Regardless of dosing interval, dupilumab successfully and steadily reduces IgE serum levels in patients with atopic dermatitis, according to a recent study1 published in Clinical and Experimental Allergy.
Investigators Dekkers et al sought to examine the transition from a dosing of 300 mg of dupilumab every 4 weeks to 300 mg every 6 weeks and the subsequent immunological effects of adjusting the dosing interval. They noted that prior research has demonstrated the efficacy of dupilumab in reducing IgE levels; however, they intended to explore the long-term effects of dosing interval extensions of the drug.
- Dupilumab effectively reduces IgE serum levels in patients with atopic dermatitis (AD), regardless of dosing interval.
- Patients with AD who extended the dosing interval due to well-controlled AD still experienced a significant decrease in IgE levels over time, supporting the potential for extending the dosing interval of dupilumab in well-controlled AD patients.
Using the retrospective Dutch BioDay registry, investigators studied the IgE serum level of patients with AD whose treatment had entailed a dosing interval extension beginning at once every 2 weeks. The interval had been adjusted to once every 4 weeks and then to once every 6 weeks using a patient-centered dosing regimen reliant on Eczema Area and Severity Index (EASI) scoring.
Twenty-one patients were assigned to undergo prolongation of dupilumab dosing interval, while 20 patients were assigned to a stable dosing interval. At treatment initiation, 1 year after Q2W dosing, and annually after, investigators collected blood samples from all participants. These blood samples were also compared to that of 11 otherwise healthy volunteers who did not have AD or another atopic disease.
At baseline, the average EASI score among patients in the prolongation dosing group was 17.24, while in members of the stable dosing group, the average was 19.37. Compared to healthy volunteer samples, IgE levels were significantly higher.
“It is clearly visible that the mean EASI in group A [prolongation] remains lower compared to group B [stable], which can be explained by the fact that the patients in group A were able to extend the dosing interval due to well-controlled AD, whereas the patients in group B were not,” wrote study authors.
Both prolongation and stable dosing groups experienced significant decreases in IgE levels from one dosing to another. In members of the stable dosing group, IgE levels became stable with consistent, unchanged dosing. According to investigators, these results may demonstrate that patients with AD may take longer to achieve similar IgE levels as healthy individuals, if at all. Furthermore, IgE levels may come to a plateau in some patients.
“With the findings of our study it is demonstrated that dupilumab significantly reduces IgE production from baseline up to a median of 2.5 years of treatment,” according to study authors. “Our findings show that IgE levels continue to decrease significantly over time irrespective of treatment interval. This can play an important supporting role in the decision to extend the dosing interval of dupilumab in patients in whom AD is well controlled.”
- Dekkers C, van der Wal MM, van den Noort L, Bakker DS, de Bruin‐Weller M, van Wijk F. IgE levels in patients with atopic dermatitis steadily decrease during treatment with dupilumab regardless of dose interval. Clin Exp Allergy. Published online September 12, 2023. doi:10.1111/cea.14384