenomenon and clarify its potential mechanism,” they added.