Department of Dermatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; Ph.D. Program of Interdisciplinary Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan.
J Am Acad Dermatol. 2024 Sep;91(3):466-473. doi: 10.1016/j.jaad.2024.05.029. Epub 2024 Jun 14.
BACKGROUND: Dupilumab effectively treats atopic dermatitis (AD); however, its role in halting the atopic march remains uncertain. OBJECTIVE: To investigate dupilumab's effect on atopic march in pediatric AD patients versus conventional immunomodulators. METHODS: 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). Cumulative incidence was plotted using Kaplan-Meier, with risk assessment via Cox regression. RESULTS: The study included 2192 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. LIMITATIONS: Observational study. CONCLUSION: Among pediatric AD patients, dupilumab was associated with reduced risk of atopic march progression compared with conventional therapies.
背景：度普利尤单抗有效治疗特应性皮炎（AD）；然而，其在阻止特应性进程中的作用仍不确定。
目的：研究度普利尤单抗对儿科 AD 患者特应性进程的影响与传统免疫调节剂的比较。
方法：本回顾性队列研究利用了 TriNetX 美国合作网络（2011-2024 年）的数据。将儿科 AD 患者（≤18 岁）分为 DUPI 队列（新处方度普利尤单抗）或 CONV 队列（未处方度普利尤单抗的传统免疫调节剂）。在 1:1 倾向评分匹配后，我们分析了特应性进程的进展，定义为哮喘或过敏性鼻炎（AR）的发生。使用 Kaplan-Meier 绘制累积发生率，并用 Cox 回归进行风险评估。
结果：每个队列纳入了 2192 名患者。DUPI 队列的 3 年累积特应性进程进展发生率低于 CONV 队列（20.09% vs. 27.22%；P < 0.001）。DUPI 队列在特应性进程进展（风险比 [HR] 0.68，95%CI 0.55-0.83）、个体哮喘（HR 0.60，0.45-0.81）和个体 AR（HR 0.69，0.54-0.88）方面表现出显著的风险降低。使用度普利尤单抗的年轻患者特应性进程进展和个体哮喘的风险降低幅度更大，与个体 AR 的相反年龄相关模式形成对比。
局限性：观察性研究。
结论：在儿科 AD 患者中，与传统疗法相比，度普利尤单抗与特应性进程进展风险降低相关。
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