Dupilumab and Catch-Up Growth in Children With Severe Atopic Dermatitis

Eingun James Song, MD, dermatologist, director of clinical research, and co-chief medical officer at Frontier Dermatology, recently discussed growth in children with severe atopic dermatitis (AD) in a Dermatology Times Expert Perspectives custom video series. He addressed how often the topic arises in practice and how he interprets post hoc dupilumab (Dupixent; Sanofi and Regeneron) data on height percentiles.

Growth in the Risk-Benefit Discussion

Song said children with more severe AD are disproportionately represented at the lower end of the height curve. Whether growth comes up in clinic depends on the patient.

“Kids who have bad atopic dermatitis, they tend to be smaller compared to their peers,” Song said.

For a child younger than 12 years with severe disease, growth is an important part of the risk-benefit discussion. In an early teenager or adolescent with moderate disease, the topic arises less often because the window for intervention has probably passed. Song said children whose disease is controlled with effective targeted therapies can catch up to their peers over several weeks to months.

Height Percentile Findings With Dupilumab

Song described 2 findings from a recent study evaluating linear growth and bone biomarkers in children with atopic dermatitis who were treated with dupilumab. Children with severe AD were more likely to be below the 40th height percentile at baseline. Among those children, about one third receiving dupilumab gained at least 5 height percentiles.¹

Song explained a 5-percentile gain was chosen as the threshold because it exceeds expected growth for age.

“We’re seeing about a third of patients on dupilumab versus about 15% of patients who are just in the placebo arm,” Song said.

He described a 2- to 2.5-fold difference. By week 52, about half of dupilumab-treated children had reached the threshold. Children switched from placebo to dupilumab showed the same positive trajectory. The difference held after adjustment for topical corticosteroid use, which could in theory blunt growth and affect bone health.¹

“Dupilumab-treated patients actually did quite a bit better compared to placebo patients,” Song said.

Weighing the Data and the Window of Opportunity

Song said the findings confirm what many clinicians have seen in practice, with small children falling off the growth curve and catching up on effective therapy. Trial data give clinicians something concrete to share with patients and parents.

“Oftentimes anecdotal evidence isn’t as good as clinical trial experience,” Song said.

He noted catch-up was not seen in patients older than 12 years.

“There probably is this window of opportunity where we could intervene,” Song said.

Intervening within this window can make the biggest difference, Song said, while waiting too long may leave the catch-up period behind.

Reference

1. Irvine AD, Paller AS, Siegfried EC, et al. Dupilumab treatment improves linear growth and bone biomarkers in children with atopic dermatitis: post hoc analysis of a phase 3 randomized, placebo-controlled clinical trial and an open-label extension study. J Am Acad Dermatol. 2026;95(5):1324-1334. doi:10.1016/j.jaad.2026.07.006