Clinical course of atopic dermatitis after dupilumab discontinuation: a multicentre real-world study

Background: Limited data exist on the clinical course of atopic dermatitis (AD) after the discontinuation of dupilumab. Objectives: To assess disease progression following dupilumab discontinuation. Methods: A multicentre, retrospective study was conducted on 208 patients with severe AD who discontinued dupilumab for reasons unrelated to inefficacy. The Eczema Area and Severity Index (EASI), pruritus numerical rating scale (P-NRS), Atopic Dermatitis Control Tool (ADCT) and Dermatology Life Quality Index (DLQI) were used to assess disease activity after discontinuation. Kaplan-Meier analysis was used to estimate the time and probability of disease worsening (defined as EASI > 7.0, EASI increase ≥ 6.6, P-NRS ≥ 4, P-NRS increase ≥ 4, ADCT ≥ 7, ADCT increase ≥ 5, or DLQI increase ≥ 4), as well as the need to restart systemic treatment. Results: The main reasons for discontinuing dupilumab were clinical remission or good clinical control (43.3%), patient's decision (11.1%) and pregnancy or desire to become pregnant (20.7%). Patients with a family history of AD or nonclassical phenotypes had a significantly higher likelihood of disease worsening. A significant portion (42.8%) of patients resumed systemic treatment within a median time of 47 weeks. They had a baseline median EASI score of 10.0 and a median P-NRS of 6.0. The probability of resuming systemic treatment was 25% at 31 weeks and 50% at 94 weeks. Reinitiation of dupilumab significantly improved EASI and P-NRS scores within 16 weeks. Conclusions: Discontinuing dupilumab is associated with disease recurrence in some patients, especially those with a family history or nonclassical AD. Dupilumab reinitiation is effective, leading to significant clinical improvements and supporting its use after treatment interruption.