Decreased risk of reduced linear growth among children with atopic dermatitis receiving dupilumab: A cohort study

Abstract

Background: Existing studies have shown inconsistent results regarding the association between atopic dermatitis (AD) and linear growth, and the relationship between dupilumab (DUPI) use and height remains unclear.

Objective: This study examines the association between AD and reduced stature in children and evaluates the influence of DUPI on growth outcomes in real-world clinical settings.

Methods: Utilizing the TriNetX US Collaborative Network, we conducted a retrospective cohort study from January 2018 to December 2023 involving children aged <18 years. Children with AD were compared to propensity score-matched non-AD controls to evaluate the risk of falling below the 5th, 25th, and 50th height percentiles. Among children with AD, a target trial emulation framework was applied to compare growth outcomes between those initiating DUPI and those receiving conventional systemic immunomodulators. Cox proportional hazards models, adjusted for relevant confounders, were used to estimate relative risks (RRs) for reduced stature over a 5-year follow-up period.

Results: The study included 745,046 pediatric individuals. Children with AD exhibited a significantly increased risk of reduced height compared to matched controls (<5th percentile: RR 1.15, 95% CI 1.12-1.18; <25th percentile: RR 1.13, 95% CI 1.08-1.21; <50th percentile: RR 1.22, 95% CI 1.20-1.25), with elevated risks particularly evident in males and those aged over 6 years. Sleep disturbance and corticosteroid use emerged as potential effect modifiers. Additionally, among children with AD, treatment with DUPI was associated with a significantly lower risk of falling below the 5th (RR 0.69, 95% CI 0.57-0.84, P < .001), 25th (RR 0.70, 95% CI 0.54-0.91, P < .001), and 50th (RR 0.74, 95% CI 0.58-0.95, P < .001) height percentiles, with the strongest associations observed in males, children over 6 years, and those of body mass index ≥20.

Limitations: The data lack AD severity.

Conclusions: Children with AD are at increased risk of impaired linear growth; however, treatment with DUPI appears to attenuate this risk. These findings highlight the potential growth-preserving benefits of DUPI in the management of pediatric AD and emphasize the importance of routine growth monitoring in this population.

Keywords: atopic dermatitis; body height percentile; cohort; dupilumab; stature.