The dupilumab It is a drug that has been used in our country since 2019 in adults and since 2021 in adolescents, but now it can also be indicated from the age of 6.
Although some parents find it difficult to be encouraged to ‘climb a therapeutic step’ and start treatment with a biological, Pediatric dermatologists and allergists assure that it is a very good option and that they already have decades of experience in the use of this type of medication in another chronic skin disease such as psoriasis.
What is the atopic dermatitis?
Atopic dermatitis affects practically 1 in 10 children and at least a quarter of pediatric patients have moderate or severe variants, in which the impact on their life and that of their family environment is much greater.
Atopic dermatitis (AD) is a chronic and relapsing inflammatory skin disease characterized by redness, scaling and intense itching. It frequently manifests itself in childhood and the international survey EPI-CARE, in which Argentina participated, recently revealed that, in our country, around 9.7% of children have atopic dermatitis, but, among them, 27.9% present moderate variants. and severe1. However, despite being so frequent and disabling in childhood, there were not enough therapeutic options and those that did were not able to maintain good control over time.
New medicine for children
The National Administration of Medicines, Food and Medical Technology (ANMAT) approved the use of the biological dupilumab to treattar the severe atopic dermatitis from 6 years of age (it had been used from 12 years of age since 2021 and in adults since 2019, with consistent efficacy and safety results)
“It is a mostly pediatric disease, extremely common in our offices, but the modern tools that were being developed were logically studied and approved first in adults and then in adolescents, so we knew them for their effectiveness in these populations. For a long time we hoped to be able to have it available for children who need it, “explained the Dr. Margarita Larralde, dermatologist, Head of the Dermatology Service of the German Hospital.
How to treat atopic dermatitis?
The treatment of atopic dermatitis begins with daily skin care, with constant moisturizing with creams and emollients, avoiding exposure to irritants such as some fabrics, perfumes, and changes in ambient temperature, among others. Then, topical corticosteroids, phototherapy are indicated and, in a next step, if necessary, systemic treatments are considered, among which are biological ones such as dupilumab.
The Dr. Carla Castro, dermatologist, Coordinator of the Atopic Dermatitis Unit of the Dermatology Service of the Hospital Universitario Austral, explained that “many children manage very well only with creams and emollients, with or without corticosteroids. But, those whose atopic dermatitis is more severe will need systemic treatments and this is the first biological designed specifically for this disease, because we had been using other non-specific treatments, with variable efficacy or with levels of toxicity that made them unsuitable for some children or for their sustained use over time.
When the skin itches a lot all the time
“Parents tell us that they listen to their children scratching all night; they injure the skin and, from then on, rubbing against any item of clothing or the shower water can be painful. How are they going to concentrate in school if they go several times a week with hardly any sleep? how do they play with their friends if they can only think about scratching, which also infects their skin? If the child sweats at recess, he can trigger an outbreak; if the classroom is too heated, the same, and so with many everyday situations”, she pointed out. Dr. Paula Luna, medical specialist in Dermatology and Children’s Dermatology at the German Hospital.
A separate chapter is also the looks that atopic skin generates: “we still have a long way to go to eradicate once and for all the myths surrounding skin diseases of inflammatory and autoimmune origin. They are not contagious and what the person who has it needs is our empathy, because perhaps he is suffering too much from it to add to that that others point him out or impose a distance on him, ”he stressed. Dr. Claudio Parisi, Head of the Adult and Pediatric Allergy Sections of the Italian Hospital of Buenos Aires.
Sometimes, it’s not just atopic dermatitis, because the same inflammatory process that triggers this disease, known as ‘type 2 inflammation’, is caused by an overactivation of the immune system that uncontrollably produces a series of proteins (among others, interleukins 4 and 13) and is also involved in the development of other diseases that can appear simultaneously, such as asthma, allergic rhinitis and food allergies.
“Sometimes, there is a certain fear or reluctance on the part of parents -and doctors not accustomed to new medications- to make the leap from creams to systemic treatment for their children, even when these are clearly not being enough. However, modern biological treatments have a very good safety profile and have been shown to rapidly obtain significant and sustainable benefits over time”, added the Dr. Luna.
In an international, double-blind, phase III clinical study that lasted 16 weeks, 367 children with severe AD participated: one group received a 300 mg dose of dupilumab. every 4 weeks + topical corticosteroids, another received treatment every two weeks, with a dose adjusted according to body weight + topical corticosteroids, and the third received placebo and the same corticosteroids.
At 16 weeks, significantly more patients receiving the medication improved by 3 to 4 points in average itching peaks and also markedly reduced skin lesions as well as other consequences of this disease, such as anxiety, depression and night rest. Benefits were seen in all the parameters the study measured.
This medication also improved associated comorbidities such as asthma and rhinosinusitis.