The following is a summary of “Attenuating the atopic march: Meta-analysis of the dupilumab atopic dermatitis database for incident allergic events,” published in the MARCH 2023 issue of Allergy & Immunology by Geba, et al.

The term “atopic march” describes the progression of allergic disorders from childhood to adolescence. Typically, atopic dermatitis (AD), food allergies, and airway problems come before a broader or exacerbated spectrum of allergic diseases develops. No intervention has proven to change its trajectory. For a study, researchers sought to determine the rate of acquisition or worsening of allergic events in patients with atopic dermatitis (AD) treated with dupilumab versus placebo.

Allergy-related events were categorized into 17 allergy categories, and IgE changes from baseline were defined. The rate of new or worsened events was considered one step of the atopic march. The incidence rate ratios (IRRs) of dupilumab versus placebo were assessed through meta-analysis.

A total of 1,359 patient-years were included from 12 clinical trials of AD (n=2,296 dupilumab, n=1,229 placebo, median age 35 years) with a duration of 4 to 52 weeks. The median age of AD onset was two years. The baseline allergic disease burden was comparable between the groups. Dupilumab reduced the risk of new or worsening allergies by 34% (IRR 0.66; 95% CI, 0.52-0.84) and new allergies by 37% (IRR 0.63; 95% CI, 0.48-0.83) compared to placebo. Including the IgE category shift further reduced the IRR for combined new or worsening allergies by 54% (IRR 0.46; 95% CI, 0.36-0.57). Treatment benefits were sustained during off-treatment follow-up.

In adult and adolescent patients with inadequately controlled AD, allergic conditions suggestive of the atopic march were acquired or worsened. Treatment with dupilumab reduced the incidence of new or worsened allergic events compared to placebo, and this benefit was sustained during off-treatment follow-up. The inclusion of the IgE category shift in the analysis further increased the apparent benefit.