Use of Extended Dosing Intervals of Dupilumab in Treatment of Atopic Dermatitis: A Systematic Review and Meta-Analysis

Dupilumab is a biological agent used in atopic dermatitis (AD) with 2-weekly dosing. Extending dosing intervals in patients with a good response to dupilumab can lead to increased convenience, cost savings, and possibly fewer adverse events (AEs). There has been no systematic review or meta-analysis so far to assess the feasibility of extending dupilumab dosing intervals in well-controlled patients. This study aims to determine the efficacy and ocular AE occurrence in extended dosing intervals of dupilumab in comparison to the standard 2-weekly dosing regimen. We performed a systematic review and meta-analysis of articles using MEDLINE, EMBASE, Cochrane, and ClinicalTrials.gov which reported either efficacy (by measure of Eczema Area and Severity Index) or ocular AE occurrence in extended dosing interval regimens (3-weekly or 4-weekly dosing) in comparison to standard dosing regimens. Random effects analysis was used to obtain the pooled mean difference for efficacy and relative risk for ocular AEs. Thirteen reports from 11 studies were analysed. The pooled mean difference in the extended dosing interval regimen is 0.04 lower (95% confidence interval [CI]: -0.77 to 0.69) than the standard dosing regimen. The relative risk of ocular AEs in the extended dosing interval regimen in comparison to the standard dosing regimen is 0.58 (95% CI: 0.28-1.21). We conclude that extended dosing interval dupilumab regimens are at least as effective as standard dosing regimens in the treatment of AD in well-controlled patients. It cannot be concluded that ocular AEs are reduced with dose tapering. More work can be done to improve the current body of evidence for extended dosing intervals of dupilumab in AD.