Predictors Identified for Super-Responder Status to Dupilumab in Atopic Dermatitis

Lower Eczema Area and Severity Index (EASI) scores at baseline are an independent predictor of super responder (SR) status among adults with atopic dermatitis on dupilumab, new data suggest.1

Marco Galluzzo, MD, from the Dermatology Unit at the Fondazione Policlinico “Tor Vergata,” authored these data alongside a team of other investigators. Galluzzo and colleagues highlighted the importance of identifying reliable predictors of longer-lasting remission of disease in atopic dermatitis management.

A recent consensus-based characterization of “super-responders” to treatment was established, defining such individuals as having attained an Investigator's Global Assessment (IGA) score of 0 or 1 by the 16th week of treatment and maintaining such a response up to Week 52.2 Galluzzo et al then sought to assess the performance of such criteria in clinical practice.

“We conducted a retrospective monocentric analysis including all adult patients with moderate-to-severe [atopic dermatitis] treated with dupilumab for at least 52 weeks in our University Dermatology Clinic,” the investigators wrote.1

Study Design and Findings

Patients were categorized by the investigative team as SRs or non–super responders (nSRs) via the established consensus criteria. They limited their analysis of individuals with complete clinical evaluations available at both the 16 and 52-week marks. Reviews were systematically conducted, keeping with routine clinical care, any temporary interruptions in treatment, adherence to dosing, utilization of concomitant topical drugs, and the occurrence of adverse events (AEs), at each follow-up visit.

There were 133 patients who the team found met their eligibility requirements. Super responders made up 42.8% of these individuals. A lack of significant distinctions between SR and nSRs was identified, with respect to dupilumab dosing regimens, interruptions to treatment use, or the concurrent implementation of topical corticosteroids or other anti-inflammatory drugs. Galluzzo and coauthors also found baseline demographics, the existence of atopic comorbidities, clinical phenotypes, and prior systemic drug exposure were well balanced between the 2 arms.

Despite such similarities, they did note several clinical distinctions. In 1 example, SRs presented with lower baseline EASI scores (25.9 versus 28.8, P = .028) and had a significantly shorter mean duration of atopic dermatitis compared with nSRs (17.8 versus 23.8 years, P = .028). Observance of hand involvement was also more common in SRs as opposed to nSRs (17.5% versus 6.5%, P = .047).

In their univariate logistic regression analysis, the investigators’ findings, were supported; both longer disease duration and higher EASI scores at baseline were inversely linked with the likelihood of attaining SR status.

When the team looked at duration of disease as a categorical variable, a duration lasting under 10 years was associated significantly with super response, with an odds ratio of 2.19 (95% CI, 1.05–4.54; P = .036). Despite this conclusion, Galluzzo et al’s multivariate model, baseline EASI emerged as the sole independent predictor of super response (OR, 0.95; 95% CI, 0.91–0.99; P = .041).

These data differ in part from those of a recent Italian real-world study highlighted by the investigators assessing combined response criteria across varied timepoints. In this previous analysis, there was no baseline demographic or clinical characteristic consistently found to predict early, super, or sustained response. However, the exception was higher baseline POEM scores, shown to be linked with poorer early outcomes.

In contrast to this, Galluzzo and colleagues’ present findings suggest a lower baseline EASI score, even within the moderate-to-severe disease spectrum, raises one’s likelihood of meeting an IGA–based definition of super response to treatment. A large Chinese cohort identified baseline severity of itch and DLQI impairment as the strongest predictors of dupilumab super response.

Variability across various studies likely points to differences in SR definitions, the team noted, as well as differences in patient populations and treatment practices. Notably, the investigators highlighted, the link between shorter atopic dermatitis duration and super response seen here lends support to the concept that earlier initiation of biologic drug use may optimize long-term disease outcomes.

“Prospective studies with detailed phenotypic characterization are needed,” Galluzzo and coauthors concluded.1 “This study is limited by its retrospective, single-center design and by the relatively small sample size typical of monocentric real-world cohorts.”

References

1. Mortato E, Talamonti M, Galluzzo M, et al. Predictive Factors of Super-Responder Status to Dupilumab in Adult Atopic Dermatitis: A Real-World Monocentric Study. Int J Dermatol. 2026 Jan 7. doi: 10.1111/ijd.70254. Epub ahead of print. PMID: 41498182.

2. Liñán-Barroso JM, Hernández-Rodríguez JC, Pereyra-Rodríguez JJ, et al. Definition of the Concept of Super-responders in Atopic Dermatitis: A Spanish Delphi Consensus. Acta Derm Venereol. 2025 Mar 6;105:adv42240. doi: 10.2340/actadv.v105.42240. PMID: 40047386; PMCID: PMC11898106.