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.
Minimal Disease Activity as A New Therapeutic Target in Atopic Dermatitis: A 5‐Year Real‐Life Experience With Dupilumab
Leo, Francesco;Mastorino, LucaCo-first
;Cangialosi, Luca;Favre, Davide;Fiasconaro, Chiara Anna;Liao, Yingying;Goso, Federico;Cavaliere, Giovanni;Quaglino, Pietro;Ribero, Simone;Ortoncelli, Michela
2026-01-01
Abstract
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.
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