Dupilumab tied to lower atopic march risk vs steroids in children

Children with atopic dermatitis (AD) who started dupilumab were less likely to develop food allergy, asthma, allergic rhinitis, or eosinophilic esophagitis (EoE) than matched peers treated with systemic corticosteroids (SCS), according to a retrospective US claims analysis presented at the 2026 Fall Clinical Dermatology Conference in Las Vegas, Nevada.¹ Across 4 age cohorts spanning infancy through adolescence, dupilumab was associated with a 33% to 52% lower risk of atopic march progression, with the largest reduction in children aged 2 to 5 years.¹

Atopic march describes the sequential accumulation of atopic conditions, typically beginning with AD in infancy and followed by food allergy and airway disease in early childhood.⁴ Whether any AD therapy can alter that trajectory remains an open question, particularly in very young children.¹

Dupilumab vs SCS study design in pediatric atopic dermatitis

Investigators led by Eric L. Simpson, MD, of Oregon Health & Science University in Portland, analyzed the Inovalon Insights Real-World Database, which covers more than 150 US health plans, using a prevalent new-user design with time-conditional propensity score matching.¹ A total of 2897 dupilumab initiators were matched 1:1 with 2897 SCS users across cohorts aged younger than 2 years, 2 to 5 years, 6 to 11 years, and 12 to 17 years.¹ Each cohort's identification period began with the FDA approval of dupilumab for that age group.¹

Patients with any prior diagnosis of food allergy, asthma, allergic rhinitis, or EoE were excluded.¹ The primary outcome was a new diagnosis of any of these conditions on at least 1 inpatient or outpatient claim.¹ Follow-up extended up to 2 years for children younger than 6 years and up to 3 years for older children.¹

Atopic march risk reduction with dupilumab by pediatric age group

In children aged 2 to 5 years, atopic march progression occurred in 231 of 1055 dupilumab-treated patients vs 423 of 1055 SCS-treated patients (HR, 0.48; 95% CI, 0.40-0.56).¹ Hazard ratios in the remaining cohorts were 0.67 (95% CI, 0.52-0.86) for children younger than 2 years, 0.66 (95% CI, 0.52-0.84) for those aged 6 to 11 years, and 0.64 (95% CI, 0.52-0.79) for adolescents.¹

A sensitivity analysis requiring at least 1 inpatient or 2 outpatient claims 30 or more days apart showed stronger associations in the youngest cohorts (HR, 0.39 for <2 years; HR, 0.29 for 2-5 years).¹ In children aged 6 to 11 years, however, the difference was not statistically significant (HR, 0.71; 95% CI, 0.48-1.05).¹

The study did not assess safety.¹ Per prescribing information, the most common adverse events with dupilumab in AD include injection site reactions, eye disorders such as conjunctivitis and dry eye, oral herpes, and eosinophilia.²

How the findings fit prior dupilumab atopic march data

Dupilumab, a biologic targeting type 2 inflammation, is approved in the US for moderate to severe AD in patients aged 6 months and older, as well as for asthma and other type 2 conditions.² Earlier evidence pointed in the same direction. A TriNetX cohort study of 2192 matched pairs found a lower risk of incident asthma or allergic rhinitis with dupilumab vs conventional immunomodulators (HR, 0.68; 95% CI, 0.55-0.83).³ A meta-analysis of 12 dupilumab trials, conducted mostly in adults, reported a 34% lower rate of new or worsened allergic events vs placebo.⁴ The current analysis adds food allergy and EoE as outcomes and includes children younger than 2 years.¹

References

1. Simpson EL, Paller A, Eichenfield LF, et al. Modification of atopic march progression in dupilumab-treated pediatric atopic dermatitis patients in the United States: a retrospective, real-world study. Poster presented at: Fall Clinical Dermatology Conference; October 8-11, 2026; Las Vegas, NV.

2. Dupixent (dupilumab). Prescribing information. Regeneron Pharmaceuticals Inc; 2026. Accessed October 9, 2026. https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/761055s074lbl.pdf

3. Lin TL, et al. Reduced atopic march risk in pediatric atopic dermatitis patients prescribed dupilumab versus conventional immunomodulatory therapy: a population-based cohort study. J Am Acad Dermatol. 2024;91(3):466-473.

4. Geba GP, Li D, Xu M, et al. Attenuating the atopic march: meta-analysis of the dupilumab atopic dermatitis database for incident allergic events. J Allergy Clin Immunol. 2023;151(3):756-766. doi:10.1016/j.jaci.2022.08.026