Dupilumab Provides Favourable Long-Term Safety And Efficacy In Children Aged >= 6 To < 12 Years With Uncontrolled Severe Atopic Dermatitis: Results From An Open-Label Phase Iia Study And Subsequent Phase Iii Open-Label Extension Study

Background Children aged >= 6 to < 12 years with severe atopic dermatitis (AD) have limited treatment options. In a 16-week, randomized, placebo-controlled, phase III trial in children, dupilumab, a monoclonal antibody inhibiting interleukin (IL)-4/IL-13 signalling, significantly improved signs and symptoms with acceptable safety; longer-term safety and efficacy data are lacking. Objectives To report the pharmacokinetic profile and long-term safety and efficacy of dupilumab in children (aged >= 6 to < 12 years) with severe AD. Methods Children (aged >= 6 to < 12 years) with severe AD were enrolled in a global, multicentre, phase IIa, open-label, ascending-dose, sequential cohort study and subsequent open-label extension (OLE) study. Patients received single-dose dupilumab 2 or 4 mg kg(-1)followed by 8-week pharmacokinetic sampling, then 2 or 4 mg kg(-1)weekly for 4 weeks (phase IIa), followed by the same weekly regimen (OLE). Primary endpoints were dupilumab concentration-time profile and treatment-emergent adverse events (TEAEs); secondary assessments included Eczema Area and Severity Index (EASI) and Peak Pruritus Numeric Rating Scale (PP-NRS) score. Results Of 38 children enrolled, 37 completed phase IIa and 33 continued to the OLE. Nonlinear, target-mediated pharmacokinetics characterized dupilumab concentrations (week 24-48 mean serum concentrations: 2 mg kg(-1), 61-77 mg L-1; 4 mg kg(-1), 143-181 mg L-1). TEAEs were mostly mild to moderate and transient; none led to treatment discontinuation. The most commonly reported TEAEs were nasopharyngitis (2 mg kg(-1), 47%; 4 mg kg(-1), 56%) and AD exacerbation (29% and 13%, respectively). Single-dose dupilumab rapidly improved AD with further improvements through week 52. Mean EASI and PP-NRS improved by -37%/-33% and -17%/-20% at week 2 (phase IIa) and -92%/-84% and -70%/-58% at week 52 (OLE), respectively. Conclusions These safety and efficacy results support the use of dupilumab as a continuous long-term treatment for children aged >= 6 to < 12 years with severe AD.