CONFERENCE UPDATE: EADV 2024

Dupilumab treatment in younger children with AD may improve lifelong growth outcomes

DERMATOLOGY
08 Feb 2025

STUDY DESIGN 

A 2007-2008 assessment of atopic dermatitis (AD) severity and height revealed that adolescents with moderate to severe AD had significantly higher odds of having a height <25th percentile on Center for Disease Control (CDC) growth reference chart.1 In particular, children with AD and in the ≤25th height percentile have a greater risk of having low bone mineral density and alkaline phosphatase (ALP) levels.1 The underlying mechanisms of this phenomenon remain unclear but may be linked to chronic sleep disruption associated with AD, the use of oral and topical glucocorticoids, and the effects of prolonged inflammation.1

Dupilumab was previously shown to significantly increase the levels of bone ALP in serum compared to placebo in children aged 6 to 11 with moderate-to-severe AD enrolled in a phase 3 trial and it’s open-label extension (OLE) study.1 In the LIBERTY-AD PEDS trial, the proportion of children aged 6 to 11 years with severe AD and lower stature who reached a ≥5-percentile improvement in height following 16 weeks of treatment with dupilumab compared to those in the placebo group was reported.1

LIBERTY-AD PEDS was a double-blind, randomized, placebo-controlled study that enrolled 304 children aged 6 to 11 years with severe AD.1 Participants were randomized 1:1 to receive 300mg dupilumab every 4 weeks or placebo, in addition to mild or moderately potent topical corticosteroids.1 The height and weight of the participants were collected at baseline and at week 16 in a post-hoc analysis.1

"Prompt and effective management of AD with dupilumab in younger children may have lifelong benefit in those who are below expected height by improving vertical growth" 

Presented by Professor Alan Irvine Trinity College Dublin Dublin, Ireland

 

FINDINGS

Baseline results:
  • Children aged 6 to 11 years with severe AD were overrepresented in the lower height percentiles, with 54.2% (83/153) of girls and 57.6% (87/151) of boys below the 50th percentile for their respective genders1
  • Children aged 6 to 11 years with severe AD were also overrepresented in the higher weight percentiles at baseline, with 55.6% of girls and 57.6% of boys above the 50th percentile for their respective genders1
  • As such, these children with severe AD were overrepresented in the higher body mass index (BMI) percentiles (67.3% of girls and 62.9% of boys above the 50th percentile)1
Results at 16 weeks:
  • The proportion of patients aged 6 to 11 years with lower stature at baseline who showed a ≥5-percentile improvement in height after 16 weeks was significantly greater in those treated with dupilumab compared to with placebo1
  • There was a greater difference between the dupilumab arm vs. the placebo arm in the proportion of patients who achieved this for patients <25th height percentile at baseline (30.6% vs. 11.9%; p<0.05) compared to those <50th height percentile at baseline (29.0% vs. 15.7%; p=0.0653)1
  • The difference between arms was also significant (p<0.05) for patients <30th height percentile (31.9% vs. 11.1%) and <40th height percentile (31.3% vs. 15.5%) at baseline1

 

 

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