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Wu J, Guttman-Yassky E. Efficacy of biologics in atopic dermatitis. Expert Opin Biol Ther 2020; 20:525-538. [PMID: 32003247 DOI: 10.1080/14712598.2020.1722998] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/25/2020] [Indexed: 12/22/2022]
Abstract
Introduction: Atopic dermatitis (AD) is a heterogeneous disease. Recent advancements in understanding AD pathogenesis resulted in the exponential expansion of its therapeutic pipeline, particularly following the success and FDA-approval of dupilumab. Different phenotypes of AD by age and ethnicity have also recently been described and clinical studies of emerging treatments will further clarify the role of each cytokine pathway in AD.Areas covered: We review the impressive repertoire of biologics for treatment of moderate-to-severe AD, including those targeting Th2, Th22, Th17/IL-23 and IgE. We highlight the scientific rationale behind each approach and provide a discussion of the most recent clinical efficacy and safety data.Expert opinion: AD is a complex disease and recent research has identified numerous endotypes, reinforcing the rationale for developing targeted therapeutics to antagonize these factors. Dupilumab has revolutionized AD treatment and its mechanistic studies also offer crucial insight into AD pathogenesis. Nevertheless, this biologic does not work for everyone, highlighting the need for a more precise approach to address the unique immune fingerprints of each AD subset. Ultimately targeted therapeutics will complement our understanding of the AD molecular map and help push AD management into an era of personalized medicine.
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Affiliation(s)
- Jianni Wu
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, USA
- College of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Emma Guttman-Yassky
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, USA
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
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252
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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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253
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Chello C, Carnicelli G, Sernicola A, Gagliostro N, Paolino G, Di Fraia M, Faina V, Muharremi R, Grieco T. Atopic dermatitis in the elderly Caucasian population: diagnostic clinical criteria and review of the literature. Int J Dermatol 2020; 59:716-721. [PMID: 32311089 DOI: 10.1111/ijd.14891] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/22/2020] [Accepted: 03/26/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic relapsing eczematous dermatitis typically affecting young patients in a percentage from 15 to 20%; although it typically affects young people and adults, recent papers highlighted the emerging of the disease in the elderly population. METHODS The aim of the study was to identify the clinical criteria and allergic sensitization that may be able to support physicians and dermatologists in making a correct diagnosis of AD in the elderly. The second aim of this study was to investigate the incidence, the main features, the gender prevalence, the immunological profile, and comorbidities characterizing patients older than 65 years affected by AD. RESULTS Based on clinical and serological patterns, different phenotypes of AD were identified: generalized AD (55%) characterized by eczematous lesions involving typical areas of the body or prurigo nodularis-like AD; chronic eczematous hand dermatitis (23%); face and neck involvement (9%); and nummular eczema (13%). Skin prick tests revealed a positivity for aeroallergens in 49.6% of patients, most of them being polysensitized (55%). Additionally, food skin prick tests were positive in 25% of patients. Most of the patients reported comorbidities, particularly IgE-mediated diseases, such as seasonal rhino-conjunctivitis, asthma, and chronic obstructive pulmonary disease. Gastrointestinal symptoms such as meteorism, dyspepsia, cramps/abdominal pain, and diarrhea/constipation, were observed in 35% of patients consequent to food allergy. CONCLUSION In our study, we suggest clinical and serological criteria that may be able to guide in the diagnosis of AD in Caucasian elderly, and to design an appropriate treatment according to the current standard protocol.
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Affiliation(s)
- Camilla Chello
- Dermatologic Clinic, Sapienza University of Rome, Rome, Italy
| | | | | | | | - Giovanni Paolino
- Dermatologic Clinic, Sapienza University of Rome, Rome, Italy.,Unit of Dermatology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Marco Di Fraia
- Dermatologic Clinic, Sapienza University of Rome, Rome, Italy
| | - Valentina Faina
- Dermatologic Clinic, Sapienza University of Rome, Rome, Italy
| | | | - Teresa Grieco
- Dermatologic Clinic, Sapienza University of Rome, Rome, Italy
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254
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Abraham S, Haufe E, Harder I, Heratizadeh A, Kleinheinz A, Wollenberg A, Weisshaar E, Augustin M, Wiemers F, Zink A, Biedermann T, von Kiedrowski R, Hilgers M, Worm M, Pawlak M, Sticherling M, Fell I, Handrick C, Schäkel K, Staubach P, Asmussen A, Schwarz B, Bell M, Neubert K, Effendy I, Bieber T, Homey B, Gerlach B, Tchitcherina E, Stahl M, Schwichtenberg U, Rossbacher J, Buck P, Mempel M, Beissert S, Werfel T, Weidinger S, Schmitt J. Implementation of dupilumab in routine care of atopic eczema: results from the German national registry TREATgermany. Br J Dermatol 2020; 183:382-384. [PMID: 32068242 DOI: 10.1111/bjd.18958] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- S Abraham
- Department of Dermatology, University Allergy Center, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - E Haufe
- Center of Evidence-Based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - I Harder
- Center for Inflammatory Skin Diseases, Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A Heratizadeh
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - S Beissert
- Department of Dermatology, University Allergy Center, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - T Werfel
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - S Weidinger
- Center for Inflammatory Skin Diseases, Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - J Schmitt
- Center of Evidence-Based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
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Atopic dermatitis. Interdisciplinary diagnostic and therapeutic recommendations of the Polish Dermatological Society, Polish Society of Allergology, Polish Pediatric Society and Polish Society of Family Medicine. Part II. Systemic treatment and new therapeutic methods. Postepy Dermatol Alergol 2020; 37:129-134. [PMID: 32489345 PMCID: PMC7262801 DOI: 10.5114/ada.2020.94829] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/04/2019] [Indexed: 01/11/2023] Open
Abstract
The treatment goal in atopic dermatitis is eliminating clinical symptoms of the disease, preventing exacerbations and complications, as well as improving patients’ quality of life. In cases of severe atopic dermatitis and lack of response it is recommended to introduce systemic therapy. Patients ofter require multi-specialist consultations, and occasionally hospitalization. It is not recommended to use acupuncture, acupressure, bioresonance, homeopathy, or Chinese herbs in the treatment of atopic dermatitis.
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256
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Dupilumab: Basic aspects and applications to allergic diseases. Allergol Int 2020; 69:187-196. [PMID: 32007360 DOI: 10.1016/j.alit.2020.01.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/12/2019] [Accepted: 12/15/2019] [Indexed: 12/23/2022] Open
Abstract
Interleukin (IL)-4 and IL-13, signature type 2 cytokines, exert their actions by binding to two types of receptors sharing the IL-4R α chain (IL-4Rα). Since IL-4 and IL-13 play important and redundant roles in the pathogenesis of allergic diseases, blocking both the IL-4 and IL-13 signals would be a powerful and effective strategy for treating allergic diseases. Dupilumab (Dupixent®) is a fully human monoclonal antibody recognizing IL-4Rα and blocking both the IL-4 and IL-13 signals. Dupilumab was first prescribed for atopic dermatitis (AD) patients and has been widely approved for adult patients with moderate to severe AD since 2018. Dupilumab has since been used for asthma, receiving approval for uncontrolled asthma in 2019. A phase 3 study using dupilumab for chronic rhinosinusitis with nasal polyps (CRSwNP) has been just completed, with positive results. Several clinical trials of dupilumab for other diseases in which type 2 inflammation is dominant are now underway. It is hoped that dupilumab will open the door to a new era for treating allergic patients with AD, asthma, and CRSwNP, and for more patients with type 2 inflammations.
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257
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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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258
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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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259
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Abstract
Atopic dermatitis (AD) in older adults (elderly AD) has recently emerged as a newly defined subgroup of AD. When selecting treatment options, clinical characteristics of elderly AD and age-specific factors of older patients must be considered. As in other age groups, regular application of moisturizers in combination with topical corticosteroids and calcineurin inhibitors, adjunctive administration of oral antihistamines/anti-allergic drugs, and avoidance of exacerbating factors comprise basic treatments for elderly AD. For moderate-to-severe cases and/or in those with a decreased ability to use topical treatments, powerful anti-inflammatory treatments may become necessary as additional treatment options. While low-dose oral corticosteroids may be useful for cases of elderly AD, careful attention should be paid to adverse effects. Oral cyclosporine (ciclosporin) is less commonly used due to the increased risk of malignancy and organ toxicity in older patients with AD. Narrow-band ultraviolet B phototherapy may also be useful for older patients, although the necessity of frequent hospital visits for irradiation therapy may become a burden of disease for such patients. As a biologic, dupilumab therapy markedly improves skin lesions and itch in older patients with AD, with a rapid response and non-serious adverse effects. Nevertheless, injection pain, expensive medical care, and regular follow-up every 2 weeks are disadvantages of dupilumab therapy. Therefore, clinicians must prioritize individualized treatment options that will reduce the burden of disease for cases of elderly AD.
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Affiliation(s)
- Ryoji Tanei
- Department of Dermatology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakaecho, Itabashi, Tokyo, 173-0015, Japan.
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260
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Kovalenko P, Davis JD, Li M, Rippley R, Ardeleanu M, Shumel B, Graham NMH, Pirozzi G, Kamal MA, DiCioccio AT. Base and Covariate Population Pharmacokinetic Analyses of Dupilumab Using Phase 3 Data. Clin Pharmacol Drug Dev 2020; 9:756-767. [PMID: 32096596 PMCID: PMC7496533 DOI: 10.1002/cpdd.780] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/02/2020] [Indexed: 12/28/2022]
Abstract
Population pharmacokinetic base and covariate models were developed to study functional dupilumab for regulatory submissions, using data from healthy volunteers and patients with moderate‐to‐severe atopic dermatitis (AD) receiving intravenous or subcutaneous doses. Sixteen studies were pooled (N = 2115; 202 healthy volunteers, 1913 AD patients). The best model was a 2‐compartment model with linear and Michaelis‐Menten elimination and 3 transit compartments describing absorption. A stepwise approach to model building, with some parameters estimated using mostly rich data and subsequently fixed, was used to avoid adverse effects of sparse data and a steep target‐mediated phase on pharmacokinetic parameters, which require rich sampling for proper estimation. Parameterization of models in terms of rates was a useful alternative to the parameterization in terms of clearances, allowing for a reduced number of covariates while providing accurate predictions. While antidrug antibodies, albumin, race, body mass index, and Eczema Area and Severity Index score were statistically significant covariates, only body weight had a notable effect on central volume, explaining interindividual variability. The model adequately described dupilumab pharmacokinetics in phase 3 trials.
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Affiliation(s)
| | - John D Davis
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Meng Li
- Sanofi, Bridgewater, New Jersey, USA
| | - Ronda Rippley
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | | | - Brad Shumel
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
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261
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Abstract
Purpose Dupilumab, a monoclonal antibody directed against the interleukin-4 receptor subunit α (IL-4Rα) of IL-4 and IL-13, is increasingly being used to control atopic disease. Dupilumab use has been associated with a poorly understood conjunctivitis. In this study, we sought to investigate the hypothesis that dupilumab use and the associated IL-13 blockade causes a relative ocular mucin deficiency. Methods Tear levels of mucin 5ac (Muc5AC) and total tear protein levels were evaluated from 28 eyes of 14 patients. Bilateral tear samples were acquired from seven patients on dupilumab and seven patients with no exposure to dupilumab. Study subjects were age and gender matched. In addition to tear samples, photographic documentation of ocular surface findings and a questionnaire of ocular surface symptoms were obtained. Between-group mean differences were calculated. Results Compared with control, ocular Muc5AC levels normalized to total tear protein was statistically significantly lower. The average Muc5AC levels for persons on dupilumab was 1.54 ± 0.58 ng/mg and that of controls was 7.99 ± 1.16 ng/ mg. Persons on dupilumab reported a statistically increased occurrence of ocular fatigue/eye strain, uncomfortable sensation, pain, red eye, and itching. Conclusions This study demonstrates for the first time, a relative deficiency of Muc5AC in patients on dupilumab. Translational Relevance The results of this study support the previously reported role of IL-13 in increasing goblet cell density and associated Muc5AC production. Further efforts are underway to better understand the relative contribution of Muc5AC deficiency in the overall presentation of conjunctivitis associated with dupilumab use.
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Affiliation(s)
- Brad P Barnett
- Duke University Eye Center, Duke University Medical Center, Durham, NC, USA
| | - Natalie A Afshari
- Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
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262
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Andreasen T, Christensen M, Halling A, Egeberg A, Thyssen J. Placebo response in phase 2 and 3 trials of systemic and biological therapies for atopic dermatitis—a systematic review and meta‐analysis. J Eur Acad Dermatol Venereol 2020; 34:1143-1150. [DOI: 10.1111/jdv.16163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 11/19/2019] [Indexed: 12/30/2022]
Affiliation(s)
- T.H. Andreasen
- Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Hellerup Denmark
| | - M.O. Christensen
- Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Hellerup Denmark
| | - A.‐S. Halling
- Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Hellerup Denmark
| | - A. Egeberg
- Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Hellerup Denmark
- Copenhagen Research Group for Inflammatory Skin CORGIS Hellerup Denmark
| | - J.P. Thyssen
- Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Hellerup Denmark
- Copenhagen Research Group for Inflammatory Skin CORGIS Hellerup Denmark
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263
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Dupuis P, Prokopich CL, Hynes A, Kim H. A contemporary look at allergic conjunctivitis. Allergy Asthma Clin Immunol 2020; 16:5. [PMID: 31993069 PMCID: PMC6975089 DOI: 10.1186/s13223-020-0403-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/09/2020] [Indexed: 01/16/2023] Open
Abstract
Allergic eye disease is common, yet often overlooked in North America. In the U.S., up to 40% of the population is deemed to be affected and this number is growing. Symptoms and signs of ocular allergy can lead to decreased productivity and negatively impact quality of life (QoL). Various treatment options exist to achieve symptom control. For allergic conjunctivitis, ophthalmic agents include antihistamines, mast cell stabilizers, dual-activity agents, nonsteroidal anti-inflammatory drugs (NSAIDs), steroids and some off-label treatments. Immunotherapy is recommended as a therapeutic option. This review provides a summary of the forms of ocular allergies, with a focus on symptoms and signs, impact on QoL, physical examination, diagnosis and therapeutic options of allergic conjunctivitis. Through multidisciplinary collaborations, a simplified algorithm for the treatment of allergic conjunctivitis is proposed for Canadian clinical practice.
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Affiliation(s)
- Pascale Dupuis
- 1Division of Clinical Immunology and Allergy, Department of Medicine, St. Joseph's Hospital, Western University, Room B3-102, 268 Grosvenor Street, London, ON N6A 4V2 Canada
| | - C Lisa Prokopich
- 2School of Optometry & Vision Science, University of Waterloo, 200 Columbia St W., Waterloo, ON N2L 3G1 Canada
| | | | - Harold Kim
- 1Division of Clinical Immunology and Allergy, Department of Medicine, St. Joseph's Hospital, Western University, Room B3-102, 268 Grosvenor Street, London, ON N6A 4V2 Canada.,4Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University Health Sciences Centre, 1280 Main St. W., Hamilton, ON L8S 4K1 Canada
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Lee DH, Cohen LM, Yoon MK, Tao JP. Punctal stenosis associated with dupilumab therapy for atopic dermatitis. J DERMATOL TREAT 2020; 32:737-740. [DOI: 10.1080/09546634.2019.1711010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Debora H. Lee
- Oculofacial Plastic and Orbital Surgery, Department of Ophthalmology, Gavin Herbert Eye Institute, University of California, Irvine, CA, USA
| | - Liza M. Cohen
- Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Michael K. Yoon
- Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Jeremiah P. Tao
- Oculofacial Plastic and Orbital Surgery, Department of Ophthalmology, Gavin Herbert Eye Institute, University of California, Irvine, CA, USA
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Raffi J, Suresh R, Botto N, Murase JE. The impact of dupilumab on patch testing and the prevalence of comorbid allergic contact dermatitis in recalcitrant atopic dermatitis: A retrospective chart review. J Am Acad Dermatol 2020; 82:132-138. [DOI: 10.1016/j.jaad.2019.09.028] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 09/01/2019] [Accepted: 09/14/2019] [Indexed: 12/23/2022]
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Simpson EL, Paller AS, Siegfried EC, Boguniewicz M, Sher L, Gooderham MJ, Beck LA, Guttman-Yassky E, Pariser D, Blauvelt A, Weisman J, Lockshin B, Hultsch T, Zhang Q, Kamal MA, Davis JD, Akinlade B, Staudinger H, Hamilton JD, Graham NMH, Pirozzi G, Gadkari A, Eckert L, Stahl N, Yancopoulos GD, Ruddy M, Bansal A. Efficacy and Safety of Dupilumab in Adolescents With Uncontrolled Moderate to Severe Atopic Dermatitis: A Phase 3 Randomized Clinical Trial. JAMA Dermatol 2020; 156:44-56. [PMID: 31693077 PMCID: PMC6865265 DOI: 10.1001/jamadermatol.2019.3336] [Citation(s) in RCA: 281] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 08/30/2019] [Indexed: 01/01/2023]
Abstract
Importance Adolescents with atopic dermatitis (AD) have high disease burden negatively affecting quality of life, with limited treatment options. The efficacy and safety of dupilumab, a monoclonal antibody, approved for treatment in adolescent patients with inadequately controlled AD, remain unknown in this patient population. Objective To assess the efficacy and safety of dupilumab monotherapy in adolescents with moderate to severe inadequately controlled AD. Design, Setting, and Participants A randomized, double-blind, parallel-group, phase 3 clinical trial was conducted at 45 US and Canadian centers between March 21, 2017, and June 5, 2018. A total of 251 adolescents with moderate to severe AD inadequately controlled by topical medications or for whom topical therapy was inadvisable were included. Interventions Patients were randomized (1:1:1; interactive-response system; stratified by severity and body weight) to 16-week treatment with dupilumab, 200 mg (n = 43; baseline weight <60 kg), or dupilumab, 300 mg (n = 39; baseline weight ≥60 kg), every 2 weeks; dupilumab, 300 mg, every 4 weeks (n = 84); or placebo (n = 85). Main Outcomes and Measures Proportion of patients with 75% or more improvement from baseline in Eczema Area and Severity Index (EASI-75) (scores range from 0 to 72, with higher scores indicating greater severity) and Investigator's Global Assessment (IGA) 0 or 1 on a 5-point scale (scores range from 0 to 4, with higher scores indicating greater severity) at week 16. Results A total of 251 patients were randomized (mean [SD] age, 14.5 [1.7] years; 148 [59.0%] male). Of 250 patients with data available on concurrent allergic conditions, most had comorbid type 2 diseases (asthma, 134 [53.6%]; food allergies, 60.8%; allergic rhinitis, 65.6%). A total of 240 patients (95.6%) completed the study. Dupilumab achieved both coprimary end points at week 16. The proportion of patients with EASI-75 improvement from baseline increased (every 2 weeks, 41.5%; every 4 weeks, 38.1%; placebo, 8.2%) with differences vs placebo of 33.2% (95% CI, 21.1%-45.4%) for every 2 weeks and 29.9% (95% CI, 17.9%-41.8%) for every 4 weeks (P < .001). Efficacy of the every-2-week regimen was generally superior to the every-4-week regimen. Patients in the dupilumab arms had higher percentage values of conjunctivitis (every 2 weeks, 9.8%; every 4 weeks, 10.8%; placebo, 4.7%) and injection-site reactions (every 2 weeks, 8.5%; every 4 weeks, 6.0%; placebo, 3.5%), and lower nonherpetic skin infections (every 2 weeks, 9.8%; every 4 weeks, 9.6%; placebo, 18.8%). Conclusions and Relevance In this study, dupilumab significantly improved AD signs, symptoms, and quality of life in adolescents with moderate to severe AD, with an acceptable safety profile. Placebo-corrected efficacy and safety of dupilumab were similar in adolescents and adults. Trial Registration ClinicalTrials.gov identifier: NCT03054428.
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Affiliation(s)
- Eric L. Simpson
- Department of Dermatology, Oregon Health & Science University, Portland
| | - Amy S. Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elaine C. Siegfried
- Department of Pediatrics, School of Medicine, Saint Louis University, St. Louis, Missouri
| | - Mark Boguniewicz
- Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine, Denver
| | - Lawrence Sher
- Peninsula Research Associates, Rolling Hills Estates, California
| | - Melinda J. Gooderham
- Skin Centre for Dermatology, Peterborough, Ontario, Canada
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Probity Medical Research, Waterloo, Ontario, Canada
| | - Lisa A. Beck
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
- Laboratory for Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
- Laboratory for Investigative Dermatology, Rockefeller University, New York, New York
| | - David Pariser
- Department of Dermatology, Eastern Virginia Medical School, Norfolk
| | | | | | - Benjamin Lockshin
- US Dermatology Partners, Rockville, Maryland
- Georgetown University, Washington, District of Columbia
| | | | - Qin Zhang
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | | | | | | | | | | | | | | | | | | | - Neil Stahl
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
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Harb H, Chatila TA. Mechanisms of Dupilumab. Clin Exp Allergy 2020; 50:5-14. [PMID: 31505066 PMCID: PMC6930967 DOI: 10.1111/cea.13491] [Citation(s) in RCA: 231] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/02/2019] [Accepted: 09/03/2019] [Indexed: 12/13/2022]
Abstract
The Th2 cytokines interleukin 4 (IL-4) and IL-13 and the heterodimeric IL-4 receptor (IL-4R) complexes that they interact with play a key role in the pathogenesis of allergic disorders. Dupilumab is a humanized IgG4 monoclonal antibody that targets the IL-4 receptor alpha chain (IL-4Rα), common to both IL-4R complexes: type 1 (IL-4Rα/γc; IL-4 specific) and type 2 (IL-4Rα/IL-13Rα1; IL-4 and IL-13 specific). In this review, we detail the current state of knowledge of the different signalling pathways coupled to the IL-4R complexes and examine the possible mechanisms of Dupilumab action and survey its clinical efficacy in different allergic disorders. The development of Dupilumab and the widening spectrum of its clinical applications is relevant to the current emphasis on precision medicine approaches to the blockade of pathways involved in allergic diseases.
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Affiliation(s)
- Hani Harb
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Talal A Chatila
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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268
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Lee HH, Patel KR, Rastogi S, Singam V, Vakharia PP, Chopra R, Silverberg JI. Placebo responses in randomized controlled trials for systemic therapy in atopic dermatitis: A systematic review and meta-analysis. J Am Acad Dermatol 2020; 82:62-71. [DOI: 10.1016/j.jaad.2019.05.102] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/10/2019] [Accepted: 05/30/2019] [Indexed: 12/27/2022]
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Ariëns LFM, Schaft J, Bakker DS, Balak D, Romeijn MLE, Kouwenhoven T, Kamsteeg M, Giovannone B, Drylewicz J, Amerongen CCA, Delemarre EM, Knol EF, Wijk F, Nierkens S, Thijs JL, Schuttelaar MLA, Bruin‐Weller MS. Dupilumab is very effective in a large cohort of difficult-to-treat adult atopic dermatitis patients: First clinical and biomarker results from the BioDay registry. Allergy 2020; 75:116-126. [PMID: 31593343 DOI: 10.1111/all.14080] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/22/2019] [Accepted: 09/07/2019] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Dupilumab has recently been approved for the treatment of moderate to severe atopic dermatitis (AD) in adults. Daily practice data on dupilumab treatment are scarce. OBJECTIVE To study the effect of 16-week treatment with dupilumab on clinical response and serum biomarkers in adult patients with moderate-severe AD in daily practice. METHODS Data were extracted from the BioDay registry, a prospective multicenter registry. Sixteen-week clinical effectiveness of dupilumab was expressed as number of patients achieving EASI-50 (Eczema Area and Severity Index) or EASI-75, as well as patient-reported outcomes measures (Patient-Oriented Eczema Measure, Dermatology Life Quality Index, Numeric Rating Scale pruritus). Twenty-one biomarkers were measured in patients treated with dupilumab without concomitant use of oral immunosuppressive drugs at five different time points (baseline, 4, 8, 12, and 16 weeks). RESULTS In total, 138 patients treated with dupilumab in daily practice were included. This cohort consisted of patients with very difficult-to-treat AD, including 84 (61%) patients who failed treatment on ≥2 immunosuppressive drugs. At week 16, the mean percent change in EASI score was 73%. The EASI-50 and EASI-75 were achieved by 114 (86%) and 82 (62%) patients after 16 weeks of treatment. The most reported side effect was conjunctivitis, occurring in 47 (34%) patients. During dupilumab treatment, disease severity-related serum biomarkers (TARC, PARC, periostin, and IL-22), eotaxin-1, and eotaxin-3 significantly decreased. CONCLUSION Treatment with dupilumab significantly improved disease severity and decreased severity-related serum biomarkers in patients with very difficult-to-treat AD in a daily practice setting.
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Affiliation(s)
- Lieneke F. M. Ariëns
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
| | - Jorien Schaft
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
| | - Daphne S. Bakker
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
| | - Deepak Balak
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
| | - Margreet L. E. Romeijn
- Department of Dermatology University Medical Center Groningen University of Groningen Groningen The Netherlands
| | - Tessa Kouwenhoven
- Department of Dermatology Radboud University Medical Center Nijmegen Nijmegen The Netherlands
| | - Marijke Kamsteeg
- Department of Dermatology Radboud University Medical Center Nijmegen Nijmegen The Netherlands
| | - Barbara Giovannone
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
| | - Julia Drylewicz
- Laboratory of Translational Immunology University Medical Center Utrecht Utrecht The Netherlands
| | | | - Evelien M. Delemarre
- Laboratory of Translational Immunology University Medical Center Utrecht Utrecht The Netherlands
| | - Edward F. Knol
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
- Laboratory of Translational Immunology University Medical Center Utrecht Utrecht The Netherlands
| | - Femke Wijk
- Laboratory of Translational Immunology University Medical Center Utrecht Utrecht The Netherlands
| | - Stefan Nierkens
- Laboratory of Translational Immunology University Medical Center Utrecht Utrecht The Netherlands
| | - Judith L. Thijs
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
| | - Marie L. A. Schuttelaar
- Department of Dermatology Radboud University Medical Center Nijmegen Nijmegen The Netherlands
| | - Marjolein S. Bruin‐Weller
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
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Wollenberg A, Beck LA, Blauvelt A, Simpson EL, Chen Z, Chen Q, Shumel B, Khokhar FA, Hultsch T, Rizova E, Rossi AB, Graham NMH, Pirozzi G, Lu Y, Ardeleanu M. Laboratory safety of dupilumab in moderate-to-severe atopic dermatitis: results from three phase III trials (LIBERTY AD SOLO 1, LIBERTY AD SOLO 2, LIBERTY AD CHRONOS). Br J Dermatol 2019; 182:1120-1135. [PMID: 31407311 PMCID: PMC7317598 DOI: 10.1111/bjd.18434] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2019] [Indexed: 12/13/2022]
Abstract
Background Dupilumab [a monoclonal antibody blocking the shared receptor subunit for interleukin (IL)‐4 and IL‐13] is approved for patients aged ≥ 12 years with inadequately controlled, moderate‐to‐severe atopic dermatitis (AD). Dupilumab trials of up to 52 weeks demonstrated efficacy and a favourable safety profile in patients with moderate‐to‐severe AD inadequately controlled with topical medications. Objectives To further characterize the safety of dupilumab by evaluating clinical laboratory findings from three randomized, double‐blinded, placebo‐controlled phase III trials (LIBERTY AD SOLO 1 & 2 and LIBERTY AD CHRONOS). Methods Patients were randomized 1 : 1 : 1 (SOLO 1 & 2) or 3 : 1 : 3 (CHRONOS) for 16 and 52 weeks, respectively, to dupilumab weekly, every 2 weeks or placebo. CHRONOS patients received a standardized concomitant topical corticosteroid regimen. Laboratory outcomes were summarized descriptively in 1376 patients from SOLO 1 & 2 and 740 from CHRONOS. Results Treatment groups had similar results in baseline laboratory parameters. Platelets and neutrophils showed mild decreases from baseline in dupilumab vs. placebo groups. Some dupilumab‐treated patients had small transient increases in eosinophils. Grade 3 eosinophilia was reported in < 1% of dupilumab‐treated and placebo‐treated patients; no adverse events were associated with eosinophilia. Lactate dehydrogenase levels decreased from baseline during dupilumab treatment in all trials. No clinically meaningful changes were observed between treatment groups in other haematology, chemistry or urinalysis parameters. Conclusions There were no clinically important changes in routine laboratory parameters that could be attributed to dupilumab. This study supports the use of dupilumab as a systemic treatment for moderate‐to‐severe AD that does not require laboratory monitoring. What's already known about this topic? Long‐term treatment of atopic dermatitis (AD) with conventional immunosuppressive agents is limited by the risk of significant side‐effects and a need for repeated tests to monitor haematological and/or organ (e.g. liver, kidney) toxicities. Dupilumab [a monoclonal antibody blocking the shared receptor subunit for interleukin (IL)‐4 and IL‐13] is approved for the treatment of patients with inadequately controlled, moderate‐to‐severe AD. In 16‐week and 52‐week studies, dupilumab demonstrated a positive risk/benefit profile in moderate‐to‐severe AD.
What does this study add? This study is the first comprehensive analysis of dupilumab laboratory safety data of the 16‐week SOLO 1 & 2 (pooled N = 1376) and 52‐week CHRONOS (N = 740) trials, demonstrating an absence of clinically important changes in haematology, serum chemistry and urinalysis parameters in patients with moderate‐to‐severe AD treated with dupilumab. Our data support the use of dupilumab as a systemic treatment for the long‐term management of moderate‐to‐severe AD without routine laboratory monitoring in clinical practice.
Respond to this article
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Affiliation(s)
- A Wollenberg
- Department of Dermatology and Allergology, Ludwig Maximilian University of Munich, Frauenlobstraße 9-11, 80337, Munich, Germany
| | - L A Beck
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY, U.S.A
| | - A Blauvelt
- Oregon Medical Research Center, Portland, OR, U.S.A
| | - E L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, OR, U.S.A
| | - Z Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - Q Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - B Shumel
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - F A Khokhar
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - T Hultsch
- Sanofi Genzyme, Cambridge, MA, U.S.A
| | - E Rizova
- Sanofi Genzyme, Cambridge, MA, U.S.A
| | - A B Rossi
- Sanofi Genzyme, Cambridge, MA, U.S.A
| | - N M H Graham
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | | | - Y Lu
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - M Ardeleanu
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
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272
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Agnihotri G, Shi K, Lio PA. A Clinician's Guide to the Recognition and Management of Dupilumab-Associated Conjunctivitis. Drugs R D 2019; 19:311-318. [PMID: 31728936 PMCID: PMC6890653 DOI: 10.1007/s40268-019-00288-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Dupilumab, a monoclonal antibody that inhibits both interleukin (IL)-4 and IL-13 signaling, is an effective treatment option in moderate-to-severe atopic dermatitis (AD). Patients with AD are already at increased risk of developing conjunctivitis, and clinical trials and case reports have shown a greater incidence of conjunctivitis in individuals with AD treated with dupilumab. As this is one of the more commonly reported side effects of this biologic agent, it is important that clinicians are aware of this association and advise patients receiving dupilumab to report signs of conjunctivitis. This review summarizes the risk factors, clinical features, and management options for patients with AD presenting with conjunctivitis after receiving dupilumab therapy.
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Affiliation(s)
- Gaurav Agnihotri
- University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Katherine Shi
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Peter A Lio
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Medical Dermatology Associates of Chicago, 363 W Erie Street, Suite 350, Chicago, IL, 60654, USA.
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Thyssen J, Halling‐Sønderby A, Wu J, Egeberg A. Pain severity and use of analgesic medication in adults with atopic dermatitis: a cross‐sectional study. Br J Dermatol 2019; 182:1430-1436. [DOI: 10.1111/bjd.18557] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2019] [Indexed: 12/01/2022]
Affiliation(s)
- J.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
| | - A.‐S. Halling‐Sønderby
- 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
| | - J.J. Wu
- Dermatology Research and Education Foundation Irvine CA U.S.A
| | - A. Egeberg
- 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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274
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Yosipovitch G, Berger T, Fassett MS. Neuroimmune interactions in chronic itch of atopic dermatitis. J Eur Acad Dermatol Venereol 2019; 34:239-250. [PMID: 31566796 PMCID: PMC7027518 DOI: 10.1111/jdv.15973] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/11/2019] [Indexed: 12/30/2022]
Abstract
Itch is a defining symptom of atopic dermatitis. Crosstalk between keratinocytes, the immune system and non‐histaminergic sensory nerves is responsible for the pathophysiology of chronic itch in atopic dermatitis. An expanding understanding of the contribution of the nervous system and its interaction with immune pathways in atopic itch are helping to identify new therapeutic strategies.
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Affiliation(s)
- G Yosipovitch
- Department of Dermatology and Cutaneous Surgery and Miami Itch Center, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - T Berger
- Department of Dermatology, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - M S Fassett
- Department of Dermatology, School of Medicine, University of California San Francisco, San Francisco, CA, USA
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275
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Raffi J, Suresh R, Fishman H, Botto N, Murase JE. Investigating the role of allergic contact dermatitis in residual ocular surface disease on dupilumab (ROSDD) ,. Int J Womens Dermatol 2019; 5:308-313. [PMID: 31909149 PMCID: PMC6938871 DOI: 10.1016/j.ijwd.2019.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 11/16/2022] Open
Abstract
Background The mechanisms underlying eye-related complications with dupilumab are poorly understood. Objective This study aimed to determine the incidence and characteristics of ocular complications with dupilumab and the prevalence of comorbid allergic contact dermatitis in the same subpopulation. Methods This is a retrospective chart review of 48 patients with atopic dermatitis who received dupilumab. For patients with eye involvement at first follow-up, we discuss the presence of eyelid dermatitis, blepharitis, or conjunctivitis and analyze available patch test findings in patients with ocular complications while treated with dupilumab. Results A total of 14 patients (29.2%) showed eye involvement while on dupilumab, all of whom experienced eye involvement prior to dupilumab. The results of the patch test were most commonly positive for emulsifier/surfactants (42.5%) and fragrances (30.4%). Nine patients experienced improvement with allergen avoidance subsequent to patch testing, and four of nine patients’ conditions cleared almost entirely. This is a non-randomized study in a small cohort of patients. Only 18 patients had their disease confirmed by an ophthalmologist. Conclusion All patients with eye involvement while on dupilumab had a history of eye involvement prior to dupilumab, suggest that dupilumab may encourage rather than cause ocular surface inflammation. Significant improvement after patch testing in nearly half of patients suggests that allergic contact dermatitis contributes to some cases of dupilumab-associated eye complications.
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Affiliation(s)
- Jodie Raffi
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States.,Department of Dermatology, University of California, Irvine, Irvine, CA, United States
| | - Raagini Suresh
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | | | - Nina Botto
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Jenny E Murase
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States.,Department of Dermatology, Palo Alto Foundation Medical Group, Mountain View, CA, United States
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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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Cork MJ, Thaçi D, Eichenfield LF, Arkwright PD, Hultsch T, Davis JD, Zhang Y, Zhu X, Chen Z, Li M, Ardeleanu M, Teper A, Akinlade B, Gadkari A, Eckert L, Kamal MA, Ruddy M, Graham NMH, Pirozzi G, Stahl N, DiCioccio AT, Bansal A. Dupilumab in adolescents with uncontrolled moderate-to-severe atopic dermatitis: results from a phase IIa open-label trial and subsequent phase III open-label extension. Br J Dermatol 2019; 182:85-96. [PMID: 31595499 PMCID: PMC6972638 DOI: 10.1111/bjd.18476] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2019] [Indexed: 12/15/2022]
Abstract
Background Dupilumab (monoclonal antibody inhibiting IL‐4/IL‐13 signalling) is approved for use in adolescents aged ≥ 12 years with inadequately controlled moderate‐to‐severe atopic dermatitis (AD). Dupilumab significantly improved AD signs/symptoms in a 16‐week, randomised, placebo‐controlled phase III trial in adolescents (NCT03054428). Objectives To characterize the pharmacokinetics of dupilumab, and long‐term safety and efficacy in adolescents. Methods This was a global, multicentre, phase IIa, open‐label, ascending‐dose, sequential cohort study with a phase III open‐label extension (OLE) in adolescents with moderate‐to‐severe AD. In the phase IIa study, patients received one dupilumab dose (2 mg kg−1 or 4 mg kg−1) and 8 weeks of pharmacokinetic sampling. Thereafter, patients received the same dose weekly for 4 weeks, with 8‐week safety follow‐up. Patients then enrolled in the OLE, continuing 2 mg kg−1 or 4 mg kg−1 dupilumab weekly. Primary end points were dupilumab concentration–time profile and incidence of treatment‐emergent adverse events (TEAEs). Secondary outcomes included Eczema Area and Severity Index (EASI). Results Forty adolescents received dupilumab in the phase IIa study; 36 enrolled in the OLE. Dupilumab showed nonlinear, target‐mediated pharmacokinetics. Mean ± SD trough dupilumab concentrations in serum at week 48 (OLE) were 74 ± 19 mg L−1 and 161 ± 60 mg L−1 for 2 mg kg−1 and 4 mg kg−1, respectively. Dupilumab was well tolerated over 52 weeks; the most common TEAEs were nasopharyngitis (week 52: 41% [2 mg kg−1], 47% [4 mg kg−1]) and AD exacerbation (29%, 42%). After one dupilumab dose in the phase IIa study, EASI improved from baseline to week 2 [mean ± SD reduction −34% ± 20% (2 mg kg−1) and −51% ± 29% (4 mg kg−1)]. With continuing treatment, EASI scores improved further [week 52: −85% ± 12% (2 mg kg−1) and −84% ± 20% (4 mg kg−1)]. Conclusions In adolescents with moderate‐to‐severe AD, dupilumab's pharmacokinetic profile was similar to that in adults. These 52‐week safety and efficacy data support long‐term use of dupilumab in this patient population. What's already known about this topic? Adolescents with moderate‐to‐severe atopic dermatitis (AD) have high unmet medical need, with significant disease burden and limited treatment options. Dupilumab (monoclonal antibody against interleukin‐4 receptor α) is approved for the treatment of adolescents with moderate‐to‐severe AD who are inadequately responsive to standard of care (U.S.A.) or candidates for systemic therapy (European Union). A 16‐week, randomized, placebo‐controlled phase III trial in adolescents demonstrated significant improvements in AD signs/symptoms with an acceptable safety profile.
What does this study add? These studies demonstrate the long‐term safety and efficacy of dupilumab in adolescents with moderate‐to‐severe AD for up to 52 weeks of treatment, thus extending and reinforcing the findings from the 16‐week dupilumab phase III trial. The data from these studies also support the use of dupilumab in combination with current standard of care (topical corticosteroids), which was not evaluated in the 16‐week phase III monotherapy trial.
Linked Comment: https://doi.org/10.1111/bjd.18627. https://doi.org/10.1111/bjd.18661 available online
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Affiliation(s)
- M J Cork
- The University of Sheffield, Sheffield Children's Hospital, Sheffield, U.K
| | - D Thaçi
- University of Lübeck, Lübeck, Germany
| | - L F Eichenfield
- University of California San Diego, Rady Children's Hospital, San Diego, CA, U.S.A
| | - P D Arkwright
- University of Manchester, Royal Manchester Children's Hospital, Manchester, U.K
| | - T Hultsch
- Sanofi Genzyme, Cambridge, MA, U.S.A
| | - J D Davis
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - Y Zhang
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - X Zhu
- Regeneron Pharmaceuticals, Inc., Basking Ridge, NJ, U.S.A
| | - Z Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - M Li
- Sanofi, Bridgewater, NJ, U.S.A
| | - M Ardeleanu
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - A Teper
- Sanofi, Bridgewater, NJ, U.S.A
| | - B Akinlade
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - A Gadkari
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | | | - M A Kamal
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - M Ruddy
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - N M H Graham
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | | | - N Stahl
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - A T DiCioccio
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - A Bansal
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
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278
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Aszodi N, Thurau S, Seegräber M, de Bruin-Weller M, Wollenberg A. Management der Dupilumab-assoziierten Konjunktivitis beim atopischen Ekzem. J Dtsch Dermatol Ges 2019; 17:488-492. [PMID: 31115977 DOI: 10.1111/ddg.13809_g] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/19/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Nora Aszodi
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, München, Deutschland
| | - Stephan Thurau
- Augenklinik Mathildenstraße, Klinikum der Universität München, München, Deutschland
| | - Marlene Seegräber
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, München, Deutschland.,Städtisches Klinikum München, Thalkirchner Straße, München, Deutschland
| | | | - Andreas Wollenberg
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, München, Deutschland.,Städtisches Klinikum München, Thalkirchner Straße, München, Deutschland
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279
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Maudinet A, Law-Koune S, Duretz C, Lasek A, Modiano P, Tran THC. Ocular Surface Diseases Induced by Dupilumab in Severe Atopic Dermatitis. Ophthalmol Ther 2019; 8:485-490. [PMID: 31230264 PMCID: PMC6692787 DOI: 10.1007/s40123-019-0191-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Indexed: 12/24/2022] Open
Abstract
We report 10 cases of conjunctivitis in atopic dermatitis (AD) patients treated with dupilumab from November 2017 to November 2018 in our institution, who were referred to the ophthalmology department for diagnosis and management of conjunctivitis. We also describe ocular surface findings in these patients before the first injection of dupilumab. During the first 6 months post initiation of dupilumab, incidence of conjunctivitis was 27% (5/18) in patients treated from November 2017 to April 2018 who had not had ocular examination previously. This rate dropped to 12% (3/25) after systematic ophthalmological referral before initiation of dupilumab. Patients who developed conjunctivitis had mean SCORAD score (Scoring Atopic Dermatitis) of 60.4 ± 20 (35-88) and mean EASI score (Eczema Area and Severity Index) of 37 ± 17 (14.6-56). Mean age was 36 years (20-51). Most patients had a long history of AD (> 10 years). Mean delay of ocular surface inflammation was 3.5 months, ranging from 1 to 8 months. One patient had to discontinue dupilumab because of severe follicular conjunctivitis. We observed two clinical patterns of ocular surface diseases: a mild non-specific conjunctivitis with dry eyes, which improved with warm compresses and artificial tears without any recurrence; and a severe dupilumab-induced follicular conjunctivitis without keratitis, which required specific ophthalmological management.
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Affiliation(s)
- Adrien Maudinet
- Ophthalmology Department, Lille Catholic Hospitals, Lille Catholic University, Lille, France
| | - Sandrine Law-Koune
- Ophthalmology Department, Lille Catholic Hospitals, Lille Catholic University, Lille, France
| | - Claire Duretz
- Dermatology Department, Lille Catholic Hospitals, Lille Catholic University, Lille, France
| | - Audrey Lasek
- Dermatology Department, Lille Catholic Hospitals, Lille Catholic University, Lille, France
| | - Philippe Modiano
- Dermatology Department, Lille Catholic Hospitals, Lille Catholic University, Lille, France
| | - Thi Ha Chau Tran
- Ophthalmology Department, Saint-Vincent de Paul Hospital, Boulevard de Belfort, Lille Cedex, France.
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280
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Akinlade B, Guttman‐Yassky E, de Bruin‐Weller M, Simpson E, Blauvelt A, Cork M, Prens E, Asbell P, Akpek E, Corren J, Bachert C, Hirano I, Weyne J, Korotzer A, Chen Z, Hultsch T, Zhu X, Davis J, Mannent L, Hamilton J, Teper A, Staudinger H, Rizova E, Pirozzi G, Graham N, Shumel B, Ardeleanu M, Wollenberg A. Conjunctivitis in dupilumab clinical trials. Br J Dermatol 2019; 181:459-473. [PMID: 30851191 PMCID: PMC6850316 DOI: 10.1111/bjd.17869] [Citation(s) in RCA: 251] [Impact Index Per Article: 50.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Dupilumab blocks the shared receptor component for interleukin (IL)-4 and IL-13. It is approved in the U.S.A. for patients aged ≥ 12 years with moderate-to-severe atopic dermatitis (AD) uncontrolled by topical prescription medicines or who cannot use topical medicines, for patients in Japan whose AD is uncontrolled with existing therapies, for patients with moderate-to-severe AD in Europe who are candidates for systemic therapy and for patients aged ≥ 12 years for maintenance treatment of moderate-to-severe asthma uncontrolled with their current medicines. AD trials have reported increased incidence of conjunctivitis for dupilumab vs. placebo. OBJECTIVES To characterize further the occurrence and risk factors of conjunctivitis in dupilumab clinical trials. METHODS We evaluated randomized placebo-controlled trials of dupilumab in AD (n = 2629), asthma (n = 2876), chronic rhinosinusitis with nasal polyps (CRSwNP) (n = 60) and eosinophilic oesophagitis (EoE) (n = 47). RESULTS In most AD trials, dupilumab-treated patients had higher conjunctivitis incidence than placebo controls. Higher baseline AD severity and previous history of conjunctivitis were associated with increased conjunctivitis incidence. Conjunctivitis was mostly mild to moderate. Most cases recovered or resolved during the treatment period; two patients permanently discontinued dupilumab due to conjunctivitis or keratitis. Common treatments included ophthalmic corticosteroids, antibiotics, and antihistamines or mast cell stabilizers. Most cases were diagnosed by the investigators. In asthma and CRSwNP trials, the incidence of conjunctivitis was lower for both dupilumab and placebo than in AD trials; dupilumab did not increase the incidence compared with placebo. In the EoE trial, no patients had conjunctivitis. CONCLUSIONS Conjunctivitis was more frequent with dupilumab treatment in most AD trials. In dupilumab trials in other type 2 diseases, incidence of conjunctivitis was overall very low, and was similar for dupilumab and placebo. In AD, the incidence of conjunctivitis was associated with AD severity and prior history of conjunctivitis. The aetiology and treatment of conjunctivitis in dupilumab-treated patients require further study. What's already known about this topic? Ocular disorders, including allergic conjunctivitis, are common in patients with atopic dermatitis (AD). In most dupilumab AD trials, dupilumab-treated patients had higher conjunctivitis incidence than those receiving placebo. Most cases were mild to moderate and recovered or were recovering during study treatment; study treatment discontinuation due to conjunctivitis was rare. Conjunctivitis incidence was very low and similar for dupilumab and placebo in clinical trials in asthma, chronic rhinosinusitis with nasal polyps and eosinophilic oesophagitis. What does this study add? This analysis confirms and extends the results of the individual clinical trials. Baseline disease-related factors, including AD severity, prior conjunctivitis history and certain biomarkers (thymus and activation-regulated chemokine, IgE, eosinophils), were associated with increased incidence of conjunctivitis. Patients who responded well to dupilumab had reduced incidence of conjunctivitis. Further study is needed to elucidate the aetiology and treatment of conjunctivitis in dupilumab-treated patients with AD.
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Affiliation(s)
- B. Akinlade
- Regeneron Pharmaceuticals, Inc.TarrytownNYU.S.A.
| | - E. Guttman‐Yassky
- Department of DermatologyIcahn School of Medicine at Mount Sinai Medical CenterNew YorkNYU.S.A.
| | - M. de Bruin‐Weller
- Department of Dermatology & Allergology, University Medical Center UtrechtUtrechtthe Netherlands
| | - E.L. Simpson
- Department of DermatologyOregon Health & Science UniversityPortlandORU.S.A.
| | - A. Blauvelt
- Oregon Medical Research CenterPortlandORU.S.A.
| | - M.J. Cork
- Sheffield Dermatology ResearchDepartment of Infection, Immunity and Cardiovascular DiseaseThe University of Sheffield Medical SchoolSheffieldU.K.
| | - E. Prens
- Department of DermatologyErasmus MCRotterdamthe Netherlands
| | - P. Asbell
- Hamilton Eye InstituteUniversity of Tennessee Health Science CenterMemphisTNU.S.A.
| | - E. Akpek
- Wilmer Eye Institute at Johns Hopkins University School of MedicineBaltimoreMDU.S.A.
| | - J. Corren
- David Geffen School of Medicine at UCLALos AngelesCAU.S.A.
| | - C. Bachert
- ENT DepartmentGhent University HospitalGhentBelgium
- Department of Clinical Science, Intervention and Technology (CLINTEC)Karolinska InstitutetStockholmSweden
| | - I. Hirano
- Northwestern University Feinberg School of MedicineChicagoILU.S.A.
| | - J. Weyne
- Regeneron Pharmaceuticals, Inc.TarrytownNYU.S.A.
| | - A. Korotzer
- Regeneron Pharmaceuticals, Inc.TarrytownNYU.S.A.
| | - Z. Chen
- Regeneron Pharmaceuticals, Inc.TarrytownNYU.S.A.
| | | | - X. Zhu
- Regeneron Pharmaceuticals, Inc.TarrytownNYU.S.A.
| | - J.D. Davis
- Regeneron Pharmaceuticals, Inc.TarrytownNYU.S.A.
| | | | | | | | | | | | | | | | - B. Shumel
- Regeneron Pharmaceuticals, Inc.TarrytownNYU.S.A.
| | - M. Ardeleanu
- Regeneron Pharmaceuticals, Inc.TarrytownNYU.S.A.
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281
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Uchida H, Kamata M, Mizukawa I, Watanabe A, Agematsu A, Nagata M, Fukaya S, Hayashi K, Fukuyasu A, Tanaka T, Ishikawa T, Ohnishi T, Tada Y. Real-world effectiveness and safety of dupilumab for the treatment of atopic dermatitis in Japanese patients: a single-centre retrospective study. Br J Dermatol 2019; 181:1083-1085. [PMID: 31127860 DOI: 10.1111/bjd.18163] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- H Uchida
- Department of Dermatology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - M Kamata
- Department of Dermatology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - I Mizukawa
- Department of Dermatology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - A Watanabe
- Department of Dermatology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - A Agematsu
- Department of Dermatology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - M Nagata
- Department of Dermatology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - S Fukaya
- Department of Dermatology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - K Hayashi
- Department of Dermatology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - A Fukuyasu
- Department of Dermatology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - T Tanaka
- Department of Dermatology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - T Ishikawa
- Department of Dermatology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - T Ohnishi
- Department of Dermatology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Y Tada
- Department of Dermatology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
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282
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Olesen C, Holm J, Nørreslet L, Serup J, Thomsen S, Agner T. Treatment of atopic dermatitis with dupilumab: experience from a tertiary referral centre. J Eur Acad Dermatol Venereol 2019; 33:1562-1568. [DOI: 10.1111/jdv.15609] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/27/2019] [Indexed: 01/01/2023]
Affiliation(s)
- C.M. Olesen
- Department of Dermato‐venereology Bispebjerg Hospital University of Copenhagen Copenhagen Denmark
| | - J.G. Holm
- Department of Dermato‐venereology Bispebjerg Hospital University of Copenhagen Copenhagen Denmark
| | - L.B. Nørreslet
- Department of Dermato‐venereology Bispebjerg Hospital University of Copenhagen Copenhagen Denmark
| | - J.V. Serup
- Department of Dermato‐venereology Bispebjerg Hospital University of Copenhagen Copenhagen Denmark
| | - S.F. Thomsen
- Department of Dermato‐venereology Bispebjerg Hospital University of Copenhagen Copenhagen Denmark
- Department of Biomedical Sciences University of Copenhagen Copenhagen Denmark
| | - T. Agner
- Department of Dermato‐venereology Bispebjerg Hospital University of Copenhagen Copenhagen Denmark
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283
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Deleuran M, Thaçi D, Beck LA, de Bruin-Weller M, Blauvelt A, Forman S, Bissonnette R, Reich K, Soong W, Hussain I, Foley P, Hide M, Bouaziz JD, Gelfand JM, Sher L, Schuttelaar MLA, Wang C, Chen Z, Akinlade B, Gadkari A, Eckert L, Davis JD, Rajadhyaksha M, Staudinger H, Graham NMH, Pirozzi G, Ardeleanu M. Dupilumab shows long-term safety and efficacy in patients with moderate to severe atopic dermatitis enrolled in a phase 3 open-label extension study. J Am Acad Dermatol 2019; 82:377-388. [PMID: 31374300 DOI: 10.1016/j.jaad.2019.07.074] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 07/19/2019] [Accepted: 07/24/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Significant unmet need exists for long-term treatment of moderate to severe atopic dermatitis (AD). OBJECTIVE To assess the long-term safety and efficacy of dupilumab in patients with AD. METHODS This ongoing, multicenter, open-label extension study (NCT01949311) evaluated long-term dupilumab treatment in adults who had previously participated in phase 1 through 3 clinical trials of dupilumab for AD. This analysis examined patients given 300 mg dupilumab weekly for up to 76 weeks at data cutoff (April 2016). Safety was the primary outcome; efficacy was also evaluated. RESULTS Of 1491 enrolled patients (1042.9 patient-years), 92.9% were receiving treatment at cutoff. The safety profile was consistent with previously reported trials (420.4 adverse events/100 patient-years and 8.5 serious adverse events/100 patient-years), with no new safety signals; common adverse events included nasopharyngitis, conjunctivitis, and injection-site reactions. Sustained improvement was seen up to 76 weeks in all efficacy outcomes, including measures of skin inflammation, pruritus, and quality of life. LIMITATIONS Lack of control arm, limited number of patients with 76 weeks or longer of treatment (median follow-up, 24 weeks), and patients not receiving the approved dose regimen of 300 mg every 2 weeks. CONCLUSION The safety and efficacy profile from this study supports the role of dupilumab as continuous long-term treatment for patients with moderate to severe AD.
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Affiliation(s)
| | | | - Lisa A Beck
- University of Rochester Medical Center, Rochester, New York
| | | | | | - Seth Forman
- Forman Dermatology and Skin Cancer Institute, Tampa, Florida
| | | | - Kristian Reich
- Center for Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Skinflammation Center, Hamburg, Germany; Dermatologikum Berlin, Berlin, Germany
| | - Weily Soong
- Alabama Allergy & Asthma Center, Birmingham, Alabama
| | - Iftikhar Hussain
- Vital Prospects Clinical Research Institute, PC, Tulsa, Oklahoma
| | - Peter Foley
- University of Melbourne, Skin & Cancer Foundation, Inc., Carlton, Australia
| | | | | | | | - Lawrence Sher
- Peninsula Research Associates, Rolling Hills Estates, California
| | - Marie L A Schuttelaar
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Chen Wang
- Regeneron Pharmaceuticals, Inc., Basking Ridge, New Jersey
| | - Zhen Chen
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York
| | | | | | | | - John D Davis
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York
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284
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Affiliation(s)
- Hiraku Suga
- Department of Dermatology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shinichi Sato
- Department of Dermatology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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285
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Lázaro-Sastre M, García-Sánchez A, Gómez-Cardeñosa A, Dávila I. Dupilumab in Atopic Dermatitis. CURRENT TREATMENT OPTIONS IN ALLERGY 2019. [DOI: 10.1007/s40521-019-00218-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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286
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Development of conjunctivitis with a conjunctival proliferative lesion in a patient treated with dupilumab for atopic dermatitis. Allergol Int 2019; 68:383-384. [PMID: 30718036 DOI: 10.1016/j.alit.2018.12.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/25/2018] [Accepted: 12/28/2018] [Indexed: 11/22/2022] Open
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Rodrigues MA, Nogueira M, Torres T. Dupilumab for atopic dermatitis: evidence to date. GIORN ITAL DERMAT V 2019; 154:696-713. [PMID: 31210470 DOI: 10.23736/s0392-0488.19.06417-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Atopic dermatitis (AD) is a common chronic, pruritic inflammatory dermatosis. The inflammatory response is characterized by a T helper 2 (Th2) immune response phenotype. EVIDENCE ACQUISITION To assess current available data on dupilumab, the writers of this article did a comprehensive search in different databases, including Medline, EMBASE, SCOPUS, and clinical trial registries. All relevant articles identified were then manually reviewed. Information regarding dupilumab mechanism of action, pharmacokinetics, clinical efficacy, safety, and future trends was then summarized. EVIDENCE SYNTHESIS Topical therapy is the main treatment in mild-to-moderate AD, but many cases of moderate-to-severe require systemic treatments. Dupilumab is the first biologic approved for the treatment of adults with moderate-to-severe AD. It inhibits IL-4 and IL-13 signaling pathways and reduces Th2 response. Clinical trials have demonstrated significantly improved clinical and patient-reported outcomes. The addition of application of topical corticosteroids results in a more significant improvement in signs and symptoms of AD than with use of dupilumab in monotherapy. The vast majority of patients improves under dupilumab, and almost 40% of patients achieve clear or nearly clear skin. In addition to its effectiveness, dupilumab also has a favorable safety profile. Frequent adverse events reported in the clinical trials were mostly mild-to-moderate and included nasopharyngitis, upper respiratory tract infection, injection site reactions, and conjunctivitis. CONCLUSIONS In general, rates of adverse events occurred with similar frequency between the treatment and placebo groups. Conjunctivitis seems to be a dupilumab-specific side effect and so far has only been observed in atopic dermatitis patients (not in asthma or nasal polyposis). There were no major serious safety concerns identified in phase III clinical trials. Trials in the pediatric population are ongoing and are highly awaited.
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Affiliation(s)
- Maria A Rodrigues
- Service of Dermatology, University Hospital of Porto, Porto, Portugal
| | - Miguel Nogueira
- Service of Dermatology, University Hospital of Porto, Porto, Portugal
| | - Tiago Torres
- Service of Dermatology, University Hospital of Porto, Porto, Portugal - .,Abel Salazar Institute of Biomedica Sciences, University of Porto, Porto, Portugal
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288
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Eichenfield LF, Bieber T, Beck LA, Simpson EL, Thaçi D, de Bruin-Weller M, Deleuran M, Silverberg JI, Ferrandiz C, Fölster-Holst R, Chen Z, Graham NMH, Pirozzi G, Akinlade B, Yancopoulos GD, Ardeleanu M. Infections in Dupilumab Clinical Trials in Atopic Dermatitis: A Comprehensive Pooled Analysis. Am J Clin Dermatol 2019; 20:443-456. [PMID: 31066001 PMCID: PMC6533236 DOI: 10.1007/s40257-019-00445-7] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Patients with moderate-to-severe atopic dermatitis (AD) have increased infection risk, including skin infections and systemic infections. Immunomodulators (e.g., anti-tumor necrosis factors, anti-interleukin [anti-IL]-23, anti-IL-17, Janus kinase inhibitors) increase risk of infections. Dupilumab (a monoclonal antibody blocking the shared receptor component for IL-4 and IL-13) is approved for inadequately controlled moderate-to-severe AD and for moderate-to-severe eosinophilic or oral corticosteroid-dependent asthma. OBJECTIVE The aim was to determine the impact of dupilumab on infection rates in patients with moderate-to-severe AD. METHODS This analysis pooled data from seven randomized, placebo-controlled dupilumab trials in adults with moderate-to-severe AD. Exposure-adjusted analyses assessed infection rates. RESULTS Of 2932 patients, 1091 received placebo, 1095 dupilumab 300 mg weekly, and 746 dupilumab 300 mg every 2 weeks. Treatment groups had similar infection rates overall per 100 patient-years (placebo, 155; dupilumab weekly, 150; dupilumab every 2 weeks, 156; dupilumab combined, 152), and similar non-skin infection rates. Serious/severe infections were reduced with dupilumab (risk ratio 0.43; p < 0.05), as were bacterial and other non-herpetic skin infections (risk ratio 0.44; p < 0.001). Although herpesviral infection rates overall were slightly higher with dupilumab than placebo, clinically important herpesviral infections (eczema herpeticum, herpes zoster) were less common with dupilumab (risk ratio 0.31; p < 0.01). Systemic anti-infective medication use was lower with dupilumab. CONCLUSIONS Dupilumab is associated with reduced risk of serious/severe infections and non-herpetic skin infections and does not increase overall infection rates versus placebo in patients with moderate-to-severe AD. CLINICALTRIALS. GOV IDENTIFIERS NCT01548404, NCT02210780, NCT01859988, NCT02277743, NCT02277769, NCT02260986, and NCT02755649.
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MESH Headings
- Adult
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal, Humanized
- Clinical Trials, Phase II as Topic
- Clinical Trials, Phase III as Topic
- Dermatitis, Atopic/complications
- Dermatitis, Atopic/diagnosis
- Dermatitis, Atopic/drug therapy
- Double-Blind Method
- Humans
- Incidence
- Injections, Subcutaneous
- Placebos/administration & dosage
- Placebos/adverse effects
- Randomized Controlled Trials as Topic
- Severity of Illness Index
- Skin Diseases, Infectious/epidemiology
- Skin Diseases, Infectious/etiology
- Skin Diseases, Infectious/prevention & control
- Treatment Outcome
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Affiliation(s)
- Lawrence F Eichenfield
- Departments of Dermatology and Pediatrics, University of California, San Diego, San Diego, CA, 92123, USA.
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, 3020 Children's Way, Mail Code 5092, San Diego, CA, 92123, USA.
| | - Thomas Bieber
- Department of Dermatology and Allergy, Christine Kühne-Center for Allergy Research and Education, University of Bonn, Bonn, Germany
| | - Lisa A Beck
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY, USA
| | - Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - Diamant Thaçi
- Comprehensive Center for Inflammation Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | | | - Mette Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Carlos Ferrandiz
- Servicio de Dermatología, Hospital Universitario Germans Trias i Pujol, Badalona Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | - Zhen Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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289
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Thyssen JP, de Bruin-Weller MS, Paller AS, Leshem YA, Vestergaard C, Deleuran M, Drucker AM, Foelster-Holst R, Traidl-Hoffmann C, Eyerich K, Taieb A, Su JC, Bieber T, Cork MJ, Eichenfield LF, Guttman-Yassky E, Wollenberg A. Conjunctivitis in atopic dermatitis patients with and without dupilumab therapy - international eczema council survey and opinion. J Eur Acad Dermatol Venereol 2019; 33:1224-1231. [PMID: 31056788 PMCID: PMC6619239 DOI: 10.1111/jdv.15608] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/07/2019] [Indexed: 12/25/2022]
Abstract
Background Conjunctivitis is common in patients with atopic dermatitis (AD) in general and a commonly reported adverse event in AD clinical trials with dupilumab. Objective To survey opinions and experience about conjunctivitis occurring in AD, including those during dupilumab treatment in a group of AD experts from the International Eczema Council (IEC). Methods Electronic survey and in‐person discussion of management strategies. Results Forty‐six (53.5%) IEC members from 19 countries responded to the survey. Consensus was reached for several statements regarding diagnostic workup, referral and treatment. IEC members suggest that patients with AD should (i) routinely be asked about ocular complaints or symptoms, (ii) obtain information about the potential for conjunctivitis before starting dupilumab therapy and (iii) if indicated, be treated with dupilumab despite previous or current conjunctivitis. In cases of new‐onset conjunctivitis, there was consensus that dupilumab treatment should be continued when possible, with appropriate referral to an ophthalmologist. Limitations The study relies on expert opinion from dermatologists. Responses from few dermatologists without dupilumab access were not excluded from the survey. Conclusion The IEC recommends that dermatologists address conjunctivitis in patients with AD, especially during treatment with dupilumab.
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Affiliation(s)
- J P Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Hellerup, Denmark.,Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - M S de Bruin-Weller
- National Expertise Center of Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Y A Leshem
- Department of Dermatology, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - C Vestergaard
- Department of Dermatology, Aalborg University Hospital, Aalborg, Denmark
| | - M Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - A M Drucker
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - R Foelster-Holst
- Department of Dermatology, Venereology and Allergy, University Clinics of Schleswig-Holstein, Kiel, Germany
| | - C Traidl-Hoffmann
- Institute of Environmental Medicine, UNIKA-T, Technical University of Munich, Augsburg, Germany.,Research Center for Environmental Health, Helmholtz Zentrum München, Augsburg, Germany.,Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | - K Eyerich
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - A Taieb
- Department of Adult and Pediatric Dermatology, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - J C Su
- Department of Dermatology, Eastern Health, Monash University, Parkville, Vic, Australia.,Department of Pediatrics, MCRI, University of Melbourne, Parkville, Vic, Australia
| | - T Bieber
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany.,Department of Dermatology and Allergy, University of Bonn, Bonn, Germany
| | - M J Cork
- Sheffield Dermatology Research, Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - L F Eichenfield
- Department of Dermatology, San Diego School of Medicine, University of California, San Diego, CA, USA.,Department of Pediatrics, San Diego School of Medicine, University of California, San Diego, CA, USA
| | | | - A Wollenberg
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany.,Klinikum Thalkirchner Straße, München, Germany
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290
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New and emerging therapies for paediatric atopic dermatitis. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:343-353. [DOI: 10.1016/s2352-4642(19)30030-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/16/2019] [Accepted: 01/16/2019] [Indexed: 01/02/2023]
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291
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Ruiz‐Villaverde R, Dominguez‐Cruz J, Armario‐Hita JC, Martinez‐Pilar L, Alcantara‐Luna S, Pereyra‐Rodriguez JJ. Fifty‐two week follow‐up safety and effectiveness results of dupilumab treatment of moderate‐to‐severe atopic dermatitis from a retrospective, multicentric series. Dermatol Ther 2019; 32:e12931. [DOI: 10.1111/dth.12931] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 04/10/2019] [Indexed: 01/01/2023]
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292
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Schmitt J. After the approval of dupilumab for moderate-to-severe atopic dermatitis: what is next on the research agenda? Br J Dermatol 2019; 178:992-993. [PMID: 29785811 DOI: 10.1111/bjd.16505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J Schmitt
- Centre for Evidence-Based Healthcare, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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293
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Silverberg JI, Simpson EL, Ardeleanu M, Thaçi D, Barbarot S, Bagel J, Chen Z, Eckert L, Chao J, Korotzer A, Rizova E, Rossi AB, Lu Y, Graham NMH, Hultsch T, Pirozzi G, Akinlade B. Dupilumab provides important clinical benefits to patients with atopic dermatitis who do not achieve clear or almost clear skin according to the Investigator's Global Assessment: a pooled analysis of data from two phase III trials. Br J Dermatol 2019; 181:80-87. [PMID: 30791102 PMCID: PMC6849829 DOI: 10.1111/bjd.17791] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND In the U.S.A., an Investigator's Global Assessment (IGA) score of ≤ 1 (clear or almost clear skin) has been the standard measure in regulatory outcomes for registration clinical trials in atopic dermatitis (AD), including those supporting the recent approval of dupilumab. OBJECTIVES To evaluate the treatment effect of dupilumab in patients with IGA > 1 at the end of treatment, using other validated outcome measures for AD signs, symptoms and quality of life. METHODS LIBERTY AD SOLO 1 and 2 were two 16-week, randomized, double-blind trials enrolling adult patients with moderate-to-severe AD (IGA ≥ 3) inadequately controlled with topical treatment. We performed a post hoc analysis in patients receiving dupilumab 300 mg every 2 weeks (q2w) or placebo. Outcome measures in patients with IGA > 1 included Eczema Area and Severity Index (EASI), pruritus numerical rating scale (NRS), affected body surface area (BSA), Patient-Oriented Eczema Measure (POEM) and Dermatology Life Quality Index (DLQI). The trials were registered at ClinicalTrials.gov: NCT02277743 and NCT02277769. RESULTS At week 16, 278 of 449 dupilumab q2w-treated patients (median age 36·0 years) and 396 of 443 placebo-treated patients had IGA > 1. Among patients with IGA > 1 at week 16, dupilumab significantly improved several outcome measures compared with placebo: EASI (-48·9% vs. -11·3%, P < 0·001), pruritus NRS (-35·2% vs. -9·1%, P < 0·001), affected BSA (-23·1% vs. -4·5%, P < 0·001), POEM score ≥ 4-point improvement (57·4% vs. 21·0%, P < 0·001) and DLQI score ≥ 4-point improvement (59·3% vs. 24·4%, P < 0·001). CONCLUSIONS In patients with IGA > 1 at week 16, dupilumab induced statistically significant benefits in multiple validated outcome measures compared with placebo. The IGA ≤ 1 end point significantly underestimates clinically relevant dupilumab treatment effects.
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Affiliation(s)
- J I Silverberg
- Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, NMH/Arkes Family Pavilion Suite, 1600, 676 N. Saint Clair, Chicago, IL, 60611, U.S.A
| | - E L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, OR, U.S.A
| | - M Ardeleanu
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - D Thaçi
- University of Lübeck, Lübeck, Germany
| | - S Barbarot
- Service de Dermatologie, Centre Hospitalier Universitaire (CHU) de Nantes, Nantes, France
| | - J Bagel
- Eczema Treatment Center of Central New Jersey, East Windsor, NJ, U.S.A
| | - Z Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | | | - J Chao
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - A Korotzer
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - E Rizova
- Sanofi Genzyme, Cambridge, MA, U.S.A
| | - A B Rossi
- Sanofi Genzyme, Cambridge, MA, U.S.A
| | - Y Lu
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - N M H Graham
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - T Hultsch
- Sanofi Genzyme, Cambridge, MA, U.S.A
| | | | - B Akinlade
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
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294
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Jonstam K, Swanson BN, Mannent LP, Cardell L, Tian N, Wang Y, Zhang D, Fan C, Holtappels G, Hamilton JD, Grabher A, Graham NMH, Pirozzi G, Bachert C. Dupilumab reduces local type 2 pro-inflammatory biomarkers in chronic rhinosinusitis with nasal polyposis. Allergy 2019; 74:743-752. [PMID: 30488542 PMCID: PMC6590149 DOI: 10.1111/all.13685] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 09/20/2018] [Accepted: 10/08/2018] [Indexed: 12/31/2022]
Abstract
Background Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a type 2‐mediated inflammatory disease associated with significant clinical, social, and economic burdens and high unmet therapeutic need. Dupilumab, a fully human monoclonal antibody targeting the interleukin‐4 receptor α (IL‐4Rα) subunit, demonstrated efficacy and acceptable safety in CRSwNP and other type 2 diseases (eg, atopic dermatitis and asthma). We now report the local effects of dupilumab on type 2 inflammatory biomarkers in nasal secretions and nasal polyp tissues of patients with CRSwNP in a randomized, placebo‐controlled, phase 2 trial (NCT01920893). Methods Cytokines, chemokines, and total immunoglobulin E (IgE) levels were measured using immunoassay techniques in nasal secretions and nasal polyp tissue homogenates of CRSwNP patients receiving dupilumab 300 mg or placebo weekly for 16 weeks. Results With dupilumab, type 2 biomarker concentrations decreased in nasal secretions (least squares mean area under the curve from 0 to 16 weeks for the change from baseline) vs placebo for eotaxin‐3 (−30.06 vs −0.86 pg/mL; P = 0.0008) and total IgE (−7.90 vs −1.86 IU/mL; P = 0.022). Dupilumab treatment also decreased type 2 biomarker levels in nasal polyp tissues at Week 16 vs baseline for eosinophilic cationic protein (P = 0.008), eotaxin‐2 (P = 0.008), eotaxin‐3 (P = 0.031), pulmonary and activation‐regulated chemokine (P = 0.016), IgE (P = 0.023), and IL‐13 (P = 0.031). Conclusions Dupilumab treatment reduced multiple biomarkers of type 2 inflammation in nasal secretions and polyp tissues of patients with CRSwNP, demonstrating that antagonism of IL‐4Rα signaling suppresses IL‐4‐/IL‐13‐dependent processes, such as mucosal IgE formation, as well as the expression of chemokines attracting inflammatory cells to the nasal mucosa.
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Affiliation(s)
- Karin Jonstam
- Division of ENT Diseases Department of Clinical Sciences, Intervention and Technology Karolinska Institute Stockholm Sweden
- Department of Ear, Nose and Throat Diseases Karolinska University Hospital Stockholm Sweden
| | | | | | - Lars‐Olaf Cardell
- Division of ENT Diseases Department of Clinical Sciences, Intervention and Technology Karolinska Institute Stockholm Sweden
- Department of Ear, Nose and Throat Diseases Karolinska University Hospital Stockholm Sweden
| | | | | | | | | | | | | | | | | | | | - Claus Bachert
- Division of ENT Diseases Department of Clinical Sciences, Intervention and Technology Karolinska Institute Stockholm Sweden
- Department of Ear, Nose and Throat Diseases Karolinska University Hospital Stockholm Sweden
- Upper Airways Research Laboratory Ghent University Hospital Ghent Belgium
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295
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Tauber M, Apoil PA, Richet C, Laurent J, De Bonnecaze G, Mouchon E, Cassagne M, Marguery MC, Hegazy S, Konstantinou MP, Severino M, Uthurriague C, Giordano-Labadie F, Didier A, Paul C. Effect of dupilumab on atopic manifestations in patients treated for atopic dermatitis in real-life practice. Br J Dermatol 2019; 180:1551-1552. [PMID: 30633329 DOI: 10.1111/bjd.17629] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- M Tauber
- Dermatology and Allergology Department, Larrey Hospital, Toulouse University, Toulouse, France.,INSERM-Paul Sabatier Toulouse University, U1056 UDEAR, Purpan Hospital, Toulouse, France
| | - P A Apoil
- Immunology Department, Rangueil Hospital, Toulouse University, Toulouse, France
| | - C Richet
- Dermatology and Allergology Department, Larrey Hospital, Toulouse University, Toulouse, France
| | | | - G De Bonnecaze
- Ear Nose and Throat Department, Larrey Hospital, Toulouse University, Toulouse, France
| | - E Mouchon
- Ear Nose and Throat Department, Larrey Hospital, Toulouse University, Toulouse, France
| | - M Cassagne
- Ophthalmology Department, Pierre Paul Riquet Hospital, Toulouse University, Toulouse, France
| | - M C Marguery
- Dermatology and Allergology Department, Larrey Hospital, Toulouse University, Toulouse, France
| | - S Hegazy
- Dermatology and Allergology Department, Larrey Hospital, Toulouse University, Toulouse, France
| | - M P Konstantinou
- Dermatology and Allergology Department, Larrey Hospital, Toulouse University, Toulouse, France
| | - M Severino
- Dermatology and Allergology Department, Larrey Hospital, Toulouse University, Toulouse, France
| | - C Uthurriague
- Dermatology and Allergology Department, Larrey Hospital, Toulouse University, Toulouse, France
| | - F Giordano-Labadie
- Dermatology and Allergology Department, Larrey Hospital, Toulouse University, Toulouse, France
| | - A Didier
- Pneumology and Allergology Department, Larrey Hospital, Toulouse University, Toulouse, France
| | - C Paul
- Dermatology and Allergology Department, Larrey Hospital, Toulouse University, Toulouse, France.,INSERM-Paul Sabatier Toulouse University, U1056 UDEAR, Purpan Hospital, Toulouse, France
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296
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Thibodeaux Q, Smith MP, Ly K, Beck K, Liao W, Bhutani T. A review of dupilumab in the treatment of atopic diseases. Hum Vaccin Immunother 2019; 15:2129-2139. [PMID: 30785362 DOI: 10.1080/21645515.2019.1582403] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Dupilumab is a fully human monoclonal IgG4 antibody directed against the alpha subunit of the IL-4 receptor and prevents the signaling of IL-4 and IL-13, two type 2 cytokines known to be important drivers of atopic diseases. In March of 2017, the United States Food and Drug Administration (FDA) approved dupilumab for the treatment of moderate-to-severe atopic dermatitis in adults that is uncontrolled with topical medications, becoming the first biologic agent approved to treat this chronic skin condition. In October of 2018, Dupilumab received approval by the FDA as an add-on maintenance therapy in patients with moderate-to-severe asthma aged 12 years or older with an eosinophilic phenotype or with oral corticosteroid-dependent asthma. This review summarizes the characteristics of dupilumab and the clinical research that has been published to date, including treatment efficacy and adverse events.
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Affiliation(s)
- Quinn Thibodeaux
- Department of Dermatology, University of California, San Francisco , San Francisco , USA
| | - Mary Patricia Smith
- Department of Dermatology, University of California, San Francisco , San Francisco , USA
| | - Karen Ly
- Department of Dermatology, University of California, San Francisco , San Francisco , USA
| | - Kristen Beck
- Department of Dermatology, University of California, San Francisco , San Francisco , USA
| | - Wilson Liao
- Department of Dermatology, University of California, San Francisco , San Francisco , USA
| | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco , San Francisco , USA
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297
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Blauvelt A, Rosmarin D, Bieber T, Simpson E, Bagel J, Worm M, Deleuran M, Katoh N, Kawashima M, Shumel B, Chen Z, Rossi A, Hultsch T, Ardeleanu M. Improvement of atopic dermatitis with dupilumab occurs equally well across different anatomical regions: data from phase III clinical trials. Br J Dermatol 2019; 181:196-197. [PMID: 30719707 PMCID: PMC6850039 DOI: 10.1111/bjd.17703] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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298
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Aszodi N, Thurau S, Seegräber M, Bruin‐Weller M, Wollenberg A. Management of dupilumab‐associated conjunctivitis in atopic dermatitis. J Dtsch Dermatol Ges 2019; 17:488-491. [DOI: 10.1111/ddg.13809] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/19/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Nora Aszodi
- Department of Dermatology and AllergologyUniversity Medical Center Munich Germany
| | - Stephan Thurau
- Department of Ophthalmology at MathildenstraßeUniversity Medical Center Munich Germany
| | - Marlene Seegräber
- Department of Dermatology and AllergologyUniversity Medical Center Munich Germany
- Munich City Medical CenterThalkirchner Straße Munich Germany
| | - Marjolein Bruin‐Weller
- Department of Dermatology and AllergologyUniversity Medical Center Utrecht The Netherlands
| | - Andreas Wollenberg
- Department of Dermatology and AllergologyUniversity Medical Center Munich Germany
- Munich City Medical CenterThalkirchner Straße Munich Germany
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299
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Thaçi D, L Simpson E, Deleuran M, Kataoka Y, Chen Z, Gadkari A, Eckert L, Akinlade B, Graham NMH, Pirozzi G, Ardeleanu M. Efficacy and safety of dupilumab monotherapy in adults with moderate-to-severe atopic dermatitis: a pooled analysis of two phase 3 randomized trials (LIBERTY AD SOLO 1 and LIBERTY AD SOLO 2). J Dermatol Sci 2019; 94:266-275. [PMID: 31109652 DOI: 10.1016/j.jdermsci.2019.02.002] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/07/2019] [Accepted: 02/13/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Two phase 3 trials with identical design, LIBERTY AD SOLO 1 (NCT02277743) and LIBERTY AD SOLO 2 (NCT02277769), confirmed dupilumab efficacy and safety versus placebo in adults with moderate-to-severe atopic dermatitis (AD). OBJECTIVES To report a pooled analysis of these trials to further explore dupilumab's effects on AD clinical parameters, patient-reported outcomes (PROs), symptoms of anxiety/depression, health-related quality of life (HRQoL), and safety. METHODS A pooled analysis of two 16-week phase 3 studies in adults with moderate-to-severe AD (N = 1379) inadequately controlled with/inadvisable for topical medications, randomized to dupilumab 300 mg once weekly (qw), every 2 weeks (q2w), or placebo. RESULTS Dupilumab significantly improved all pre-specified efficacy endpoints versus placebo (P < 0.0001), including clinical severity outcomes and PROs, symptoms of anxiety/depression, and HRQoL, consistent with previously published results. In post-hoc analyses, among patients reporting at least some baseline pain/discomfort on the EuroQoL-5D, no pain/discomfort at Week 16 was reported by 43%/46%/14% of dupilumab qw/q2w/placebo-treated patients (P < 0.0001). The distribution of dupilumab-treated patients within pre-defined score categories on the Investigator's Global Assessment (0-1/2/3/4) and Eczema Area and Severity Index (≥90%/≥75-<90%/≥50-<75%/<50%) steadily and consistently improved over time versus marginal changes with placebo. Dupilumab significantly improved pruritus within 1-3 days of treatment initiation. No new safety signals were observed. Injection-site reactions and conjunctivitis were more common with dupilumab; AD exacerbation and non-herpetic skin infections more frequent with placebo. CONCLUSIONS Dupilumab versus placebo significantly improved objective AD signs, subjective PROs, symptoms of anxiety/depression, and HRQoL, with a favorable benefit-risk profile in adults with moderate-to-severe AD.
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Affiliation(s)
- Diamant Thaçi
- Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany.
| | - Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - Mette Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Yoko Kataoka
- Department of Dermatology, Osaka Habikino Medical Center, Habikino, Osaka, Japan
| | - Zhen Chen
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
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Leshem YA, Bissonnette R, Paul C, Silverberg JI, Irvine AD, Paller AS, Cork MJ, Guttman-Yassky E. Optimization of placebo use in clinical trials with systemic treatments for atopic dermatitis: an International Eczema Council survey-based position statement. J Eur Acad Dermatol Venereol 2019; 33:807-815. [PMID: 30859656 PMCID: PMC6594032 DOI: 10.1111/jdv.15480] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 01/04/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND As novel systemic therapeutics for patients with atopic dermatitis (AD) are developed, ethical and methodological concerns regarding placebo-controlled-trials (PCT) have surfaced. OBJECTIVE To guide the design and implementation of PCT in AD, focusing on trials with systemic medications. METHODS A subgroup of the International Eczema Council (IEC) developed a consensus e-survey, which was disseminated to IEC members. RESULTS The response rate was 43/82 (52%). Consensus was reached on 24/27 statements and on 3/11 options from multiple-selection statements, including: performing monotherapy studies in proof-of-concept phases; avoiding concomitant topical corticosteroids or calcineurin inhibitors until a predefined timepoint as rescue (borderline consensus); selection of sites and assessors with recognized expertise in AD clinical trials; clear definition and identification of baseline disease severity; minimizing time and proportion of patients on placebo; using daily emollients with several options provided; instigating open-label extension studies for enrolment after a predefined timepoint; and including outcomes which set a higher bar for disease clearance. CONCLUSION Conducting PCT in AD requires balancing several, sometimes opposing principles, including ethics, methodology, regulatory requirements and real-world needs. This paper can provide a framework for conducting PCT with systemic medications for patients with AD.
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Affiliation(s)
- Y A Leshem
- Department of Dermatology, Beilinson Hospital, Rabin Medical Center, Petach-Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - C Paul
- Paul Sabatier University, Toulouse, France
| | - J I Silverberg
- Department of Dermatology, Department of Preventive Medicine, and Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - A D Irvine
- Pediatric Dermatology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.,National Children's Research Centre, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.,Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - A S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine and Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - M J Cork
- Sheffield Dermatology Research Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
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