Dupilumab Reduces Levels of Immunoglobulin E in Pediatric Patients with Moderate-to-Severe AD

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A poster presented at the 2025 American Academy of Dermatology (AAD) Annual Meeting in Orlando, Florida, showed that levels of immunoglobulin E (IgE) were reduced in young children with moderate-to-severe atopic dermatitis (AD) after treatment with dupilumab (Dupixent).¹ Patients taking dupilumab saw a 70% deduction in IgE levels after 16 weeks of treatment.

Background

Elevated allergen-specific IgE levels, often referred to as “IgE sensitization,” are heavily associated with the severity and flare frequency of AD, especially in children. This could potentially correlate with the development of atopic comorbidities, like asthma and food allergies.

“Previous reports document a reduction in dupilumab-associated aeroallergen-specific IgE levels in AD patients with comorbid asthma or allergic rhinitis as well as decreases in total and food allergen-specific-IgE levels in patients with AD,” the authors wrote.

IL-4Rα expressed on B cells induces B cell proliferation and isotype switching, which then results in high levels of circulating IgE. When dupilumab binds to IL-4Rα, type 2 memory B cells reduce, thus decreasing IgE levels.

Methods and Materials

The LIBERTY AD PRESCHOOL (NCT03346434) phase 3 trial was a randomized, double-blind, parallel-group, placebo-controlled, study. Infants and young children <6 years received topical corticosteroids (TCS) with either dupilumab (n = 71) or placebo (n = 69) for 16 weeks. Participants were categorized by age: 0.5 to <2 years, ≥2 to <4 years, and ≥4 to <6 years.

Investigators recorded total IgE serum levels at baseline and week 16. A mixed effect model for repeated measures was used to determine IgE ratios and further compare dupilumab and placebo.

Results

In infants and young children, the total baseline IgE levels (IU/mL) were higher in older ages, regardless of the therapy administered. Dupilumab was administered at a dosage of 200 or 300 mg every 4 weeks.

In the 0.5 to < 2 years age group, there was a decrease from 3,481.8 to 275.9 (-84.9%) in those who took dupilumab and an increase from 636.3 to 918.0 in the placebo group. In the ≥2 to <4 years cohort, those who were treated with dupilumab saw a decrease from 5,736.4 to 1,233.3 (-73.2%) while those who took the placebo saw a minor decrease from 5,066.7 to 4,960.0. Finally, in the ≥4 to < 6 years category, patients taking dupilumab observed a decrease in levels from 10,046.0 to 3,932.8 (-51.7%) and patients taking the placebo observed a change from 9,044.9 to 9,510.4.

Additionally, safety was consistent with the existing safety profile of dupilumab. The researchers did acknowledge that the small sample size, especially in those between the ages of 0.5 to <2, could be a potential limitation.

Conclusion

Overall, dupilumab significantly reduced IgE levels by 70% while placebo significantly increased IgE levels by 30% in all ages (IgE ratio, p <0.001; IgE difference, p = 0.001). The researchers can conclude that a reduction in IgE levels with dupilumab in children with moderate-to-severe AD may contribute to lowering the risk of developing atopic sensitization and other comorbidities.

Reference

1. Beck L, Paller A, Siegfried E, et al. Dupilumab Treatment Significantly Reduces Age-Dependent Total IgE Levels in Young Children With Atopic Dermatitis. Poster presented at the 2025 American Academy of Dermatology Annual Meeting. Orlando, Florida. March 7 to 11, 2025.