Racial and ethnic disparities in dupilumab for pediatric atopic dermatitis in Florida

Background: Dupilumab is an mAb that has been shown to decrease symptoms and severity of atopic dermatitis (AD). It was approved for use in adolescents and children in a stepwise manner from 2019 to 2022. Racial and ethnic disparities have been described in access to emerging therapies in many conditions, including treatment with dupilumab for AD in adult patients. Objective: We sought to assess racial and ethnic disparities in moderate to severe AD treatment with dupilumab in the pediatric population. Methods: This retrospective study identified 12,918 patients with AD aged 0 to 17 years who had at least a 6-month follow-up period between January 2020 and September 2023. The primary end point of dupilumab prescription was compared between racial and ethnic groups and a reference group of non-Hispanic White patients while adjusting for confounders. Results: Among the patients, 18.1% were Black, 40.5% Hispanic, 28.9% non-Hispanic White, and 12.4% Other race. Black (odds ratio, 0.43; P = .006) and Hispanic (odds ratio, 0.46; P < .001) patients had significantly lower odds of receiving dupilumab compared with the reference group. Conclusions: This study may indicate a racial and ethnic disparity negatively affecting access to treatment with dupilumab for Black and Hispanic children and adolescents with AD. Because previous studies have not indicated decreased severity of AD in these patient populations, less frequent use is likely due to other underlying factors such as differential access to care, cultural differences, language barriers, and socioeconomic factors. The contributing factors must be further identified and addressed to ensure health equity in pediatric AD.