Dupilumab Associated With Lower Atopic March Risk in Pediatric Atopic Dermatitis

Dupilumab (Dupixent; Sanofi and Regeneron Pharmaceuticals) was associated with a significantly lower risk of atopic march progression than systemic corticosteroids (SCS) across all pediatric age groups with atopic dermatitis (AD), according to a retrospective real-world study. The analysis of US claims data included 2897 matched pairs of patients younger than 18 years. Results were presented at the 2026 Fall Clinical Dermatology Conference, held October 8–11 in Las Vegas, Nevada.¹

Prior evidence suggests early dupilumab intervention may mitigate progression to food allergy, asthma, allergic rhinitis, and eosinophilic esophagitis (EoE) in children with AD. Comprehensive data across the full pediatric age spectrum, particularly in very young children, remain limited.¹

The retrospective, comparative cohort study used the Inovalon Insights Real-World Database, a US administrative claims database, covering 2016 to 2025. Investigators stratified pediatric patients with AD who initiated dupilumab or received SCS into 4 age cohorts: younger than 2 years, 2 to 5 years, 6 to 11 years, and 12 to 17 years. Patients with prior food allergy, asthma, allergic rhinitis, or EoE, or recent exposure to biologics targeting type 2 immunity, were excluded.¹

The team used a prevalent new-user design with time-conditional propensity score matching, pairing each dupilumab initiator 1:1 with an SCS user by nearest-neighbor matching. Matching produced 2,897 pairs, including 336, 1055, 543, and 963 pairs in the respective age cohorts, with acceptable covariate balance. The primary outcome was incidence of any new atopic disease, defined as at least 1 inpatient or outpatient claim during up to 3 years of follow-up for patients 6 years and older and 2 years for younger patients.¹

Dupilumab was associated with a significantly lower risk of new atopic disease than SCS in every cohort (all P < .01). Hazard ratios (HRs) were 0.67 (95% CI, 0.52–0.86) for patients younger than 2 years, 0.48 (95% CI, 0.40–0.56) for ages 2 to 5 years, 0.66 (95% CI, 0.52–0.84) for ages 6 to 11 years, and 0.64 (95% CI, 0.52–0.79) for ages 12 to 17 years.¹

These values correspond to risk reductions of 33% to 52%, with the greatest benefit in the 2–5 year cohort. Kaplan-Meier analyses showed lower cumulative incidence of atopic march progression among dupilumab-treated patients in all 4 cohorts.¹

Dupilumab Sensitivity Analysis Results and Study Limitations

A sensitivity analysis defined the outcome more stringently, requiring at least 1 inpatient claim or at least 2 outpatient claims 30 or more days apart. Under this definition, HRs were 0.39 (95% CI, 0.26–0.58) in patients younger than 2 years, 0.29 (95% CI, 0.22–0.38) for ages 2 to 5 years, and 0.65 (95% CI, 0.48–0.88) for ages 12 to 17 years (all P < .01). In the 6 to 11 year cohort, the HR was 0.71 (95% CI, 0.48–1.05; P = .09), which did not reach statistical significance.¹

The poster did not report safety outcomes, as the analysis focused on incidence of new atopic disease rather than adverse events. The authors noted follow-up was limited to up to 3 years, and longer-term studies are needed to assess whether the observed reduction in atopic march progression is sustained after dupilumab discontinuation. The retrospective analysis relied on claims data, and the study was funded by Sanofi and Regeneron Pharmaceuticals.¹

“In this large, real-world US claims study, dupilumab treatment was associated with significantly lower risk of atopic march progression across all pediatric age groups compared with SCS. These findings support the potential of early dupilumab intervention to modify the development of additional atopic comorbidities in pediatric patients with AD,” Simpson et al concluded.¹

Reference

1. Simpson EL, Paller A, Eichenfield LF, et al. Modification of atopic march progression in dupilumab-treated pediatric atopic dermatitis patients in the United States: a retrospective, real-world study. Poster presented at: Fall Clinical Dermatology Conference 2026; October 8–11, 2026; Las Vegas, NV.