In an encouraging development for children with severe atopic dermatitis (AD), dupilumab, an interleukin-4
(IL-4) receptor alpha antagonist, has shown evidence of improving height outcomes. According to new findings presented by Prof. Alan Irvine (Trinity College Dublin, Ireland) at the 2024 EADV Congress during a late-breaking session, children aged 6–11 years with severe AD and shorter stature who received dupilumab were significantly more likely to experience height improvements compared with those receiving a placebo.
Atopic dermatitis, a chronic inflammatory skin condition, has been linked to growth challenges in children.1 Previous research has shown that children with moderate to severe AD are more likely to fall below the 25th percentile for height, and are at greater risk of low bone mineral density and reduced alkaline phosphatase (ALP) levels.2,3
In a previous study presented at last year’s EADV meeting, dupilumab was shown to significantly increase bone ALP levels in children aged 6–11 years with moderate-to-severe AD compared with placebo.4 Building on these findings, the latest study collected height and weight data from children with severe AD and analyzed these based on gender and their standing above or below the 50th percentile for height, weight and BMI on the CDC growth reference charts. The study aimed to report the proportion of children achieving a ≥5 percentile height improvement over 16 weeks, particularly those below the 25th, 30th, 40th, and 50th percentiles.
The results showed that a significantly higher proportion of children who were below the 25th, 30th, or 40th percentiles at baseline achieved a greater than 5 percentile improvement in height after treatment with dupilumab compared to those receiving placebo. Among children below the 25th percentile, 30.6% of those treated with dupilumab (n=62) experienced this level of growth improvement, compared to just 11.9% in the placebo group (n=42) (P=0.0329). Similarly, 31.9% of children below the 30th percentile in the dupilumab (n=69) group showed improved height, compared with 11.1% (n=45) in the placebo group (P=0.0129). In the group below the 40th percentile, 31.3% of children treated with dupilumab (n=83) saw a significant height gain, compared with 15.5% in the placebo group (n=58) (P=0.0467). However, while a similar trend was seen in children below the 50th percentile, the difference in height gain between dupilumab (n=100) and placebo (n=70) was not found to be statistically significant (29% vs. 15.7%, P=0.0653).
These findings add to the rising volume of evidence showing that children with severe AD are at risk of lower stature, as well as higher weight and BMI. The study also underscores the potential long-term benefits of early and effective AD management using dupilumab, particularly in younger children who are at risk of lower-than-expected height. By improving vertical growth, dupilumab may offer a meaningful therapeutic option that could positively impact the long-term health outcomes for children with severe AD.
References
- Eichenfield, L.F., Stripling, S., Fung, S. et al. Recent Developments and Advances in Atopic Dermatitis: A Focus on Epidemiology, Pathophysiology, and Treatment in the Pediatric Setting. Pediatr Drugs 24, 293–305 (2022)
- Silverberg JI, Paller AS. Association between eczema and stature in 9 US population-based studies. JAMA Dermatol. 2015 Apr;151(4):401-9
- Silverberg JI. Association between childhood atopic dermatitis, malnutrition, and low bone mineral density: a US population-based study. Pediatr Allergy Immunol. 2015 Feb;26(1):54-61.
- Irvine AD, et al. Presented at the 32nd Annual Congress of the European Academy of Dermatology and Venereology (EADV); Oct 2023; Berlin, Germany; poster abstract 4752.
Disclosure: This article was created by the touchDERMATOLOGY team utilizing AI as an editorial tool (ChatGPT (GPT-4o) [Large language model]. https://chat.openai.com/chat.) The content was developed and edited by human editors. No funding was received in the publication of this article.
