Efficacy of dupilumab in children with alopecia areata and atopic dermatitis

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Abstract

Background. Atopic dermatitis (AD) is a multifactorial, genetically determined, inflammatory skin disease characterized by itching, chronic relapsing course and age-related features of the localization and morphology of lesions. AD is an atopic disease with a dominant role of T helper cells type 2 (Th2), increased levels of interleukins (IL-4, -5, -13 and -31), which forms IgE-mediated sensitization and inflammation. Alopecia areata (AA) is an autoimmune disease characterized by CD8+ T cell-mediated hair loss. Although AA has historically been classified as a process driven primarily by T helper type 1 (Th1) cells, findings from genomic susceptibility loci and cytokine activation support the involvement of the Th2 pathway. Accordingly, dupilumab, an IL-4 receptor antagonist that suppresses the Th2 response, may represent an effective drug for the treatment of severe forms of AA.

Objective. Evaluation of the effectiveness of dupilumab in children with AA and AD.

Methods. A cross-sectional retrospective cohort study was conducted. The mean age of the patients was 11,3±2,8 years (range, 7 to 18 years). A total of 12 patients took part in the study, including 7 girls and 5 boys. Patients were administered dupilumab by subcutaneous injection at a dose of 600 mg, followed by 300 mg every 2 weeks. The median duration of treatment with dupilumab was 24 weeks (median 29.4, range 20–54). To assess the effectiveness of treatment for HA and AD, the SALT (Severity Alopecia Tool) scale and the Eczema Area and Severity Index (EASI) were used.

Results. After 24 weeks of dupilumab treatment, patients’ mean SALT score decreased from 71.9 to 25.2. All patients treated with dupilumab experienced significant regression of skin lesions and a significant reduction in EASI scores. The mean EASI score in patients before initiation of dupilumab was 52.3 and decreased to 8.15 after 24 weeks of treatment.

Conclusion. The results obtained indicate that dupilumab may be effective in the treatment of severe forms of AA in children with AD.

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About the authors

А. M. Dogov

National Medical Research Center for Children’s Health

Email: pharmateca@yandex.ru
ORCID iD: 0000-0001-9719-1656
Russian Federation, Moscow

N. N. Murashkin

National Medical Research Center for Children’s Health; Sechenov University; Central State Medical Academy of the Administrative Department of the President of the Russian Federation

Author for correspondence.
Email: m_nn2001@mail.ru
ORCID iD: 0000-0003-2252-8570

Dr. Sci. (Med.), Head of the Department of Dermatology with the Laser Surgery Group of the Center for Pediatric Dermatology, Head of the Laboratory of Skin Pathology in Children, Professor at the Department of Dermatovenereology and Cosmetology, Professor at the Department of Pediatrics and Pediatric Rheumatology

Russian Federation, Moscow; Moscow; Moscow

E. T. Ambarchyan

Research Institute of Pediatrics and Children’s Health, Central Clinical Hospital of the Russian Academy of Sciences

Email: pharmateca@yandex.ru
ORCID iD: 0000-0002-8232-8936
Russian Federation, Moscow

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