Using Dupilumab to Improve Circadian Function, Sleep and Pruritus in Children With Moderate/Severe Atopic Dermatitis

Study Overview
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Brief Summary
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Single center, prospective, Open label study of sleep, pruritus and circadian function pre/post 12-weeks of dupilumab treatment in children 6-17 years old

Detailed Description
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Subjects will complete two overnight sleep studies, before and after using dupilumab for 12 weeks, to assess the effect of dupilumab on sleep disturbance in eczema patients. These overnight visits will include PSG, blood draws, skin sensors, urine collection, tape stripping, and photography. Subjects will be given dupilumab to use for 12 weeks at home before returning for the second sleep study.

Official Title
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Using Dupilumab to Improve Circadian Function, Sleep and Pruritus in Children With Moderate/Severe Atopic Dermatitis

Conditions
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Atopic Dermatitis, Sleep Disturbance

Intervention / Treatment
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* Drug: Dupilumab


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participants, 6-17 years old at time of enrollment. Moderate to severe chronic AD inadequately controlled by topical treatment, diagnosed according to Hanifin and Rajka criteria by a pediatric dermatologist or allergist. AD severity will be determined at baseline with Validated Investigator Global Assessment (vIGA) score of moderate (3) or severe (4). Patient assessed or parent-proxy (under 8 years old) PROMIS sleep disturbance T-score ≥60. Willing and able to comply with visits and study-related procedures. On stable regimens (consistent use 14 days before Day 1 of study enrollment) of inhaled corticosteroids, topical steroids, and antihistamines. Exclusion Criteria: Poorly controlled asthma (Asthma Control Test ≤19). Self-reported sleep disturbance on 2 or more nights in the past 7 days due to allergic rhinitis. Use of concomitant medication that causes scratching. Major medical condition (such as cancer). Active condition that could affect sleep, such as obstructive sleep apnea, restless leg syndrome, insomnia, narcolepsy, severe sleep disordered breathing, severe depression, COVID-19, or hives (urticaria). Having applied topical steroids within 7 days of first or second PSG (important for biomarkers assessment). Use of systemic immunosuppressant within 30 days of first PSG. Having showered or used moisturizers within 12 hours of first or second PSG. Unable to communicate in English (some PROMIS questionnaires not available in translation). Other contraindication to receiving dupilumab (such as history of allergic reaction to dupilumab or any of its components). Pregnancy. Clinical blindness (circadian disturbing).

Ages Eligible for Study
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Minimum Age: 6 Years
Maximum Age: 17 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Dupilumab administration<br>dupilumab administered in weight based dosage for 12 weeks. The drug will be administered once a week during this time through a subcutaneous injection. | Drug: Dupilumab<br>* 12 week dupilumab administration<br>* Other names: Dupixent;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| PROMIS (Patient Reported Outcome Measurement Information System) parent-proxy score | Improvement from baseline in PROMIS Parent-Proxy sleep disturbance score (short format 8-item) after 12 weeks post dupilumab initiation. The minimum value is Never and the maximum value is Always. Higher scores mean worse outcomes. | 12 weeks | 
| PROMIS patient score | Improvement from baseline in PROMIS Patient-reported sleep disturbance score (short format 8-item) after 12 weeks post dupilumab initiation (in children ≥ 8 years old). The minimum value is Never and the maximum value is Always. Higher scores mean worse outcomes. | 12 weeks | 
| Wake After Sleep Onset | Percentage of patients achieving clinically significant improvement in minutes of Wake After Sleep Onset from baseline to Week 12 on inpatient polysomnography (PSG). | 12 weeks |