Management Recommendations for Dupilumab Partial and Non-durable Responders in Atopic Dermatitis

As the first targeted systemic agent for the treatment of moderate to severe atopic dermatitis (AD), dupilumab represents a novel therapeutic opportunity for both patients and providers. However, a subset of patients receiving dupilumab are either partial responders who exhibit some improvement in Investigator's Global Assessment score but not sufficient to meet the primary endpoint, or are non-durable responders who achieve therapeutic endpoint with subsequent partial loss of efficacy. We propose a therapeutic algorithm for the management of dupilumab partial responders and non-durable responders that involves maximizing topical therapy, seeking alternative diagnoses, and using dupilumab in conjunction with traditional systemic immunosuppressive agents. With a number of targeted agents for AD in the drug development pipeline, we encourage patients who do not have an adequate response to dupilumab to remain patient and optimistic as the arsenal of AD treatment modalities continues to expand.