In real-world studies, pediatric atopic dermatitis was associated with significant costs and impaired quality of life. In addition, treatment with dupilumab children with atopic dermatitis was superior to methotrexate or cyclosporin A with respect to effectiveness, safety and discontinuation rates. These were the main take-aways of the PhD thesis of Lisa van der Rijst (UMC Utrecht).
Atopic dermatitis (AD) is a chronic inflammatory, itchy skin disease and imposes a substantial burden on pediatric patients and their families. Previous studies have shown that the 1-year prevalence of pediatric AD in Europe varies between 1.8 and 17.0 percent. Approximately one-third of pediatric AD patients have moderate-to-severe AD which requires more challenging treatment, including continuous use of more potent topical corticosteroids, systemic immunosuppressants, and/or hospitalization. For decades, systemic treatment for moderate-to-severe pediatric AD has relied on the off-label use of conventional immunosuppressants.
The approval of dupilumab, a monoclonal antibody targeting IL-4 and IL-13 signaling, marked the introduction of the first targeted therapy for patients aged six months and older with (moderate-to) severe AD. The PhD thesis of Lisa van der Rijst, MD (Department of Dermatology & Allergology, UMC Utrecht) aimed to deepen our understanding of the unmet needs and real-world outcomes of dupilumab treatment in pediatric AD.
Lisa van der Rijst, MD PhD
Lisa explored the broader impact of AD on children and their families, including economic and humanistic burden. She found that AD in pediatric patients incurs considerable direct and indirect costs (ranging from € 2,000 to € 5,000 per year), especially in most patients with the most severe disease. The impaired quality of life (especially in children with moderate AD) that was reported underlines the need for effective and safe new treatment options for these patients. Lisa’s research also found that there is variability in treatment goals and preferences among young patients (with focus on convenience of treatment) and their caregivers (with focus on safety aspects).
The researchers also examined the prevalence of physician-diagnosed atopic comorbidities, such as asthma, allergic rhinitis, and the often under-recognized ocular surface disease (OSD). It was confirmed that OSD (although mostly mild) is common in pediatric patients, with the prevalence increasing with age.
Subsequently, this thesis investigated the real-world effectiveness and safety of dupilumab in pediatric AD patients as compared to conventional systemic therapies. It was demonstrated that dupilumab had a superior effectiveness and safety profile compared to methotrexate (MTX) and cyclosporine A (CsA). In addition, discontinuation due to ineffectiveness was most common in treatment episodes with CsA, whereas discontinuation due to adverse effects was more common with MTX.
Furthermore, dupilumab-associated ocular surface disease (DAOSD) occurred in one-third of pediatric AD patients, which underscores the importance of awareness of ocular symptoms during dupilumab treatment. This applies in particular to (young) pediatric patients, where diagnosis of ocular symptoms can be challenging and may lead to delayed diagnosis. Finally, van der Rijst examined the effects of dupilumab on type 2-mediated comorbidities, including changes in food- and aeroallergen-specific IgE levels and pulmonary outcomes. It was found that dupilumab when prescribed for AD resulted in a significant improvement in comorbid asthma and a profound decrease in aeroallergen-specific IgE levels in pediatric patients with asthma and/or allergic rhinitis.
By addressing the multidimensional burden of pediatric AD and evaluating the clinical and immunological effects of dupilumab, this thesis contributes to optimizing treatment strategies and advancing a more personalized approach to managing pediatric AD and improving patient outcomes.
The Dutch Federation of University Medical Centers (UMCnl) has designated the Department of Dermatology & Allergology at UMC Utrecht as the National Center of Expertise for patients with difficult-to-treat AD. The center, headed by Prof. Marjolein de Bruin-Weller, MD PhD, is heavily involved in clinical and translational AD research and patients from all over the Netherlands are referred to UMC Utrecht because of its specific expertise.
Lisa van der Rijst, MD (1994, ‘s Hertogenbosch) defended her PhD thesis on February 25, 2026, at Utrecht University. The title of her thesis was “Pediatric Atopic Dermatitis – Unmet Needs and Real-World Outcomes of Dupilumab Treatment.” Supervisors were Prof. Marjolein de Bruin-Weller, MD PhD (Department of Dermatology & Allergology, UMC Utrecht) and Prof. Femke van Wijk, PhD (Center for Translational immunology, UMC Utrecht). Co-supervisor was Marlies de Graaf, MD PhD (Department of Dermatology & Allergology, UMC Utrecht). In April 2025, Lisa van der Rijst started her residency in dermatology at UMC Utrecht.
