51
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Halling AS, Loft N, Silverberg JI, Guttman-Yassky E, Thyssen JP. Real-world evidence of dupilumab efficacy and risk of adverse events: A systematic review and meta-analysis. J Am Acad Dermatol 2020; 84:139-147. [PMID: 32822798 DOI: 10.1016/j.jaad.2020.08.051] [Citation(s) in RCA: 144] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/07/2020] [Accepted: 08/09/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Dupilumab, the first biological drug to be approved for the treatment of moderate to severe atopic dermatitis in adolescents and adults, has shown good efficacy and safety in clinical trials. OBJECTIVE To evaluate real-world data on the efficacy and safety of dupilumab in atopic dermatitis. METHODS PubMed and EMBASE were searched for observational studies with data on efficacy, drug survival, and safety of dupilumab for the treatment of atopic dermatitis. Primary outcomes were mean percentage change in Eczema Area and Severity Index (EASI) score and proportion of atopic dermatitis patients achieving 50%, 75%, and 90% improvement in EASI score after dupilumab therapy. RESULTS Twenty-two unique studies encompassing 3303 atopic dermatitis patients were included. After 16 weeks of dupilumab therapy, the pooled proportion of patients achieving 50%, 75%, and 90% EASI score improvement was 85.1%, 59.8%, and 26.8%, respectively, and the weighted mean reduction in EASI score was 69.6%. Conjunctivitis was the most common adverse event, reported in a pooled proportion of 26.1%. LIMITATIONS Limited data in terms of size and follow-up time were available. CONCLUSION Real-world data show that dupilumab is a successful and well-tolerated therapy for atopic dermatitis, but ocular adverse events commonly occur. Registries are needed to monitor for adverse events.
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Affiliation(s)
- Anne-Sofie Halling
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, Hellerup, Denmark.
| | - Nikolai Loft
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Emma Guttman-Yassky
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York
| | - Jacob P Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, Hellerup, Denmark
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52
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Treudler R, Delaroque N, Puder M, Simon JC, Szardenings M. Dupilumab-induced serum sickness-like reaction: an unusual adverse effect in a patient with atopic eczema. J Eur Acad Dermatol Venereol 2020; 35:e30-e32. [PMID: 32594596 DOI: 10.1111/jdv.16782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- R Treudler
- Department of Dermatology, Venereology and Allergology, Leipzig Interdisciplinary Allergy Centre - LICA, Universität Leipzig, Leipzig, Germany
| | - N Delaroque
- Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - M Puder
- epitopic GmbH, Leipzig, Germany
| | - J-C Simon
- Department of Dermatology, Venereology and Allergology, Leipzig Interdisciplinary Allergy Centre - LICA, Universität Leipzig, Leipzig, Germany
| | - M Szardenings
- Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany.,epitopic GmbH, Leipzig, Germany
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53
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Jang DH, Heo SJ, Jung HJ, Park MY, Seo SJ, Ahn J. Retrospective Study of Dupilumab Treatment for Moderate to Severe Atopic Dermatitis in Korea: Efficacy and Safety of Dupilumab in Real-World Practice. J Clin Med 2020; 9:jcm9061982. [PMID: 32599878 PMCID: PMC7355558 DOI: 10.3390/jcm9061982] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/18/2020] [Accepted: 06/23/2020] [Indexed: 12/23/2022] Open
Abstract
Among biological agents for the treatment of atopic dermatitis (AD), dupilumab is a front-runner. Although many studies have been conducted on the real-world use of dupilumab, the sample size is often small and data is primarily on Western people. Therefore, we investigated the efficacy and safety of dupilumab in patients with moderate-to-severe AD in Korea. All patients with moderate-to-severe AD treated with dupilumab from September 2018 to June 2019 in this institution were included and analyzed by medical records. They were evaluated using the Eczema Area and Severity Index (EASI), Numerical Rating Scale (NRS), Patient Oriented Eczema Measure (POEM), and Dermatology Quality of Life Index (DLQI), respectively on admission, after two weeks (only EASI and NRS) and after 16 weeks. Laboratory tests were measured before and 16 weeks after treatment. A total of 101 patients were included. All efficacy tools showed a significant decrease after 16 weeks; EASI 77.4%, NRS 70.0%, POEM 60.7%, and DLQI 65.0%. EASI was characterized by a marked improvement of 51.5% in just two weeks. The treatment response was not significantly different according to the interval of treatment. Elevated Lactate Dehydrogenase (LDH) at 16 weeks was associated with poor treatment response. Moreover, a high eosinophil count was related to a lower change in EASI and POEM. In the correlation analysis, EASI was not correlated to DLQI before treatment. For changes after 16 weeks, POEM showed the highest correlation with DLQI. (R = 0.66, p < 0.001) In the additional analysis for factors affecting treatment response, the female gender was associated with good treatment response. (odds ratio = 5.4, p = 0.04) Adverse events from treatment included facial erythema (9.9%) and conjunctivitis (5.0%). Overall, it was confirmed that the efficacy of dupilumab in the real-world is similar to that of the existing clinical trials. We suggest that POEM is a useful tool for identifying the quality of life. The female gender was associated with a good treatment response. Both an elevated LDH and a high eosinophil count could be a therapeutic biomarker. Further research will be needed for a long-term period.
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Affiliation(s)
- Dong Hyek Jang
- Department of Dermatology, National Medical Center, Seoul 04564, Korea; (D.H.J.); (H.J.J.); (M.Y.P.)
| | - Seok Jae Heo
- Department of Biostatistics and Computing, Yonsei University Graduate School, Seoul 03722, Korea;
| | - Hye Jung Jung
- Department of Dermatology, National Medical Center, Seoul 04564, Korea; (D.H.J.); (H.J.J.); (M.Y.P.)
| | - Mi Yeon Park
- Department of Dermatology, National Medical Center, Seoul 04564, Korea; (D.H.J.); (H.J.J.); (M.Y.P.)
| | - Seong Jun Seo
- Department of Dermatology, Chung-Ang University Hospital, Seoul 06973, Korea;
| | - Jiyoung Ahn
- Department of Dermatology, National Medical Center, Seoul 04564, Korea; (D.H.J.); (H.J.J.); (M.Y.P.)
- Correspondence: ; Tel.: +82-2-2260-7315
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54
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Kato A, Kamata M, Ito M, Uchida H, Nagata M, Fukaya S, Hayashi K, Fukuyasu A, Tanaka T, Ishikawa T, Ohnishi T, Tada Y. Higher baseline serum lactate dehydrogenase level is associated with poor effectiveness of dupilumab in the long term in patients with atopic dermatitis. J Dermatol 2020; 47:1013-1019. [DOI: 10.1111/1346-8138.15464] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/18/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Aika Kato
- Department of Dermatology Teikyo University School of Medicine Tokyo Japan
| | - Masahiro Kamata
- Department of Dermatology Teikyo University School of Medicine Tokyo Japan
| | - Makoto Ito
- Department of Dermatology Teikyo University School of Medicine Tokyo Japan
| | - Hideaki Uchida
- Department of Dermatology Teikyo University School of Medicine Tokyo Japan
| | - Mayumi Nagata
- Department of Dermatology Teikyo University School of Medicine Tokyo Japan
| | - Saki Fukaya
- Department of Dermatology Teikyo University School of Medicine Tokyo Japan
| | - Kotaro Hayashi
- Department of Dermatology Teikyo University School of Medicine Tokyo Japan
| | - Atsuko Fukuyasu
- Department of Dermatology Teikyo University School of Medicine Tokyo Japan
| | - Takamitsu Tanaka
- Department of Dermatology Teikyo University School of Medicine Tokyo Japan
| | - Takeko Ishikawa
- Department of Dermatology Teikyo University School of Medicine Tokyo Japan
| | - Takamitsu Ohnishi
- Department of Dermatology Teikyo University School of Medicine Tokyo Japan
| | - Yayoi Tada
- Department of Dermatology Teikyo University School of Medicine Tokyo Japan
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55
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Ferrucci S, Romagnuolo M, Angileri L, Berti E, Tavecchio S. Safety of dupilumab in severe atopic dermatitis and infection of Covid-19: two case reports. J Eur Acad Dermatol Venereol 2020; 34:e303-e304. [PMID: 32330323 PMCID: PMC7267596 DOI: 10.1111/jdv.16527] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 12/30/2022]
Affiliation(s)
- S Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Romagnuolo
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - L Angileri
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - E Berti
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - S Tavecchio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
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56
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Selective AhR knockout in langerin-expressing cells abates Langerhans cells and polarizes Th2/Tr1 in epicutaneous protein sensitization. Proc Natl Acad Sci U S A 2020; 117:12980-12990. [PMID: 32461368 DOI: 10.1073/pnas.1917479117] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The aryl hydrocarbon receptor (AhR) represents an environmental sensor regulating immune responses. In the skin, AhR is expressed in several cell types, including keratinocytes, epidermal Langerhans cells (LC), and dermal dendritic cells (DC). The mechanisms how AhR activates or inhibits cutaneous immune responses remain controversial, owing to differences in the cell-specific functions of AhR and the different activating ligands. Therefore, we sought to investigate the role of AhR in LC and langerin+ and negative DC in the skin. To this aim, we generated Langerin-specific and CD11c-specific knockout (-/-) mice lacking AhR, respectively, in LC and Langerin+ dermal DC and in all CD11c+ cells. These were then tested in an epicutaneous protein (ovalbumin, Ova) sensitization model. Immunofluorescence microscopy and flow cytometry revealed that Langerin-AhR-/- but not CD11c-AhR-/- mice harbored a decreased number of LC with fewer and stunted dendrites in the epidermis as well as a decreased number of LC in skin-draining lymph nodes (LN). Moreover, in the absence of AhR, we detected an enhanced T helper type-2 (Th2) [increased interleukin 5 (IL-5) and interleukin 13 (IL-13)] and T regulatory type-1 (Tr1) (IL-10) response when LN cells were challenged with Ova in vitro, though the number of regulatory T cells (Treg) in the LN remained comparable. Langerin-AhR-/- mice also exhibited increased blood levels of Ova-specific immunoglobulin E (IgE). In conclusion, deletion of AhR in langerin-expressing cells diminishes the number and activation of LC, while enhancing Th2 and Tr1 responses upon epicutaneous protein sensitization.
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57
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Ribero S, Giura MT, Viola R, Ramondetta A, Siliquini N, Cardone P, Tonella L, Quaglino P, Dapavo P, Panzone M, Ortoncelli M, Fierro MT. Effectiveness and safety of dupilumab for the treatment of atopic dermatitis in adult cohort: a real-life Italian tertiary centre experience. J Eur Acad Dermatol Venereol 2020; 34:e380-e383. [PMID: 31960496 DOI: 10.1111/jdv.16219] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- S Ribero
- Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy
| | - M T Giura
- Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy
| | - R Viola
- Faculty of Medicine, University of Turin, Turin, Italy
| | - A Ramondetta
- Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy
| | - N Siliquini
- Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy
| | - P Cardone
- Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy
| | - L Tonella
- Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy
| | - P Quaglino
- Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy
| | - P Dapavo
- Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy
| | - M Panzone
- Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy
| | - M Ortoncelli
- Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy
| | - M T Fierro
- Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy
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58
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Jo CE, Georgakopoulos JR, Ladda M, Ighani A, Mufti A, Drucker AM, Piguet V, Yeung J. Short-Term Evaluation of the Real-World Efficacy and Safety of Dupilumab for the Treatment of Moderate-to-Severe Atopic Dermatitis: A Canadian Multicenter Retrospective Cohort Study. J Cutan Med Surg 2020; 24:468-473. [DOI: 10.1177/1203475420928907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Systemic therapy for atopic dermatitis (AD) has been challenging with limited safe and efficacious long-term treatment options. In 2017, dupilumab was approved in the United States, Europe, and Canada as the first targeted therapy for patients with moderate-to-severe AD. Despite promising efficacy and safety results in clinical trials, our understanding of dupilumab in clinical practice remains limited with few studies outside clinical trials in literature. Objective The aim of this study is to evaluate the efficacy and safety of dupilumab in clinical practice and discuss any differences in results between clinical trials and real-world results. Methods A retrospective chart review was conducted of consecutive patients receiving dupilumab treatment at two tertiary hospitals in Toronto, Canada, between December 2017 and May 2019. The primary efficacy endpoint was measured by Investigator’s Global Assessment (IGA) score of 0/1 at 16 weeks and all adverse events (AEs) experienced by patients were recorded. Results Of the 93 patients included in the study, 51 (55%) reached IGA 0/1 and 38 (41%) experienced ≥1 AE. There were no severe AEs or discontinuation prior to 16 weeks due to an AE. Conclusions These findings suggest a higher IGA-based efficacy profile with no newly identified safety concerns in patients treated with dupilumab at two tertiary hospitals in Toronto, Canada, compared to those in randomized controlled trials.
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Affiliation(s)
| | | | | | - Arvin Ighani
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | - Asfandyar Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | - Aaron M. Drucker
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
- Women’s College Hospital, Toronto, ON, Canada
| | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
- Women’s College Hospital, Toronto, ON, Canada
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
- Women’s College Hospital, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Probity Medical Research Inc., Waterloo, ON, Canada
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59
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Quint T, Brunner PM, Sinz C, Steiner I, Ristl R, Vigl K, Kimeswenger S, Neubauer K, Pirkhammer D, Zikeli M, Hoetzenecker W, Reider N, Bangert C. Dupilumab for the Treatment of Atopic Dermatitis in an Austrian Cohort-Real-Life Data Shows Rosacea-Like Folliculitis. J Clin Med 2020; 9:jcm9041241. [PMID: 32344789 PMCID: PMC7230957 DOI: 10.3390/jcm9041241] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/18/2020] [Accepted: 04/22/2020] [Indexed: 12/18/2022] Open
Abstract
Dupilumab is the first biological treatment approved for moderate-to-severe atopic dermatitis (AD). Efficacy and safety have been demonstrated in clinical trials, but real-life data is still limited. The objective of this study was to retrospectively evaluate Dupilumab treatment in AD patients in a real-life clinical setting. Effectiveness and safety outcomes were collected at baseline and after 2, 6, 10, 24, 39, and 52 weeks by using clinical scores for disease activity, as well as serological markers. Ninety-four patients from five dermatological hospitals were included. After 24 weeks of treatment, the median Investigator Global Assessment (IGA) and Eczema Area and Severity Index (EASI) showed a significant reduction compared to baseline (3.9 ± 0.7 vs. 1.4 ± 0.8 and 26.5 ± 12.5 vs. 6.4 ± 6.5). Interestingly, we observed rosacea-like folliculitis as an unexpected side effect in 6.4% of patients. Dupilumab proves to be an effective and well-tolerated treatment under real-life conditions. The occurrence of rosacea-like folliculitis warrants further mechanistic investigation.
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Affiliation(s)
- Tamara Quint
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria; (T.Q.); (P.M.B.); (C.S.)
| | - Patrick M. Brunner
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria; (T.Q.); (P.M.B.); (C.S.)
| | - Christoph Sinz
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria; (T.Q.); (P.M.B.); (C.S.)
| | - Irene Steiner
- Institute of Medical Statistics, Medical University Vienna, 1090 Vienna, Austria; (I.S.); (R.R.)
| | - Robin Ristl
- Institute of Medical Statistics, Medical University Vienna, 1090 Vienna, Austria; (I.S.); (R.R.)
| | - Kornelia Vigl
- Department of Dermatology, Rudolfstiftung City Hospital, 1030 Vienna, Austria; (K.V.); (D.P.)
| | - Susanne Kimeswenger
- Department of Dermatology, Kepler University Hospital, 4020 Linz, Austria; (S.K.); (W.H.)
- Department of Soft Matter Physics, Institute for Experimental Physics, Johannes Kepler University, 4020 Linz, Austria
| | - Katharina Neubauer
- Department of Dermatology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (K.N.); (N.R.)
| | - Detlev Pirkhammer
- Department of Dermatology, Rudolfstiftung City Hospital, 1030 Vienna, Austria; (K.V.); (D.P.)
| | - Martin Zikeli
- Department of Dermatology, Wiener Neustadt Public Hospital, 2700 Wiener Neustadt, Austria;
| | - Wolfram Hoetzenecker
- Department of Dermatology, Kepler University Hospital, 4020 Linz, Austria; (S.K.); (W.H.)
| | - Norbert Reider
- Department of Dermatology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (K.N.); (N.R.)
| | - Christine Bangert
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria; (T.Q.); (P.M.B.); (C.S.)
- Correspondence: ; Tel.: +43-1-40400-77200
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Matsutani M, Imai Y, Inoue Y, Hosotani Y, Kusakabe M, Natsuaki M, Yamanishi K. Real‐world use of dupilumab for 53 patients with atopic dermatitis in Japan. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2020. [DOI: 10.1002/cia2.12099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Masako Matsutani
- Department of Dermatology Hyogo College of Medicine Nishinomiya Japan
| | - Yasutomo Imai
- Department of Dermatology Hyogo College of Medicine Nishinomiya Japan
| | - Yukako Inoue
- Department of Dermatology Hyogo College of Medicine Nishinomiya Japan
| | - Yuka Hosotani
- Department of Ophthalmology Hyogo College of Medicine Nishinomiya Japan
| | - Minori Kusakabe
- Department of Dermatology Hyogo College of Medicine Nishinomiya Japan
| | - Masaru Natsuaki
- Department of Dermatology Hyogo College of Medicine Nishinomiya Japan
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Ferrucci S, Casazza G, Angileri L, Tavecchio S, Germiniasi F, Berti E, Marzano AV, Genovese G. Clinical Response and Quality of Life in Patients with Severe Atopic Dermatitis Treated with Dupilumab: A Single-Center Real-Life Experience. J Clin Med 2020; 9:jcm9030791. [PMID: 32183179 PMCID: PMC7141229 DOI: 10.3390/jcm9030791] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 01/25/2023] Open
Abstract
Dupilumab is an anti-interleukin-4 receptor monoclonal antibody that was recently approved for the treatment of atopic dermatitis (AD). In this single-center retrospective study, clinical baseline data of 117 severe AD patients treated with dupilumab were collected. At baseline and at weeks 4 and 16, disease severity was assessed through the Eczema Area and Severity Index (EASI) and quality of life through the Dermatology Life Quality Index (DLQI) questionnaire, Patient-Oriented Eczema Measure (POEM), Hospital Anxiety and Depression Scale (HADS), Peak Pruritus Numerical Rating Scale (NRS-itch), and VAS-sleep. Response to dupilumab was defined as an improvement of ≥75% in EASI from baseline (EASI75). At multivariate analysis, AD onset before 18 years [OR, 2.9; 95% CI, 1.2–7.2; p = 0.0207] and absence of hypereosinophilia [OR, 2.24; 95% CI, 1.03–4.86; p = 0.0412] were identified as significant predictive parameters for response to dupilumab in terms of EASI75 at week 4 but not at week 16. Significant reductions in EASI, DLQI, POEM, HADS, NRS-itch, and VAS-sleep were found between week 4 versus baseline (p < 0.0001 for all) and week 16 versus baseline (p < 0.0001 for all). Early AD onset and absence of hypereosinophilia may be suggested as predictive markers of early response to dupilumab. We confirmed the efficacy and safety of this agent along with the improvement of life quality in severe AD patients.
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Affiliation(s)
- Silvia Ferrucci
- UOC Dermatologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.F.); (L.A.); (S.T.); (F.G.); (E.B.); (A.V.M.)
| | - Giovanni Casazza
- Dipartimento di Scienze Biomediche e Cliniche “L. Sacco”, Università degli Studi di Milano, 20157 Milan, Italy;
| | - Luisa Angileri
- UOC Dermatologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.F.); (L.A.); (S.T.); (F.G.); (E.B.); (A.V.M.)
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, 20122 Milan, Italy
| | - Simona Tavecchio
- UOC Dermatologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.F.); (L.A.); (S.T.); (F.G.); (E.B.); (A.V.M.)
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, 20122 Milan, Italy
| | - Francesca Germiniasi
- UOC Dermatologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.F.); (L.A.); (S.T.); (F.G.); (E.B.); (A.V.M.)
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, 20122 Milan, Italy
| | - Emilio Berti
- UOC Dermatologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.F.); (L.A.); (S.T.); (F.G.); (E.B.); (A.V.M.)
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, 20122 Milan, Italy
| | - Angelo Valerio Marzano
- UOC Dermatologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.F.); (L.A.); (S.T.); (F.G.); (E.B.); (A.V.M.)
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, 20122 Milan, Italy
| | - Giovanni Genovese
- UOC Dermatologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.F.); (L.A.); (S.T.); (F.G.); (E.B.); (A.V.M.)
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-025-503-4707; Fax: +39-025-503-5236
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Holm JG, Agner T, Sand C, Thomsen SF. Dupilumab for prurigo nodularis: Case series and review of the literature. Dermatol Ther 2020; 33:e13222. [DOI: 10.1111/dth.13222] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/09/2019] [Accepted: 12/31/2019] [Indexed: 12/15/2022]
Affiliation(s)
| | - Tove Agner
- Department of Dermatology Bispebjerg Hospital Copenhagen Denmark
| | - Carsten Sand
- Department of Dermatology Bispebjerg Hospital Copenhagen Denmark
| | - Simon Francis Thomsen
- Department of Dermatology Bispebjerg Hospital Copenhagen Denmark
- Department of Biomedical Sciences University of Copenhagen Copenhagen Denmark
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Fargnoli MC, Esposito M, Ferrucci S, Girolomoni G, Offidani A, Patrizi A, Peris K, Costanzo A, Malara G, Pellacani G, Romanelli M, Amerio P, Cristaudo A, Flori ML, Motolese A, Betto P, Patruno C, Pigatto P, Sirna R, Stinco G, Zalaudek I, Bianchi L, Boccaletti V, Cannavò SP, Cusano F, Lembo S, Mozzillo R, Gallo R, Potenza C, Rongioletti F, Tiberio R, Grieco T, Micali G, Persechino S, Pettinato M, Pucci S, Savi E, Stingeni L, Romano A, Argenziano G. Real-life experience on effectiveness and safety of dupilumab in adult patients with moderate-to-severe atopic dermatitis. J DERMATOL TREAT 2019; 32:507-513. [DOI: 10.1080/09546634.2019.1682503] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- M. C. Fargnoli
- Dermatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - M. Esposito
- Dermatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - S. Ferrucci
- Unit of Dermatology, Fondazione IRCCS Ca’ Grande Ospedale Maggiore Policlinico, Milan, Italy
| | - G. Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - A. Offidani
- Dermatology Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - A. Patrizi
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - K. Peris
- Institute of Dermatology, Catholic University, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A. Costanzo
- Dermatology Unit, Department of Biomedical Sciences, Humanitas University and Humanitas Clinical and Research Center, Rozzano, Italy
| | - G. Malara
- Dermatology Department, Grande Ospedale Metropolitano, Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - G. Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - M. Romanelli
- Dermatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - P. Amerio
- Department of Medicine and Aging Science, Dermatologic Clinic, G. D’Annunzio University, Chieti, Italy
| | - A. Cristaudo
- Unit of Dermatology, San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - M. L. Flori
- Dermatology Section, Department of Clinical Medicine and Immunological Science, University of Siena, Hospital S. Maria Alle Scotte, Siena, Italy
| | - A. Motolese
- Department of Dermatology, Macchi Hospital, Varese, Italy
| | - P. Betto
- Department of Dermatology, Ospedale San Bortolo, ULSS8 Berica, Vicenza, Italy
| | - C. Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - P. Pigatto
- Department of Biomedical, Surgical and Dental Sciences, Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, University of Milan, Milan, Italy
| | - R. Sirna
- Unit of Dermatology, Ospedale Della Misericordia, Grosseto, Italy
| | - G. Stinco
- Department of Medicine, Institute of Dermatology, University of Udine, Udine, Italy
| | - I. Zalaudek
- Dermatology Clinic, Hospital Maggiore of Trieste, Trieste, Italy
| | - L. Bianchi
- Department of Dermatology, University of Tor Vergata, Rome, Italy
| | - V. Boccaletti
- Section of Dermatology, Department of Clinical and Experimental Medicine, University Hospital, Parma
| | - S. P. Cannavò
- Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - F. Cusano
- Dermatology Unit, Gaetano Rummo Hospital Benevento, Benevento, Italy
| | - S. Lembo
- Unit of Dermatology, University Hospital San Giovanni di Dio e Ruggi di Salerno, Hospital Santa Maria Incoronata Dell’Olmo, Cava De’ Tirreni, Salerno, Italy
| | - R. Mozzillo
- Dermatology and Venereology, “San Gennaro” Hospital, Naples, Italy
| | - R. Gallo
- Dermatology Section, Department of Health Science, University of Genoa, Polyclinic Hospital San Martino, Genoa, Italy
| | - C. Potenza
- Dermatology Unit, Department of Medical and Surgical Sciences and Biotechnologies, Daniele Innocenzi, Sapienza University of Rome - Polo Pontino, Rome, Italy
| | - F. Rongioletti
- Section of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - R. Tiberio
- Department of Health Science, University of Eastern Piedmont, Novara, Italy
| | - T. Grieco
- Dermatology Clinic Umberto I, Sapienza University of Rome, Rome, Italy
| | - G. Micali
- Dermatology Clinic, University of Catania, Catania, Italy
| | - S. Persechino
- Dermatology Unit, Sant’Andrea Hospital, NESMOS Department, Sapienza University of Rome, Rome, Italy
| | - M. Pettinato
- Unit of Dermatology, University Hospital, Policlinico Vittorio Emanuele, Catania, Italy
| | - S. Pucci
- Allergology, Hospital of Civitanova Marche, Civitanova Marche, Italy
| | - E. Savi
- Unit of Dermatology, Hospital Guglielmo da Saliceto, Piacenza, Italy
| | - L. Stingeni
- Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - A. Romano
- Allergology Unit, Columbus Presidium, Catholic University, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G. Argenziano
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
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de Wijs LEM, Bosma AL, Erler NS, Hollestein LM, Gerbens LAA, Middelkamp-Hup MA, Kunkeler ACM, Nijsten TEC, Spuls PI, Hijnen DJ. Effectiveness of dupilumab treatment in 95 patients with atopic dermatitis: daily practice data. Br J Dermatol 2019; 182:418-426. [PMID: 31145810 DOI: 10.1111/bjd.18179] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Dupilumab is the first biologic registered for the treatment of moderate-to-severe atopic dermatitis (AD), and efficacy was shown in phase III clinical trials (primary outcome at week 16 was reached in 38% of patients). Currently, there are limited daily practice data available for dupilumab, especially when it is combined with systemic immunosuppressants. OBJECTIVES To evaluate dupilumab treatment in daily practice in patients with AD. METHODS In this observational cohort study, we prospectively included all adult patients with AD who had been treated with dupilumab in two university hospitals in the Netherlands. Concomitant systemic immunosuppressive treatment was monitored. Physician-reported outcome measures and patient-reported outcome measures (PROMs) after ≥ 12 weeks of follow-up were analysed. We used a linear mixed-effects model to determine changes in scores during follow-up. RESULTS Ninety-five patients were included. Of these, 62 patients were using systemic immunosuppressants at baseline; the use of systemic immunosuppressants was continued during dupilumab treatment in 43 patients. From baseline to 16 weeks of treatment, the estimated mean Eczema Area and Severity Index score (0-72) decreased from 18·6 [95% confidence interval (CI) 16·0-21·4)] to 7·3 (95% CI 5·4-10·0), and the estimated mean PROMs showed a decrease of 41-66%. Investigator's Global Assessment 0 or 1 (clear/almost clear) was reached in 38% of the patients. Five patients discontinued dupilumab treatment due to side-effects or ineffectiveness. Eye symptoms and orofacial (nonocular) herpes simplex virus (HSV) reactivation were reported in 62% and 8% of the patients, respectively. CONCLUSIONS Dupilumab treatment in daily practice shows a clinically relevant improvement of physician-reported outcome measures and PROMs, which is in line with efficacy data from clinical trials. Besides frequently reported eye symptoms and orofacial (nonocular) HSV reactivation, there were no apparent safety concerns. What's already known about this topic? Dupilumab has been shown to be an efficacious treatment for atopic dermatitis in several clinical trials. However, it is known that there may be considerable differences in patient characteristics and treatment responses between clinical trials and daily practice. What does this study add? This study presents the first experience with dupilumab treatment in 95 patients with atopic dermatitis in daily practice in two Dutch university hospitals. Less stringent inclusion and exclusion criteria and follow-up schedules, in contrast to those used in clinical trials, might better represent daily practice. Dupilumab treatment shows a clinically relevant improvement of physician- and patient-reported outcome measures; besides patient-reported eye symptoms (in 59 of 95 patients; 62%) and an apparent increase in orofacial (nonocular) herpes simplex virus reactivation (eight of 95 patients; 8%), there were no other safety concerns during follow-up up to 16 weeks of dupilumab treatment.
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Affiliation(s)
- L E M de Wijs
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - A L Bosma
- Department of Dermatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - N S Erler
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - L M Hollestein
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - L A A Gerbens
- Department of Dermatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - M A Middelkamp-Hup
- Department of Dermatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - A C M Kunkeler
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - T E C Nijsten
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - D J Hijnen
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
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