476 High loading-dose of dupilumab rapidly controls pruritus in pediatric atopic dermatitis patients

Background: The real-world experience of dupilumab in Chinese children is limited, and the initial loading dose has not yet been deeply explored in children. Objective: To explore the efficacy and safety of dupilumab in Chinese children patients with moderate-to-severe AD and investigate the effect of higher loading dose in disease control. Methods: Patients were divided into three groups according to age: <6 years, 6-11 years, and >11 years. The loading dose in children was 300mg for body weight <15kg or 600mg for body weight ≥15kg. Multiple physicians and patient-reported outcome measures were evaluated at baseline and 2, 4, 6, 8, 12, and 16 weeks after dupilumab treatment. Results: The proportion of patients showing an improvement of ≥75% in the Eczema Area and Severity Index (EASI75) was 75.0% (12/16), 76.9% (10/13), and 62.5% (25/40) in the aged <6, 6-11, and >11 years groups, respectively, at week 16. After increasing the loading dose, 69.6% (16/23) of patients aged <6 years achieved a 4-point improvement in Pruritus-Numerical Rating Scale at week 2, compared with 47.8% (11/23) and 33.3% (9/27) of patients aged 6–11 years and >11 years. Obesity was predictive of a poor response to dupilumab treatment at week 16 (odds ratio=0.13, 95% confidence interval: 0.02-0.77). The change of serum C-C motif ligand 17(CCL17/TARC) had strongest correlation with the change in EASI (r = 0.53, P = 0.002) among patients aged <18 years. No adverse events leading to drug discontinuation occurred during the treatment. Conclusions: Dupilumab was effective and well-tolerated in Chinese patients with AD. The increased loading dose helped achieve rapid pruritus control in children.