Management of inadequate response and adverse effects to dupilumab in atopic dermatitis.

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Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by pruritus, skin-pain, and sleep disturbances. Currently, dupilumab is the only U.S. FDA approved systemic therapy and biologic medication for moderate-to-severe AD in adults and children. There is a sparsity of literature available on determining treatment failure with dupilumab and the next steps healthcare providers can take to treat AD. Individual goals and quality of life, and not just body surface area should be considered when defining treatment failure. Possible confounding dermatoses should also be ruled out. Early identification of dupilumab induced adverse-events is important, and for most, dupilumab can be continued while treatment for the adverse-event is initiated. Adjusting dupilumab dosing frequency may also be considered in some circumstances. Adjuvant therapies such as methotrexate, azathioprine, mycophenolate mofetil, cyclosporine, or phototherapy can be added but the safety and efficacy of these combination treatments is not known at this time.

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Authors: Shanthi Narla, Jonathan I Silverberg, Eric L Simpson