Clinical course of atopic dermatitis after dupilumab discontinuation: a multicentre real-world study

Background Limited data exist on the clinical course of atopic dermatitis (AD) after the discontinuation of dupilumab. Objectives To assess disease progression following dupilumab discontinuation. Methods A multicentre, retrospective study was conducted on 208 patients with severe AD who discontinued dupilumab for reasons unre- lated 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 after discontinuation. Kaplan–Meier analysis was used to estimate 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’s decision (11.1%) and pregnancy or desire to become pregnant (20.7%). Patients with a family history of AD or nonclassical 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. They had 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. Reinitiation of dupilumab significantly improved EASI and P-NRS scores within 16 weeks. Conclusions Discontinuing dupilumab is associated with disease recurrence in some patients, especially those with a family history or non- classical AD. Dupilumab reinitiation is effective, leading to significant clinical improvements and supporting its use after treatment interruption.