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van der Schaft J, Thijs JL, Garritsen FM, Balak D, de Bruin-Weller MS. Towards personalized treatment in atopic dermatitis. Expert Opin Biol Ther 2019; 19:469-476. [PMID: 30768375 DOI: 10.1080/14712598.2019.1583204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION For many years, oral immunosuppressive drugs such as cyclosporine A, azathioprine, mycophenolic acid, and methotrexate were the only treatment options, in addition to topical treatment, in patients with severe atopic dermatitis (AD). Dupilumab, a monoclonal antibody targeting the IL-4 receptor alpha, is the first antibody-based treatment commercially available for the treatment of AD. In the near future, more antibody-based treatments and small molecules will become available in the treatment of severe AD. AREAS COVERED This review gives an overview of current and future therapies for severe AD, outlines options to optimize treatment with oral immunosuppressive drugs and gives an insight into the future of personalized treatment in AD. EXPERT OPINION Due to the heterogeneous character of AD, it is unlikely that all patients will respond equally to these newly tested drugs. We believe that biomarkers will lead to better identification of patients that will benefit from these highly specific, but expensive new treatments. In addition to a role for biomarkers in new treatments, the use of pharmacogenomic biomarkers can improve the efficacy of currently used oral immunosuppressive drugs in AD, which will still be needed for the treatment of moderate to severe AD in the coming years.
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Affiliation(s)
- Jorien van der Schaft
- a National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Judith L Thijs
- a National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Floor M Garritsen
- a National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - D Balak
- a National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Marjolein S de Bruin-Weller
- a National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology , University Medical Center Utrecht , Utrecht , The Netherlands
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302
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Feasibility Analysis of Interleukin-13 as a Target for a Therapeutic Vaccine. Vaccines (Basel) 2019; 7:vaccines7010020. [PMID: 30759882 PMCID: PMC6466196 DOI: 10.3390/vaccines7010020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/04/2019] [Accepted: 02/07/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The development of therapeutic vaccines requires thorough knowledge of potential hazards associated with long-term inactivation of self-proteins. Among potential targets, interleukin 13 (IL-13) merits consideration, as monoclonal antibodies disrupting IL-13 signaling are proving to be exceedingly effective in common conditions such as atopic dermatitis. OBJECTIVE Given the mass publication of scientific data, an appraisal of safety aspects is challenging. METHODS We here provide a three-fold approach to survey clinically relevant information on off-target effects, both adverse and beneficial, that may potentially be encountered in patients undergoing long-term IL-13 inactivation. First, we review non-clinical data in vivo and in vitro. Second, we summarize safety data accumulating from patients dosed with anti-IL-13 drugs. Third, we exploit human mutation data as well as emerging large-scale genetic datasets (global exome data from 60,000 patients) to obtain information on any association of IL-13-inactivating genetic variants with disease states. In addition, we: (1) dissect the precise efficacy signals obtained with various drugs targeting IL-13 and/or IL-4, and (2) summarize unintended, but potentially beneficial effects of prolonged IL-13 inactivation on several functional systems. RESULTS Prolonged repression of IL-13 in several thousand patients so far has not uncovered any non-redundant functions of IL-13 in immune defense. Furthermore, missense mutations in the key genes IL-13, IL-13Rα1, IL-13Rα2, IL-4, IL-4Rα are common, while no case reports have been published on any immune deficiency or increased risk of neoplastic disease associated with such mutations, suggesting that these genes do not harbor non-redundant roles in adult outbred humans. In terms of efficacy, data from clinically used drugs strongly suggest that targeting IL-13 only, as opposed to IL-13 and IL-4, may be effective in eczema while being more selective. Importantly, several lines of evidence suggest that inhibition of IL-13 may in fact harbor potentially beneficial effects on non-targeted systems, including glucose metabolism, hepatic fibrosis, and atherosclerosis, suggesting that respective outcomes should be systematically captured in patients dosed with IL-13 interfering drugs. Collectively, available evidence suggests that IL-13 may fulfill safety requirements required for the target of a therapeutic vaccine.
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303
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Bakker DS, Ariens LFM, van Luijk C, van der Schaft J, Thijs JL, Schuttelaar MLA, van Wijk F, Knol EF, Balak DMW, van Dijk MR, de Bruin-Weller MS. Goblet cell scarcity and conjunctival inflammation during treatment with dupilumab in patients with atopic dermatitis. Br J Dermatol 2019; 180:1248-1249. [PMID: 30597515 PMCID: PMC6850107 DOI: 10.1111/bjd.17538] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- D S Bakker
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L F M Ariens
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - C van Luijk
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J van der Schaft
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J L Thijs
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M L A Schuttelaar
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - F van Wijk
- Laboratory of Translational Immunology , University Medical Center Utrecht, Utrecht, the Netherlands
| | - E F Knol
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands.,Laboratory of Translational Immunology , University Medical Center Utrecht, Utrecht, the Netherlands
| | - D M W Balak
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M R van Dijk
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M S de Bruin-Weller
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
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304
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Alexander H, Patton T, Jabbar-Lopez ZK, Manca A, Flohr C. Novel systemic therapies in atopic dermatitis: what do we need to fulfil the promise of a treatment revolution? F1000Res 2019; 8. [PMID: 30774935 PMCID: PMC6357995 DOI: 10.12688/f1000research.17039.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2019] [Indexed: 12/26/2022] Open
Abstract
Patients with atopic dermatitis (AD) who do not adequately respond to topical therapy and phototherapy often need systemic immunomodulatory treatment to control their symptoms. Conventional systemic agents, such as ciclosporin, azathioprine, and methotrexate, have been used for decades, but there are concerns about their safety profile. There are now many novel systemic agents emerging through clinical trials, which may have great potential in the treatment of AD. Despite this, there are very few data comparing the performance of these drugs against each other. The purpose of this article is to review the current systemic therapies in AD and present an indirect comparison of systemic AD treatments using effectiveness and safety data from published randomised controlled trials, highlighting important remaining gaps in knowledge. Although the latest developments in systemic AD treatments are exciting and dearly needed, further work is required before the promise of a therapeutic revolution becomes reality.
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Affiliation(s)
- Helen Alexander
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Thomas Patton
- Centre for Health Economics, University of York, York, UK
| | - Zarif K Jabbar-Lopez
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Andrea Manca
- Centre for Health Economics, University of York, York, UK
| | - Carsten Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
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305
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Strategies for Successful Management of Severe Atopic Dermatitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1-16. [DOI: 10.1016/j.jaip.2018.10.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/18/2018] [Accepted: 10/22/2018] [Indexed: 12/21/2022]
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306
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Fabbrocini G, Napolitano M, Megna M, Balato N, Patruno C. Treatment of Atopic Dermatitis with Biologic Drugs. Dermatol Ther (Heidelb) 2018; 8:527-538. [PMID: 30182182 PMCID: PMC6261117 DOI: 10.1007/s13555-018-0258-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Indexed: 12/20/2022] Open
Abstract
Atopic dermatitis (AD) is a chronic, pruritic, inflammatory skin disease which predominately affects children and usually clears up during infancy or childhood. However, AD may persist with a chronic relapsing course until adulthood or develop at a later age. AD treatment can often be complicated. Treating moderate-to-severe AD can be challenging: only a few therapeutic options are available, with cyclosporine being the only approved and labeled systemic drug. In the last few years, advances in the knowledge of AD pathogenesis have been made that can provide the basis for developing new topical and systemic drugs. Among them, biologic drugs targeting specific cytokines involved in the development of the disease will probably revolutionize AD therapy. Currently, dupilumab, a monoclonal antibody that binds to the shared alpha chain subunit of the receptors for IL-4 and IL-13, is the only biologic drug licensed for the treatment of AD in adults. However, other biologic drugs that selectively target some key cytokines in AD pathogenesis (IL-13, IL-31, and IL-22) are also being studied. In this review, we discuss all of the biologic drugs that have been studied for AD treatment.
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Affiliation(s)
| | - Maddalena Napolitano
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Matteo Megna
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - Nicola Balato
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - Cataldo Patruno
- Department of Dermatology, University of Naples Federico II, Naples, Italy.
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307
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308
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Dhadwal G, Albrecht L, Gniadecki R, Poulin Y, Yeung J, Hong CH, Gooderham MJ. Approach to the Assessment and Management of Adult Patients With Atopic Dermatitis: A Consensus Document. Section IV: Treatment Options for the Management of Atopic Dermatitis. J Cutan Med Surg 2018; 22:21S-29S. [DOI: 10.1177/1203475418805721] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The objectives of therapy for atopic dermatitis (AD) are to reduce skin inflammation and pruritus, restore skin barrier function, and improve quality of life (QoL). Treatments can be classified as moisturizing and basic care, topical therapy, phototherapy, and systemic therapy. In this review, we summarize the treatments for AD and recommendations for their use.
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309
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Sobering G, Dika C. Vesicular hand dermatitis. Nurse Pract 2018; 43:33-37. [PMID: 30289789 DOI: 10.1097/01.npr.0000546445.09474.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Vesicular hand dermatitis is a type of eczema involving the fingers, hands, and sometimes the feet. It is common in primary care, requiring prompt treatment to prevent chronicity. The cause is often unknown, making the condition challenging to treat. Management consists of avoiding irritants and using emollients and topical corticosteroids.
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Affiliation(s)
- Geraldine Sobering
- Geraldine Sobering is an NP at Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada. Cheryl Dika is the director of the Nurse Practitioner program at the College of Nursing Rady Faculty of Health Sciences, Helen Glass Centre for Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
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310
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Shen E, Xie K, Jwo K, Smith J, Mosaed S. Dupilumab-Induced Follicular Conjunctivitis. Ocul Immunol Inflamm 2018; 27:1339-1341. [PMID: 30335586 DOI: 10.1080/09273948.2018.1533567] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Elizabeth Shen
- Ophthalmology, Gavin Herbert Eye Institute, UC Irvine Health, Irvine, California, USA
| | - Kate Xie
- Ophthalmology, Gavin Herbert Eye Institute, UC Irvine Health, Irvine, California, USA
| | - Kevin Jwo
- Ophthalmology, Gavin Herbert Eye Institute, UC Irvine Health, Irvine, California, USA
| | | | - Sameh Mosaed
- Ophthalmology, Gavin Herbert Eye Institute, UC Irvine Health, Irvine, California, USA
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311
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Yang EJ, Sekhon S, Sanchez IM, Beck KM, Bhutani T. Recent Developments in Atopic Dermatitis. Pediatrics 2018; 142:peds.2018-1102. [PMID: 30266868 DOI: 10.1542/peds.2018-1102] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2018] [Indexed: 11/24/2022] Open
Abstract
Atopic dermatitis (AD) is a bothersome and common skin disease affecting ∼10.7% of children in the United States. This skin condition significantly decreases quality of life in not only patients, but in their families as well. Pediatricians are often the first physicians to diagnose and manage these patients and thus are relied on by families to answer questions about this disease. AD is complex, multifactorial, and has historically had limited therapeutic options, but the landscape of this disease is now rapidly changing. Pathways contributing to the pathogenesis of this disease are continually being discovered, and new therapies for AD are being developed at an unprecedented rate. With this article, we will review the current guidelines regarding the management of AD, outline updates in the current understanding of its pathophysiology, and highlight novel developments available for the treatment of this burdensome disease.
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Affiliation(s)
- Eric J Yang
- Department of Dermatology, University of California, San Francisco, San Francisco, California; .,Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois; and
| | - Sahil Sekhon
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Isabelle M Sanchez
- Department of Dermatology, University of California, San Francisco, San Francisco, California.,College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Kristen M Beck
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco, San Francisco, California
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312
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Novel systemic drugs in treatment of atopic dermatitis: results from phase II and phase III studies published in 2017/2018. Curr Opin Allergy Clin Immunol 2018; 18:432-437. [DOI: 10.1097/aci.0000000000000477] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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313
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Guttman-Yassky E, Bissonnette R, Ungar B, Suárez-Fariñas M, Ardeleanu M, Esaki H, Suprun M, Estrada Y, Xu H, Peng X, Silverberg JI, Menter A, Krueger JG, Zhang R, Chaudhry U, Swanson B, Graham NMH, Pirozzi G, Yancopoulos GD, D Hamilton JD. Dupilumab progressively improves systemic and cutaneous abnormalities in patients with atopic dermatitis. J Allergy Clin Immunol 2018; 143:155-172. [PMID: 30194992 DOI: 10.1016/j.jaci.2018.08.022] [Citation(s) in RCA: 390] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 07/19/2018] [Accepted: 08/14/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Dupilumab is an IL-4 receptor α mAb inhibiting signaling of IL-4 and IL-13, key drivers of type 2-driven inflammation, as demonstrated by its efficacy in patients with atopic/allergic diseases. OBJECTIVE This placebo-controlled, double-blind trial (NCT01979016) evaluated the efficacy, safety, and effects of dupilumab on molecular/cellular lesional and nonlesional skin phenotypes and systemic type 2 biomarkers of patients with moderate-to-severe atopic dermatitis (AD). METHODS Skin biopsy specimens and blood were evaluated from 54 patients randomized 1:1 to weekly subcutaneous doses of 200 mg of dupilumab or placebo for 16 weeks. RESULTS Dupilumab (vs placebo) significantly improved clinical signs and symptoms of AD, was well tolerated, and progressively shifted the lesional transcriptome toward a nonlesional phenotype (weeks 4-16). Mean improvements in a meta-analysis-derived AD transcriptome (genes differentially expressed between lesional and nonlesional skin) were 68.8% and 110.8% with dupilumab and -10.5% and 55.0% with placebo (weeks 4 and 16, respectively; P < .001). Dupilumab significantly reduced expression of genes involved in type 2 inflammation (IL13, IL31, CCL17, CCL18, and CCL26), epidermal hyperplasia (keratin 16 [K16] and MKi67), T cells, dendritic cells (ICOS, CD11c, and CTLA4), and TH17/TH22 activity (IL17A, IL-22, and S100As) and concurrently increased expression of epidermal differentiation, barrier, and lipid metabolism genes (filaggrin [FLG], loricrin [LOR], claudins, and ELOVL3). Dupilumab reduced lesional epidermal thickness versus placebo (week 4, P = .001; week 16, P = .0002). Improvements in clinical and histologic measures correlated significantly with modulation of gene expression. Dupilumab also significantly suppressed type 2 serum biomarkers, including CCL17, CCL18, periostin, and total and allergen-specific IgEs. CONCLUSION Dupilumab-mediated inhibition of IL-4/IL-13 signaling through IL-4 receptor α blockade significantly and progressively improved disease activity, suppressed cellular/molecular cutaneous markers of inflammation and systemic measures of type 2 inflammation, and reversed AD-associated epidermal abnormalities.
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Affiliation(s)
- Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY; Laboratory for Investigative Dermatology, Rockefeller University, New York, NY.
| | | | - Benjamin Ungar
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY; Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Mayte Suárez-Fariñas
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY; Laboratory for Investigative Dermatology, Rockefeller University, New York, NY; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Hitokazu Esaki
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Maria Suprun
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yeriel Estrada
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hui Xu
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Xiangyu Peng
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jonathan I Silverberg
- Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Alan Menter
- Department of Dermatology, Baylor University Medical Center, Dallas, Tex
| | - James G Krueger
- Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Rick Zhang
- Regeneron Pharmaceuticals, Tarrytown, NY
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314
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Kaufman BP, Alexis AF. Biologics and Small Molecule Agents in Allergic and Immunologic Skin Diseases. Curr Allergy Asthma Rep 2018; 18:55. [PMID: 30171358 DOI: 10.1007/s11882-018-0804-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW Biologics and small molecules are key therapeutic options in the treatment of chronic immunologic and allergic skin conditions. By directly targeting innate and inflammatory responses within the skin, including pro-inflammatory cytokines and cellular signaling pathways, these new agents have the potential to counteract the inflammatory cascade responsible for various conditions, including psoriasis and atopic dermatitis. Over the past decade, groundbreaking research identifying key cytokines and receptors involved in the pathogenesis of these diseases has allowed for the development of highly efficacious biologics and small molecules that are associated with unprecedented rates of skin clearance and favorable adverse event profiles. RECENT FINDINGS This narrative review evaluates new and upcoming biologic and small molecule agents for the treatment of two allergic/immunologic skin diseases-atopic dermatitis and psoriasis. Numerous small molecules and biologics targeting TNF-α, IL-12/23, IL-17 and IL-17R, and IL-23 are commercially available for the treatment of psoriasis, and newer agents are in various stages of development. Currently, dupilumab, a monoclonal antibody that blocks IL-4R∝, is the only approved biologic for atopic dermatitis. Antibodies targeting IL-13 and IL-31 and small molecules that inhibit Janus kinase and pruritus-mediating receptors are currently being studied in clinical trials. Further investigations into the pathophysiology of atopic dermatitis will likely yield additional therapeutic options in the future. This article reviews recent literature on small molecules and biologics for the treatment of atopic dermatitis and psoriasis.
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Affiliation(s)
- Bridget P Kaufman
- Mount Sinai St. Luke's and West, 1090 Amsterdam Avenue, Suite 11B, New York, NY, 10029, USA.
| | - Andrew F Alexis
- Mount Sinai St. Luke's and West, 1090 Amsterdam Avenue, Suite 11B, New York, NY, 10029, USA
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315
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Napolitano M, Marasca C, Fabbrocini G, Patruno C. Adult atopic dermatitis: new and emerging therapies. Expert Rev Clin Pharmacol 2018; 11:867-878. [PMID: 30073901 DOI: 10.1080/17512433.2018.1507734] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Adult atopic dermatitis (AD) is very difficult to manage. Indeed, AD in adults is frequently refractory to topical treatment, especially with regards to the persistent form. Therefore, long-term treatment with oral immunosuppressive therapy is often required to control the burden of the disease, prevent flare-ups and achieve better patient quality of life outcomes. Areas covered: In the last decade the better understanding of AD pathogenesis has been used to improve treatment strategies with many emerging therapeutics options. Epidermal barrier impairment often plays the initial role in the initiation of the disease. Moreover, T helper 2 cytokines interleukin (IL)-4 and IL-13 and their downstream effects are prominent in AD, with pleiotropic effects on the innate and adaptive immune system. Targeting these cells, their products or receptors appears to be a reasonable therapeutic strategy. Expert commentary: In the next years, many therapeutic options for adult AD will be available. Clinical trials showed that JAK inhibitors, PDE-4 inhibitors and monoclonal antibodies against some IL (IL-4, IL 13, IL-17, IL-22, IL-31) seem to be the most promising drugs, but dermatologists will have to evaluate their effectiveness and safety in clinical practice.
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Affiliation(s)
- Maddalena Napolitano
- a Department of Medicine and Health Sciences Vincenzo Tiberio , University of Molise , Campobasso , Italy
| | - Claudio Marasca
- b Section of Dermatology, Department of Clinical Medicine and Surgery , University of Naples Federico II , Naples , Italy
| | - Gabriella Fabbrocini
- b Section of Dermatology, Department of Clinical Medicine and Surgery , University of Naples Federico II , Naples , Italy
| | - Cataldo Patruno
- b Section of Dermatology, Department of Clinical Medicine and Surgery , University of Naples Federico II , Naples , Italy
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316
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Blauvelt A, Simpson EL, Tyring SK, Purcell LA, Shumel B, Petro CD, Akinlade B, Gadkari A, Eckert L, Graham NMH, Pirozzi G, Evans R. Dupilumab does not affect correlates of vaccine-induced immunity: A randomized, placebo-controlled trial in adults with moderate-to-severe atopic dermatitis. J Am Acad Dermatol 2018; 80:158-167.e1. [PMID: 30092324 DOI: 10.1016/j.jaad.2018.07.048] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/20/2018] [Accepted: 07/14/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The impact of dupilumab, an anti-interleukin (IL) 4 receptor α antibody that inhibits IL-4 and IL-13 signaling, on vaccine responses of patients with atopic dermatitis (AD) is unknown. OBJECTIVES To assess T-cell-dependent and T-cell-independent humoral immune responses to tetanus and meningococcal vaccines, IgE seroconversion to tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination, and dupilumab efficacy and safety. METHODS In a randomized, double-blinded, placebo-controlled study (NCT02210780), adults with moderate-to-severe AD received dupilumab (300 mg) or placebo weekly for 16 weeks, and single doses of Tdap and quadrivalent meningococcal polysaccharide vaccines at week 12. Primary endpoint was proportion of patients achieving satisfactory IgG response to tetanus toxoid at week 16. RESULTS In total, 178 patients completed the study. Similar positive immune responses (≥4-fold increase in antibody titer, or an antibody titer of ≥8) were achieved in the dupilumab and placebo groups to tetanus (83.3% and 83.7%, respectively) and meningococcal polysaccharide (86.7% and 87.0%, respectively). Dupilumab significantly decreased total serum IgE; most dupilumab-treated patients were Tdap-IgE seronegative at week 32 (62.2% dupilumab and 34.8% placebo). Dupilumab improved key AD efficacy endpoints (P < .001). Injection-site reactions and conjunctivitis were more common with dupilumab; AD exacerbations more frequent with placebo. LIMITATION Patients' prior vaccination status was not available before enrollment. CONCLUSION Dupilumab did not affect responses to the vaccines studied, significantly decreased IgE, and improved measures of AD severity versus placebo, with an acceptable safety profile.
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Affiliation(s)
| | - Eric L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Stephen K Tyring
- Center for Clinical Studies and Department of Dermatology, University of Texas Health Science Center at Houston, Houston, Texas
| | | | - Brad Shumel
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | | | | | | | | | | | | | - Robert Evans
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
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317
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Abstract
Dupilumab (Dupixent®), a subcutaneously administered, fully human IgG4 monoclonal antibody directed against the IL (interleukin)-4 receptor α subunit, blocks the signalling of IL-4 and IL-13, two T helper cell type 2 cytokines implicated in the immunopathology of atopic dermatitis (AD). It is the first biologic therapy to have been approved for the treatment of adult patients with moderate-to-severe AD in the EU and USA. In phase III trials in adults with moderate-to-severe AD who were inadequately controlled with topical medications and/or systemic treatments, such as ciclosporin, or for whom these therapies were not advisable, 16 weeks' treatment with dupilumab as monotherapy or in combination with topical corticosteroids (TCS) improved multiple measures of disease severity, pruritus, sleep disturbance, anxiety and depression, and quality of life compared with placebo. Moreover, the benefits of combination therapy at week 16 were maintained during long-term treatment for up to 1 year. Dupilumab, alone or added to TCS, was generally well tolerated, with low rates of serious adverse events and treatment discontinuations due to adverse events. Common adverse reactions included conjunctivitis, injection-site reactions and oral herpes. Thus, dupilumab represents a valuable new treatment option for adults with moderate-to-severe AD deemed appropriate for systemic therapy, a patient population for whom historically there has been a lack of safe and effective long-term treatments.
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Affiliation(s)
- James E Frampton
- Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
| | - Hannah A Blair
- Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand
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318
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Velter C. Les études clés du dupilumab. Ann Dermatol Venereol 2018; 145:532-538. [DOI: 10.1016/j.annder.2018.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/26/2018] [Accepted: 06/19/2018] [Indexed: 10/28/2022]
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319
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Schmutz JL. [Risk of conjunctivitis associated with dupilumab (Dupixent ®)]. Ann Dermatol Venereol 2018; 145:556-558. [PMID: 29941153 DOI: 10.1016/j.annder.2018.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- J-L Schmutz
- Département de dermatologie et allergologie, hôpital de Brabois, CHRU, bâtiment des spécialités médicales Philippe-Canton, rue du Morvan, 54511 Vandoeuvre-lès-Nancy, France.
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320
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Ariëns LFM, Bakker DS, van der Schaft J, Garritsen FM, Thijs JL, de Bruin-Weller MS. Dupilumab in atopic dermatitis: rationale, latest evidence and place in therapy. Ther Adv Chronic Dis 2018; 9:159-170. [PMID: 30181845 DOI: 10.1177/2040622318773686] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/23/2018] [Indexed: 01/26/2023] Open
Abstract
Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases. The prevalence of AD is increasing and is currently estimated at 10-20% in adults worldwide. In the majority of patients, AD can be adequately controlled with topical treatment or ultraviolet light therapy, but there is a high unmet need for effective and safe therapeutics in patients with more severe or difficult to treat AD. During the past decade, new advances in the understanding of the underlying immune pathogenesis of AD have led to the development of new, more targeted therapies. Dupilumab, a fully human monoclonal antibody targeting the interleukin (IL)-4 receptor α, thereby blocking the IL-4 and IL-13 pathway, is one of the first biologics that has been developed for AD. Dupilumab has shown promising results in phase III trials and has recently been approved by the US Food and Drug Administration and the European Commission for the treatment of moderate to severe AD. With the approval of dupilumab, we are entering a new era of biological therapeutics in AD management. The place of dupilumab should be established in the current treatment standards. Based on current treatment guidelines and experts' opinions in the management of AD, we have built a proposal for a treatment algorithm for systemic treatment of AD in European countries.
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Affiliation(s)
- Lieneke F M Ariëns
- Department of Dermatology and Allergology, University Medical Center Utrecht, Room G02.124, 3508 GA Utrecht, The Netherlands
| | - Daphne S Bakker
- Department of Dermatology and Allergology, University Medical Center Utrecht, The Netherlands
| | - Jorien van der Schaft
- Department of Dermatology and Allergology, University Medical Center Utrecht, The Netherlands
| | - Floor M Garritsen
- Department of Dermatology and Allergology, University Medical Center Utrecht, The Netherlands
| | - Judith L Thijs
- Department of Dermatology and Allergology, University Medical Center Utrecht, The Netherlands
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321
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Seegräber M, Srour J, Walter A, Knop M, Wollenberg A. Dupilumab for treatment of atopic dermatitis. Expert Rev Clin Pharmacol 2018; 11:467-474. [DOI: 10.1080/17512433.2018.1449642] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Marlene Seegräber
- Derpartment of Dermatology and Allergy, Ludwig-Maximilian-University, Munich, Germany
| | - Jerome Srour
- Derpartment of Dermatology and Allergy, Ludwig-Maximilian-University, Munich, Germany
| | - Alexandra Walter
- Derpartment of Dermatology and Allergy, Ludwig-Maximilian-University, Munich, Germany
| | - Macarena Knop
- Derpartment of Dermatology and Allergy, Ludwig-Maximilian-University, Munich, Germany
| | - Andreas Wollenberg
- Derpartment of Dermatology and Allergy, Ludwig-Maximilian-University, Munich, Germany
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322
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Thyssen J. Could conjunctivitis in patients with atopic dermatitis treated with dupilumab be caused by colonization with Demodex
and increased interleukin-17 levels? Br J Dermatol 2018; 178:1220. [DOI: 10.1111/bjd.16330] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- J.P. Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital; University of Copenhagen; Hellerup Denmark
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323
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▼Dupilumab for atopic dermatitis. Drug Ther Bull 2018; 56:30-33. [PMID: 29545264 DOI: 10.1136/dtb.2018.3.0599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
▼Dupilumab (Dupixent - Sanofi-Aventis Groupe), a monoclonal antibody for the treatment of moderate-to-severe atopic dermatitis in adults who require systemic therapy, was licensed by the European Medicines Agency in September 2017. It is the first biological drug approved specifically for this condition. Here, we review the evidence for its efficacy and safety and consider its place in therapy.
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324
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Wollenberg A, Ariens L, Thurau S, van Luijk C, Seegräber M, de Bruin-Weller M. Conjunctivitis occurring in atopic dermatitis patients treated with dupilumab-clinical characteristics and treatment. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1778-1780.e1. [PMID: 29432961 DOI: 10.1016/j.jaip.2018.01.034] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/20/2017] [Accepted: 01/16/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Andreas Wollenberg
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany.
| | - Lieneke Ariens
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stephan Thurau
- Department of Ophthalmology, Ludwig-Maximilian University, Munich, Germany
| | - Chantal van Luijk
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marlene Seegräber
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
| | - Marjolein de Bruin-Weller
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
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