Reduced atopic march risk in pediatric atopic dermatitis patients prescribed dupilumab versus conventional immunomodulatory therapy: a population-based cohort study

Dupilumab effectively treats atopic dermatitis (AD); however, its role in halting the atopic march remains uncertain. We aimed to to investigate dupilumab’s effect on atopic march in pediatric AD patients versus conventional immunomodulators. This retrospective cohort study utilized data from the TriNetX US Collaborative Network (2011-2024). Pediatric AD patients (≤18 years) were categorized into DUPI-cohort (newly prescribed dupilumab) or CONV-cohort (prescribed conventional immunomodulators without dupilumab). After 1:1 propensity-score matching, we analyzed atopic march progression, defined by the incident asthma or allergic rhinitis (AR). The study included 2,192 patients in each cohort. The 3-year cumulative incidence of atopic march progression was lower in the DUPI-cohort than the CONV-cohort (20.09% vs. 27.22%; P <.001). The DUPI-cohort demonstrated significant risk reduction in atopic march progression (hazard ratio [HR] 0.68, 95% CI 0.55-0.83), individual asthma (HR 0.60, 0.45-0.81), and individual AR (HR 0.69, 0.54-0.88). Younger patients on dupilumab exhibited a greater risk reduction for atopic march progression and individual asthma, contrasting with the opposite age-related pattern for individual AR. These results suggested that, among pediatric AD patients, dupilumab was associated with reduced risk of atopic march progression compared with conventional therapies.度普利尤单抗（dupilumab）可有效治疗特应性皮炎（atopic dermatitis, AD），但其阻断特应性进展（atopic march）的作用仍不明确。本研究旨在对比度普利尤单抗与常规免疫调节剂对儿科特应性皮炎患者特应性进展的影响。本项回顾性队列研究（retrospective cohort study）使用了TriNetX美国协作网络（TriNetX US Collaborative Network，2011-2024年）的数据。研究对象为≤18岁的儿科特应性皮炎患者，被分为DUPI队列（新处方度普利尤单抗）与CONV队列（处方不含度普利尤单抗的常规免疫调节剂）。经1:1倾向得分匹配（propensity-score matching）后，本研究以新发哮喘或过敏性鼻炎（allergic rhinitis, AR）定义特应性进展，并对其进展情况进行分析。两个队列各纳入2192例患者。DUPI队列的特应性进展3年累积发病率低于CONV队列（20.09% vs. 27.22%；P < 0.001）。DUPI队列的特应性进展、单独哮喘（风险比[HR] 0.68，95%置信区间0.55-0.83）及单独过敏性鼻炎（HR 0.69，95%置信区间0.54-0.88）的发病风险均显著降低。使用度普利尤单抗的低龄患者，其特应性进展及单独哮喘的发病风险降幅更为显著，而单独过敏性鼻炎的发病风险则呈现相反的年龄相关变化模式。上述结果表明，与常规治疗相比，儿科特应性皮炎患者使用度普利尤单抗可降低特应性进展的发病风险。