Eosinophilic pneumonia (EP) is a rare but noteworthy adverse effect linked to dupilumab, an interleukin-4 (IL-4) and IL-13 inhibitor used in the managing atopic diseases. The underlying mechanisms, potential predisposing factors, clinical characteristics, and optimal management strategies for dupilumab-induced EP remain unclear. We report a 71-year-old patient who developed acute EP after the first 600-mg dose of dupilumab. Eosinophils (EOSs) were also transiently increased (up to 1,600 cells/μl). After the acute EP was effectively treated with glucocorticoids, dupilumab treatment was continued. Rash, itching, and immunoglobulin E levels continued to decrease in the patient, and no further pulmonary adverse events occurred. We combined this case with a literature review of nine articles and analyzed data from 93 cases reported in the FDA Adverse Event Reporting System (FAERS) database of patients developing EP after dupilumab use. Our findings imply that dupilumab may induce EP, particularly in individuals over 45 years old, those with a history of respiratory diseases, and those who have previously used inhaled or systemic steroids. Vigilance is required, especially when there is a persistent elevation in peripheral blood EOSs during treatment. Although steroid treatment can effectively manage EP, more data are needed to determine the safety of resuming dupilumab treatment after controlling pneumonia.

Background: Atopic dermatitis (AD) is a chronic, recurrent, inflammatory skin disease. Although dupilumab has demonstrated favorable efficacy in the treatment of patients with moderate-to-severe atopic dermatitis, data on its recurrence after discontinuation remain limited.Objective: To explore the recurrence rate, time to recurrence, and factors influencing recurrence in patients with moderate-to-severe AD after discontinuing dupilumab, to bridge the existing knowledge gap and provide a reference for promoting long-term standardized management of the disease in AD patients to reduce AD recurrence.Methods: Patients with moderate-to-severe AD treated with dupilumab between January 2021 and December 2023 at Sichuan Provincial People’s Hospital were included. All patients started from the time of drug discontinuation, and baseline characteristics of patients were collected from all enrolled patients, and follow-up visits were conducted every 2 weeks after drug discontinuation utilizing telephone or medical records. Descriptive statistics summarized the relapse rate and time to relapse, and the Cox proportional hazards model was applied to determine the predictive factors of relapse after discontinuing dupilumab.Results: By the follow-up cut-off time, the median follow-up time was 49 weeks (24–85 weeks), and 141 AD patients were finally included in the statistical analysis. Of the 141 patients, 33 patients relapsed, with a relapse rate of 23.4% (95% CI, 16–30%), and the median time to relapse was 29 weeks. Predictors with a significant effect on recurrence included allergic conjunctivitis (HR = 7.912, 95% CI, 1.280–48.895, p = 0.026), duration of treatment <16 weeks (HR = 5.871, 95% CI, 2.154–16.003, p = 0.001), BMI ≥ 28 (HR = 5.653, 95% CI, 2.331–13.713, p < 0.001), male (HR = 5.634, 95% CI, 1.727–18.373, p = 0.004), and positive familial predisposition to allergy (HR = 3.438, 95% CI, 1.351–8.747, p = 0.01).Conclusion: The cumulative recurrence rate in 141 AD patients was 23.4%; the median time to recurrence in 33 AD recurrence patients was 29 weeks (22–59 weeks); comorbid allergic conjunctivitis, treatment duration shorter than 16 weeks, obesity, male patients, and positive familial predisposition to allergy were independent risk factors for AD recurrence. These findings confirm the disease characteristic of AD’s susceptibility to relapse and emphasize the need for individualized treatment, post-discontinuation monitoring, and long-term standardized management of AD patients with different risk factors for relapse.

Background Atopic dermatitis presents unique challenges in the older population owing to age-related changes in skin barrier function and immune regulation. However, there is limited evidence on the efficacy and safety of dupilumab, an anti-interleukin-4Rα monoclonal antibody, in patients with atopic dermatitis aged 80 years and above. Objective We aimed to assess the clinical efficacy and safety of dupilumab treatment in patients with atopic dermatitis aged 80 years and above. Methods Twenty-eight older patients received dupilumab and were evaluated based on several clinical parameters, including the Eczema Area and Severity Index (EASI), Numeric Rating Scale (NRS), Dermatology Life Quality Index (DELI), and AD Control Tool (ACT). Safety assessments and monitoring of concomitant medication use were conducted. Results Twenty-six patients completed 16 weeks of treatment, 13 completed 28 weeks, and two completed more than 36 weeks. Dupilumab treatment resulted in a significant improvement in atopic dermatitis symptoms after 16 weeks as demonstrated by reduced EASI, NRS, DLQI, and ADCT scores. Dupilumab had no significant impact on underlying diseases or medication use. No common adverse reactions, such as conjunctivitis and erythema of the face and neck, were identified. Among the 26 patients receiving dupilumab treatment during the COVID-19 pandemic, 17 remained uninfected or experienced milder COVID-19 symptoms than experienced in the general population. Conclusions Dupilumab treatment showed significant efficacy in improving atopic dermatitis symptoms in patients aged 80 years and above with a high level of safety. Larger long-term clinical trials are needed to validate these results and provide further evidence for the use of dupilumab in older patients with atopic dermatitis.

Granzyme B is a serine protease that can play multiple roles in intracellular and extracellular perforin-dependent or non-perforin-dependent mechanisms. Granzyme B has been found to be an important factor involved in the pathogenesis of atopic dermatitis and is increased in both skin lesions and peripheral blood of atopic dermatitis patients. In this article, we review the correlation between granzyme B and atopic dermatitis to provide a novel therapeutic targeting option for clinical treatment of the latter.

Background: Treatment methods for pruritus in patients with chronic kidney disease (CKD) are lacking. Exploring the therapeutic potential of dupilumab in alleviating pruritus in CKD patients has good clinical value.Objectives: This retrospective study aims to analyze the effectiveness and safety of dupilumab in atopic dermatitis (AD) patients with CKD and uremic pruritus (UP) patients.Methods: Demographic and clinical data from AD patients with CKD stages 3–5 and UP patients who received dupilumab treatment were retrospectively analyzed. Improvements in pruritus were assessed via Peak Pruritus Numerical Rating Scale (PP-NRS) and 5-D itch scale (5-D IS) at weeks 2, 4, 12, and 16. Eczema Area and Severity Index (EASI) and Atopic Dermatitis Control Tool (ADCT) scores were also recorded at week 16 in AD patients with CKD. Safety during treatment was observed.Results: After dupilumab treatment, the PP-NRS and 5D-IS scores of 12 AD patients with CKD and 10 UP patients were significantly decreased. The percentages of UP patients who achieved PP-NRS ≥ 4-point improvement and 5D-IS ≤ 10-point at week 4, 12, and 16 did not significantly differ from those of AD patients with CKD (p > 0.05). At week 16, the skin symptoms in AD patients significantly improved (66.67% achieved EASI-75). No significant adverse effects were found.Conclusion: Dupilumab safely and effectively reduced pruritus in UP patients in the short term and achieved a comparable anti-pruritus effect to AD patients with CKD.

Background: Stapokibart is a novel anti-interleukin-4 receptor α subunit monoclonal antibody approved for moderate-to-severe atopic dermatitis (AD) in adults. Objective: To evaluate the feasibility of extending dosing interval of stapokibart based on efficacy response in AD. Methods: In this ongoing, multicenter, open-label, single-arm trial (NCT06116565), stapokibart 300 mg was administered subcutaneously every 2 weeks (Q2W) for 12 weeks, followed by dosing interval adjustments at weeks 12 and 36. At week 12, nonresponders (failed to achieve ≥50% improvement from baseline in Eczema Area and Severity Index [EASI-50]) were withdrawn, fast responders (achieved ≥75% improvement from baseline in EASI score [EASI-75] or Investigator’s Global Assessment score of 0/1 [IGA 0/1]) were extended to every 4 weeks (Q4W), and slow responders (achieved EASI-50 but not EASI-75 or IGA 0/1) continued Q2W dosing. At week 36, fast responders achieving ≥90% improvement from baseline in EASI score (EASI-90) or IGA 0/1 were further extended to every 8 weeks (Q8W) (Q2W-Q4W-Q8W group), slow responders with EASI-90 or IGA 0/1 were extended to Q4W (Q2W-Q2W-Q4W group), and others maintained their prior dosing through week 52 (Q2W-Q4W-Q4W and Q2W-Q2W-Q2W groups). Results: As of April 7, 2025, 256 and 200 patients completed 12 and 36 weeks of treatment, respectively. In the Q2W-Q4W-Q8W group, 93.0%, 73.7%, and 70.7% of patients sustained EASI-75, IGA 0/1, and ≥4-point reduction in weekly average of daily Peak Pruritus Numerical Rating Scale at week 52, versus 99.2%, 90.1%, and 71.1% at week 36, and 98.3%, 54.5%, and 58.3% at week 12. These response rates in the Q2W-Q4W-Q4W group were 96.2%, 23.1%, and 38.5% at week 12, versus 81.8%, 63.6%, and 72.7% at week 52. In the Q2W-Q2W-Q4W group, these responses were achieved in 95.8%, 83.3%, and 77.3% of patients at week 36, increasing to 100%, 80.0%, and 80.0% at week 52. In the Q2W-Q2W-Q2W group, 84.6%, 23.1%, and 71.4% of patients progressively achieved these responses at week 52 with continued standard dosing. The overall incidence of treatment-emergent adverse events was 78.6%, mostly mild or moderate. Conclusion: Extending dosing interval of stapokibart based on efficacy response demonstrated sustained efficacy and favorable safety in AD.