For the youngest children with atopic dermatitis (AD), dupilumab improves eczema severity but does not improve quality of life as much as for older children, according to a recent study published in JAMA Dermatology.

Overall, patients aged 6 months to 16 years experienced less pain and urge to itch over 3 years of treatment. However, patients aged 6 years or older showed the greatest improvement in quality of life, while younger children were more likely to discontinue treatment.

“Younger children may experience the impact of atopic dermatitis differently, including effects on sleep and behavior,” said Florence Vroman, MD, researcher in the Department of Dermatology at the University Medical Center Utrecht in Utrecht, Netherlands, who led the study.

The FDA approved dupilumab (DUPIXENT) in 2022 as the first biologic medicine for children with moderate-to-severe AD younger than 5 years. Earlier this year, the American Academy of Dermatology listed dupilumab as a treatment option in its first-ever guidelines for treating children with the condition.

AD affects up to 20% of kids, with nearly two thirds developing symptoms in the first year of life. Symptoms occur in almost all children by age 5.

The observational cohort study included 309 children and teens (mean age, 10.2; 51.5% men) who were treated between 2019 and 2025 in Netherlands. All patients had moderate-to-severe AD and were treated with dupilumab injections, which were administered in the thigh, abdomen, or upper arm every 2-4 weeks.

Patients and caregivers reported on pruritus and quality of life at baseline; weeks 4, 16, 28, and 52; and every 3-6 months for up to 3 years. Study staff assessed outcomes by age group, defined as children aged 6 months to 5 years in the youngest group, aged 6-11 years in the middle group, and aged 12-16 years in the oldest group. Caregivers completed questionnaires as proxies for children who did not have the ability to answer. Clinicians also conducted a visual assessment of the skin.

After patients had been on dupilumab for 16 weeks, eczema severity improved from a baseline of 16.3 to 4.6 overall. This further improved with time, dropping to 3.4 after 3 years of treatment.

Pruritus improved from a baseline of 6.9 to 3.5 at the 16-week mark. However, older children showed the most improvement, while the younger population had worse scores for skin irritation and desire to itch.

Younger children also reported less improvement in quality of life than older children, despite an overall improvement. At the end of the study period, the youngest children had quality-of-life scores of 7.2, while the middle age group had a score of 3.9. Teens had a score of 2.7.

“Older children may have developed different ways of coping with their disease over time,” Vroman said. “Since scores improved substantially across all age groups, our findings suggest that factors beyond objective skin severity may contribute to differences in patient-reported outcomes.”

During treatment, 63.1% of patients experienced at least one adverse effect, which included eye-related problems, headache, fatigue, and abdominal pain. More than one third of patients developed dupilumab-associated ocular surface disease, although only 4.4% of these cases were categorized as severe. Less than 5% discontinued treatment because of an adverse effect.

More than 80% of patients remained on the treatment at the end of the study period, but 6.9% vs 3.8% of children younger than 5 years vs older children discontinued the medication because of issues related to injection administration.

Karan Lal, DO, director of pediatric dermatology and cosmetic surgery at Affiliated Dermatology in Scottsdale, Arizona, said the study findings will not change his clinical practice, even though rates of eye disease were higher in this study than in previous clinical trials.

Questions related to eye discomfort — itching, burning, swelling, or redness — are a routine part of follow-up, and he usually prescribes eye drops to mitigate the symptoms.

“I’ve probably subscribed DUPIXENT to 1000 patients, and I have only seen dupilumab ocular-related surface disorder twice, and those were seen in patients that had very severe eczema,” Lal said. “In the real world, there are very few cases.”

About one quarter of patients received injections at wider intervals, up to 8 weeks. Vroman said 90% of those patients who received extended doses still experienced successful results.

“Clinicians should consider extending dosing intervals in cases of controlled atopic dermatitis,” Vroman said. “This would be beneficial for patients, as it would mean fewer injections, which is particularly important for children.”

Given a shortage of pediatric dermatologists, Lal said family medicine clinicians and pediatricians can prescribe dupilumab and monitor patients during treatment.

“This study reinforces the information that we already know,” he said. “Dupilumab is a safe and effective treatment.”

Vroman reported receiving speaker fees from Sanofi. Lal reported being a consultant for Sanofi and Regeneron, Eli Lilly and Company, and Galderma.

Kelsey Mesmer, PhD, is a freelance journalist and journalism professor at Saint Louis University in St. Louis.