A new study highlights the risks of atopic dermatitis flare-ups after discontinuing the use of dupilumab. Nearly half of patients who stopped taking the systemic biologic treatment, for reasons other than limited clinical effectiveness, required restarting dupilumab within a year. When clinicians resumed treatment, symptoms were found to improve again within 16 weeks.
The researchers noted limited data on how discontinuing the use of dupilumab affects patients with atopic dermatitis, which is especially important for patients who may pause or stop treatment because of pregnancy, clinical remission or through personal choice.
They therefore conducted a multi-centre, retrospective study of data from 208 people with severe atopic dermatitis who discontinued dupilumab for reasons unrelated to inefficacy. Using the Eczema Area and Severity Index (EASI), the Pruritus Numerical Rating Scale (P-NRS), the Atopic Dermatitis Control Tool (ADCT), and the Dermatology Life Quality Index (DLQI), they assessed disease activity after discontinuation of treatment.
The study employed Kaplan-Meier analysis to evaluate the necessity of restarting systemic treatment and to determine the time to retreatment after stopping dupilumab.
Impact of discontinuing dupilumab
The primary outcome was the time and likelihood of disease worsening and the need to restart systemic treatment after discontinuing systemic therapy. Worsening of the condition was 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.
The main reasons for discontinuing dupilumab were clinical remission (43.3%), pregnancy or wanting to become pregnant (20.7%), and patient choice (11.1%).
Patients with a family history of atopic dermatitis or non-classical forms of the disease were more likely to see their symptoms worsen after discontinuing the therapy.
A significant portion (42.8%) of patients resumed systemic treatment, around 47 weeks after discontinuing dupilumab, with a baseline median EASI score of 10.0 and a median P-NRS of 6.0. The chances of resuming systemic therapy were 25% at 31 weeks and 50% at 94 weeks. Once patients restarted medication, atopic dermatitis symptoms improved within 16 weeks.
The researchers stated that restarting dupilumab was effective after treatment interruption and led to significant clinical improvements. This supports the long-term use of dupilumab to manage atopic dermatitis, particularly in those at higher risk of recurrence, they added.
Reference
Barei F et al. Clinical Course of Atopic Dermatitis after Dupilumab Discontinuation: A Multicenter Real-World Study. Clin Exp Dermatol. 2025 Jun 20:llaf275.
