Minimal Disease Activity as A New Therapeutic Target in Atopic Dermatitis: A 5-Year Real-Life Experience With Dupilumab.

BACKGROUND

Atopic dermatitis (AD) is a chronic inflammatory skin disease with significant physical and psychosocial burden. Dupilumab, a monoclonal antibody targeting IL-4Rα, has proven to be effective for moderate-to-severe AD, but long-term real-world data remain limited.

OBJECTIVE

The aim of this study is to evaluate the long-term effectiveness, safety, and achievement of minimal disease activity (MDA) in patients with moderate-to-severe AD treated with dupilumab over a 5-year period.

METHODS

A retrospective single-center cohort study was conducted at the Dermatologic Clinic of the University of Turin, including 583 patients aged ≥ 6 years treated with dupilumab between November 2018 and January 2025. Effectiveness was measured by Eczema Area and Severity Index (EASI), Pruritus-Numerical Rating Scale (P-NRS), and Sleep Loss-Numerical Rating Scale (S-NRS) scores, Dermatology Life Quality Index (DLQI). MDA was defined as EASI-90 combined with P-NRS ≤ 1. Safety and drug survival were also assessed.

RESULTS

Dupilumab treatment resulted in significant and sustained reductions in EASI and symptom scores over 5 years. The proportion of patients achieving MDA increased from 22.0% at 16 weeks to 56.0% at 208 weeks and remained stable at 55.3% through 5 years. Male sex and childhood onset may reduce treatment success, warranting further study. The safety profile was favorable, with low discontinuation rates, and conjunctivitis as the most common adverse event.

CONCLUSION

Our long-term real-world data support the sustained effectiveness and safety of dupilumab in moderate-to-severe AD, with over 55% of patients achieving and maintaining MDA at 5 years.