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Off-label Use of Dupilumab for Pediatric Patients With Atopic Dermatitis

Access to dupilumab is achievable for the majority of children prescribed the medication for moderate-to-severe atopic dermatitis (AD), a new study found. Researchers analyzed off-label use of dupilumab in a multicenter review. They found:

  • 111 of 124 patients (89.5%) gained access to dupilumab after a mean of 9 weeks.
  • The dosing range was 4-15.5 mg/kg load, and 2.0-15.3 mg/kg every other week maintenance, widest for children age 6-11 years, related to use of ether full or half adult dosing.
  • Associated morbidities, treatment response, and adverse events were comparable to previous adolescent and adult trials.


Igelman S, et al. Off-label use of dupilumab for pediatric patients with atopic dermatitis: A multicenter retrospective review. [Published online ahead of print October 10, 2019]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2019.10.010.


When dupilumab was first approved, studies were only performed in adults. But AD is common in younger persons. It has since been studied in adolescents and children and has undoubtedly been used "off-label" in younger patients commonly. One of the main limitations has been third party payor reluctance to cover the medication's cost. This report confirms that safety and efficacy in children is similar to that in adults, but that the optimal dosing in pediatric patients is still uncertain. — Joseph Fowler, Jr., MD, Clinical Professor of Dermatology, University of Louisville, KY