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Retrospective Study of Severe Atopic Disease in Young Children (0-5 Years) Managed with Dupilumab Highlights
Evelyn F Fagan1, Elena B Hawryluk2, LaDonya Jackson-Cowan2,3
1Department of Medical Education, Mercer University School of Medicine, Savannah, GA 31404, USA.
Insights
Young children with atopic dermatitis (AD) often have other conditions, including neurodevelopmental disorders. Dupilumab treatment access was faster when prescribed by dermatologists, highlighting the need for inter-specialty collaboration.
Area of Science:
- Pediatric Dermatology
- Neurodevelopmental Pediatrics
- Pharmacology
Background:
- Atopic dermatitis (AD) is a prevalent pediatric skin condition.
- AD is frequently associated with atopic comorbidities and neurocognitive alterations, including developmental delays and ADHD.
- Early-onset AD in children presents significant challenges due to associated health burdens.
Purpose of the Study:
- To investigate the prevalence of atopic and neurodevelopmental comorbidities in young children (0-5 years) with AD.
- To assess the time to treatment access for dupilumab in this pediatric population.
- To identify factors influencing the time to dupilumab approval.
Main Methods:
- Retrospective chart review of 79 children aged 0-5 years prescribed dupilumab.
- Data collected included demographics, atopic comorbidities, neurocognitive diagnoses, and time to dupilumab approval.
- Analysis of treatment access variation by patient or prescriber characteristics.
Main Results:
- The study cohort (n=79) had a mean age of 3.4 years, with 62.0% males and diverse ethnic representation.
- High rates of atopic comorbidities (food allergies 64.6%, asthma 34.2%, eosinophilic esophagitis 10.1%) and neurodevelopmental disorders (43.0%) were observed.
- Dupilumab approval averaged 20.9 days, significantly faster with dermatologists (10.6 days) versus other specialists (51.9 days).
Conclusions:
- Young children with AD exhibit high rates of associated atopic and neurologic comorbidities.
- Timely access to dupilumab is crucial for managing AD in this vulnerable population.
- Enhanced inter-specialty collaboration is essential to expedite dupilumab treatment initiation for pediatric patients with AD.
Background:
Atopic dermatitis (AD) is a common pediatric skin disease that is associated with other atopic comorbidities, all of which correlate with higher rates of neurocognitive alterations such as developmental delays and ADHD.
Methods:
We conducted a retrospective chart review from January 2022 through January 2024 and identified 79 children aged 0-5 years who were prescribed dupilumab in the Massachusetts General Brigham healthcare system. We defined the patient population (including demographics, atopic comorbidities, and neurocognitive burden), and assessed whether time to treatment access varied by patient or prescriber characteristics.
Results:
The mean age at dupilumab initiation was 3.4 years, and 62.0% of patients were male. The cohort was diverse (48.1% White, 25.3% Black, 16.5% Hispanic/Latino, 10.1% Asian/other), with 48.1% publicly insured. Atopic comorbidities were common: 64.6% had food allergies, 34.2% had asthma, and 10.1% had eosinophilic esophagitis (EOE); 73.4% had two or more atopic diagnoses. Neurodevelopmental disorders affected 43.0% of patients, with speech and language delay most frequent (25.3%) and higher rates among those with EOE (87.5% vs. 38.0%, p < 0.01). The mean time to dupilumab approval was 20.9 days, with dermatologists achieving faster approvals than other specialists (10.6 vs. 51.9 days, p < 0.001).
Conclusions:
Our findings reveal infrequently reported high rates of atopic and neurologic comorbidities in young children with AD and underscore the importance of coordinated inter-specialty collaboration to ensure timely access to dupilumab for these patients.
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