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Zhang J, Boesjes CM, Loman L, Kamphuis E, Romeijn MLE, Spekhorst LS, Haeck I, van der Gang LF, Dekkers CC, van der Rijst LP, Oosting AJ, van Lumig P, van Lynden-van Nes AMT, Tupker RA, Nijssen A, Flinterman A, Politiek K, Touwslager WRH, Christoffers WA, Stewart SM, Kamsteeg M, de Graaf M, de Bruin-Weller MS, Schuttelaar MLA. Dupilumab provides sustained effectiveness on patient-reported outcomes and favorable safety in patients with moderate-to-severe atopic dermatitis: Up to 5-year results from the daily practice BioDay registry. J Am Acad Dermatol 2024; 91:300-311. [PMID: 38653344 DOI: 10.1016/j.jaad.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 03/08/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Long-term daily practice data on patient-reported benefits of dupilumab for atopic dermatitis (AD) remains limited. OBJECTIVE To evaluate patient-reported outcome measures (PROMs) and the safety of dupilumab in patients with moderate-to-severe AD over a follow-up period of up to 5 years. METHODS Data were extracted from the prospective, multicenter BioDay registry (October 2017-2022) of patients with moderate-to-severe AD treated with dupilumab in daily practice. RESULTS In total 1223 patients, 1108 adults and 115 pediatric patients were included. After ≥1 year of treatment, mean Patient-Oriented Eczema Measure (POEM), Dermatology Life Quality Index (DLQI), Numeric rating scale (NRS)-pruritus ranged between 7.8 and 8.7, 3.5 and 4.2, and 2.9 and 3.1 in adults, respectively, whilst these patient-reported outcome measures (PROMs) ranged between 8.9 and 10.9, 4.4 and 6.4, and 3.0 and 3.7 in pediatric patients, respectively. At follow-up, overall work impairment decreased from 40.1% to 16.3% to 13.3% in adults. Furthermore, class I obesity and itch-dominant patients generally had less favorable treatment response. Of all patients, 66.8% reported ≥1 adverse event, with conjunctivitis being the most common (33.7%). LIMITATIONS The overall percentage of missing values for selected PROMs was 26% in adults and 46% in pediatric patients. CONCLUSION In addition to favorable safety, dupilumab has demonstrated sustained effectiveness across various PROMs, underscoring the treatment benefits from patients' perspectives.
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Affiliation(s)
- Junfen Zhang
- Department of Dermatology, University Medical Center Groningen, Groningen, The Netherlands
| | - Celeste M Boesjes
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Laura Loman
- Department of Dermatology, University Medical Center Groningen, Groningen, The Netherlands
| | - Esmé Kamphuis
- Department of Dermatology, University Medical Center Groningen, Groningen, The Netherlands
| | - Margreet L E Romeijn
- Department of Dermatology, University Medical Center Groningen, Groningen, The Netherlands
| | - Lotte S Spekhorst
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Inge Haeck
- Department of Dermatology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Lian F van der Gang
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Coco C Dekkers
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lisa P van der Rijst
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Albert J Oosting
- Department of Dermatology, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Paula van Lumig
- Department of Dermatology, University Medical Center Maastricht, Maastricht, The Netherlands
| | | | - Ron A Tupker
- Department of Dermatology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Annieke Nijssen
- Department of Dermatology, Haga Hospital, Den Haag, The Netherlands
| | | | - Klaziena Politiek
- Department of Dermatology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | | | | | - Shiarra M Stewart
- Department of Dermatology, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - Marijke Kamsteeg
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marlies de Graaf
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marjolein 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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Reguiai Z, Becherel PA, Perrot JL, Boulard C, Fougerousse AC, Begon E, Badaoui A, Poreaux C, Parier J, Liegeon AL, Levavasseur M, Bing AC, Estève E, Maccari F. Evolution of dupilumab-associated conjunctivitis in patients with atopic dermatitis after switching dupilumab to tralokinumab or Janus kinase inhibitors (RESO-ADOC study). J Eur Acad Dermatol Venereol 2024. [PMID: 39015045 DOI: 10.1111/jdv.20233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/24/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Clinical trials and real-life data have reported an increased incidence of conjunctivitis in patients treated with dupilumab for their atopic dermatitis (AD). Although mostly mild in severity, in some cases conjunctivitis will appear or increase after dupilumab initiation, which can lead to dupilumab discontinuation. OBJECTIVES (1) To describe the characteristics of patients developing conjunctivitis requiring discontinuation of dupilumab; and (2) to analyse the factors associated with a complete conjunctivitis improvement after dupilumab discontinuation and a switch to tralokinumab or Janus kinase inhibitors. METHODS This was a multicentre retrospective cohort study that included all patients with AD treated with dupilumab who developed conjunctivitis leading to dupilumab discontinuation and switching to tralokinumab or Janus kinase inhibitors in daily practice. Data on patients, their AD and conjunctivitis were analysed at the inclusion visit (corresponding to discontinuation of dupilumab and the institution of new AD treatment), at visit 2 (3-6 months after inclusion) and at visit 3 (corresponding to the last medical visit). RESULTS After multivariate analysis, the only factors associated with a complete resolution of dupilumab-associated conjunctivitis at visit 2 and/or visit 3 were conjunctivitis duration (OR 8.98, 95% CI 1.47-55) (p = 0.018), personal history of asthma (OR 10.66, 95% CI 1.82-62.63) (p = 0.009) and switching from dupilumab to Janus kinase inhibitors (OR 17.11, 95% CI 2.94-99.66) (p = 0.002). CONCLUSIONS Although uncommon, severe dupilumab-associated conjunctivitis is more frequent in daily life compared to its incidence in the dupilumab pivotal trials. In these cases, our study suggests that a rapid switch to another molecule, particularly a Janus kinase inhibitor, should be considered.
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Affiliation(s)
- Ziad Reguiai
- Department of Dermatology, Polyclinique Courlancy, Reims-Bezannes, France
| | | | | | | | | | | | | | | | | | | | | | | | | | - François Maccari
- Hôpital d'Instruction Des Armées Begin, Saint Mandé, France
- Cabinet Médical, Saint-Maur-des-Fossés, France
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3
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Fritz B, Halling AS, Cort IDP, Christensen MO, Rønnstad ATM, Olesen CM, Knudgaard MH, Zachariae C, Heegaard S, Thyssen JP, Bjarnsholt T. RNA-sequencing of paired tape-strips and skin biopsies in atopic dermatitis reveals key differences. Allergy 2024; 79:1548-1559. [PMID: 38477552 DOI: 10.1111/all.16086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/30/2024] [Accepted: 02/18/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Skin tape-strips and biopsies are widely used methods for investigating the skin in atopic dermatitis (AD). Biopsies are more commonly used but can cause scarring and pain, whereas tape-strips are noninvasive but sample less tissue. The study evaluated the performance of skin tape-strips and biopsies for studying AD. METHODS Whole-transcriptome RNA-sequencing was performed on paired tape-strips and biopsies collected from lesional and non-lesional skin from AD patients (n = 7) and non-AD controls (n = 5). RNA yield, mapping efficiency, and differentially expressed genes (DEGs) for the two methods (tape-strip/biopsy) and presence of AD (AD/non-AD) were compared. RESULTS Tape-strips demonstrated a lower RNA yield (22 vs. 4596 ng) and mapping efficiency to known genes (28% vs. 93%) than biopsies. Gene-expression profiles of paired tape-strips and biopsies demonstrated a medium correlation (R2 = 0.431). Tape-strips and biopsies demonstrated systematic differences in measured expression levels of 6483 genes across both AD and non-AD samples. Tape-strips preferentially detected many itch (CCL3/CCL4/OSM) and immune-response (CXCL8/IL4/IL5/IL22) genes as well as markers of epidermal dendritic cells (CD1a/CD207), while certain cytokines (IL18/IL37), skin-barrier genes (KRT2/FLG2), and dermal fibroblasts markers (COL1A/COL3A) were preferentially detected by biopsies. Tape-strips identified more DEGs between AD and non-AD (3157 DEGs) then biopsies (44 DEGs). Tape-strips also detected higher levels of bacterial mRNA than biopsies. CONCLUSIONS This study concludes that tape-strips and biopsies each demonstrate respective advantages for measuring gene-expression changes in AD. Thus, the specific skin layers and genes of interest should be considered before selecting either method.
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Affiliation(s)
- Blaine Fritz
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen N, Denmark
| | | | - Isabel Díaz-Pinés Cort
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen N, Denmark
| | | | | | | | | | - Claus Zachariae
- Department of Allergy, Skin, and Venereology, Gentofte Hospital, Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
| | - Steffen Heegaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
| | - Jacob P Thyssen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen NV, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
| | - Thomas Bjarnsholt
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen N, Denmark
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen N, Denmark
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4
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Deng S, Wang H, Chen Q, Chen X, Song X, Chen S, Kong M, Song Z. Long-term, observational, real-world study of dupilumab for the treatment of moderate-to-severe atopic dermatitis: a 52-week single-center retrospective analysis in China. Arch Dermatol Res 2024; 316:304. [PMID: 38819652 DOI: 10.1007/s00403-024-03029-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 04/09/2024] [Accepted: 04/26/2024] [Indexed: 06/01/2024]
Abstract
For dupilumab, real-world long-term follow-up data remain scarce, and studies on optimized treatment modes as well as drug survival rate and its predictors are lacking. To explore the effectiveness of different treatment modes of dupilumab and to understand the drug survival rates of dupilumab in China and its predictive factors. This retrospective study included patients with moderate-to-severe AD who received dupilumab treatment. Their clinical data were collected and analyzed. Compared with baseline, the SCORing Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI), numerical rating scale (NRS), and Atopic Dermatitis Control Tool (ADCT) scores significantly decreased at 12, 24, and 52 weeks (p < 0.0001), and the continuous medication group had more significant improvements in SCORAD, EASI, NRS, and ADCT scores at 52 weeks than the noncontinuous medication group (p < 0.05). The 6-month and 1-year drug survival rates of dupilumab were 59.7% and 51.9%, respectively. The most common reason for treatment discontinuation was the satisfactory control of AD. Patients with adult-onset AD (adjusted odds ratio [OR]: 0.15, 95% confidence interval [CI]: 0.03-0.73) , not complicated by other systemic diseases (adjusted OR: 0.17, 95% CI: 0.04-0.84) and eosinophilia at baseline (adjusted OR: 3.71, 95% CI: 1.12-12.26) had a higher probability of drug discontinuation. In real-world practice in China, dupilumab has exhibited good long-term effectiveness and safety for the treatment of moderate-to-severe AD, and continuous administration can benefit patients in the long term.
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Affiliation(s)
- Sisi Deng
- Department of Dermatology, Southwest Hospital, Army Medical University, No.30, Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Huan Wang
- Department of Dermatology, Southwest Hospital, Army Medical University, No.30, Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Qiquan Chen
- Department of Dermatology, Southwest Hospital, Army Medical University, No.30, Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Xueqin Chen
- Department of Dermatology, Southwest Hospital, Army Medical University, No.30, Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Xiao Song
- Department of Dermatology, Southwest Hospital, Army Medical University, No.30, Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Shuguang Chen
- Department of Dermatology, Southwest Hospital, Army Medical University, No.30, Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Minmin Kong
- Department of Dermatology, Southwest Hospital, Army Medical University, No.30, Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Zhiqiang Song
- Department of Dermatology, Southwest Hospital, Army Medical University, No.30, Gaotanyan Street, Shapingba District, Chongqing, 400038, China.
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5
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Park CO, Kim SM, Lee KH, Bieber T. Biomarkers for phenotype-endotype relationship in atopic dermatitis: a critical review. EBioMedicine 2024; 103:105121. [PMID: 38614010 PMCID: PMC11021839 DOI: 10.1016/j.ebiom.2024.105121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 04/15/2024] Open
Abstract
Atopic dermatitis (AD) is the most common form of chronic skin inflammation with diverse clinical variants. Historically, various AD phenotypes have been grouped together without considering their heterogeneity. This approach has resulted in a lack of phenotype- and endotype-adapted therapeutic strategies. Comprehensive insights into AD pathogenesis have enabled precise medicinal approach for AD. These efforts aimed to redefine the endophenotype of AD and develop various biomarkers for diverse purposes. Among these endeavours, efforts are underway to elucidate the mechanisms (and related biomarkers) that lead to the emergence and progression of atopic diseases originating from AD (e.g., atopic march). This review focuses on diverse AD phenotypes and calls for a definition of endophenotypes. While awaiting scientific validation, these biomarkers ensure predicting disease onset and trajectory and tailoring therapeutic strategies for the future.
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Affiliation(s)
- Chang Ook Park
- Department of Dermatology & Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
| | - Su Min Kim
- Department of Dermatology & Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Kwang Hoon Lee
- Department of Dermatology & Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Thomas Bieber
- Christine Kühne-Center of Allergy Research and Education, Medicine Campus, Davos, Switzerland
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Melé-Ninot G, Curto-Barredo L, Bonfill-Ortí M, Expósito-Serrano V, Munera-Campos M, Figueras Nart I, Riquelme-Mc Loughlin C, Gómez-Armayones S, Spertino J, Serra-Baldrich E. Assessment of potential predictive factors of dupilumab response in patients with moderate-to-severe atopic dermatitis. Australas J Dermatol 2024; 65:153-162. [PMID: 38058123 DOI: 10.1111/ajd.14196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/01/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Dupilumab has shown to be an effective and safe treatment for patients with moderate-to-severe atopic dermatitis (AD). OBJECTIVE To evaluate the predictive factors of response (PRF) in patients with moderate-to-severe AD treated with dupilumab. METHODS Observational, retrospective and multicentre study conducted on adult patients diagnosed with moderate-to-severe AD treated with dupilumab, with a post-treatment follow-up of at least 16 weeks. The primary endpoints were EASI-75 and the IGA scale at week 52. RESULTS A total of 198 patients were included in the analysis. Mean age was 38 ± 15.1 years and 116 (58.6%) were men. The most prevalent AD-predominant phenotypes were flexural eczema (45.3%), head-and-neck eczema (18.2%) and erythroderma (17.7%). At week 52, 140 (86.4%) patients achieved EASI-75 and 119 (93.0%) achieved an improvement in ≥2 points from baseline in IGA score. Women were 3.6 times more likely to achieve EASI-75 response than men (Odds ratio: 3.58; p = 0.020). While increased body mass index significantly reduced the probability of obtaining an improvement of ≥2 points in the IGA scale at week 52 (odds ratio: 0.88; p = 0.049). CONCLUSIONS Dupilumab was an effective treatment in patients with moderate-to-severe AD. Additionally, sex and body mass index were significantly associated with achieving EASI-75 and an improvement of ≥2 points in the IGA scale, respectively, at week 52.
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Affiliation(s)
- Gemma Melé-Ninot
- Dermatology Department, Hospital Universitari Sagrat Cor, Grupo Quirónsalud, Barcelona, Spain
| | - Laia Curto-Barredo
- Dermatology Department, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
| | | | | | - Mónica Munera-Campos
- Dermatology Department, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Germans Trias i Pujol Research Institute (IGTP), Barcelona, Spain
| | - Ignasi Figueras Nart
- Dermatology Department, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
| | | | | | - Jorge Spertino
- Dermatology Department, Hospital de la Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | - Esther Serra-Baldrich
- Dermatology Department, Hospital de la Santa Creu i Sant Pau Hospital, Barcelona, Spain
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Sakurai E, Kamata M, Uchida H, Okada Y, Suzuki S, Takeshima R, Ito M, Watanabe A, Mizukawa I, Egawa S, Chijiwa C, Hiura A, Fukaya S, Hayashi K, Fukuyasu A, Tanaka T, Ishikawa T, Tada Y. Impact of 1-year treatment with dupilumab on work productivity in Japanese patients with atopic dermatitis. Exp Dermatol 2024; 33:e15022. [PMID: 38414066 DOI: 10.1111/exd.15022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/10/2024] [Accepted: 01/14/2024] [Indexed: 02/29/2024]
Abstract
Atopic dermatitis (AD) places a burden on work productivity. Recently, dupilumab was approved for AD, but its impact on work productivity in Japanese patients has not been reported. Furthermore, data on the effect of long-term treatment with dupilumab on work productivity are limited. We investigated the work productivity and activity in Japanese patients with moderate-to-severe AD, utilizing the Japanese version of the Work Productivity and Activity Impairment (WPAI-AD-Japan) questionnaire. Furthermore, we examined the impact of dupilumab on work productivity. Adult moderate-to-severe AD patients treated with dupilumab for more than 12 months from March 2020 to June 2022 who filled out the WPAI-AD-Japan questionnaire were included. Twenty-eight adult AD patients were analysed. Absenteeism was low (mean: 5.3%), but presenteeism, work productivity loss and activity impairment were high (36.8%, 39.7%, 48.9%, respectively). Significant positive correlations were observed between work productivity loss and visual analogue scale (VAS) score of pruritus and between activity impairment and dermatology life quality index (DLQI). Dupilumab treatment significantly reduced presenteeism, work productivity loss and activity impairment at both 6 and 12 months. The extent of their amelioration was numerically higher at 12 months than at 6 months. The reduction rates in presenteeism, work productivity loss and activity impairment were positively correlated with the reduction rates in DLQI and VAS score of pruritus at 12 months. Dupilumab improved work productivity in Japanese AD patients. Long-term remission of pruritus and improved quality of life are important for comprehensive improvement of work productivity.
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Affiliation(s)
- Emi Sakurai
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Masahiro Kamata
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Hideaki Uchida
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Yoshiki Okada
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Shoya Suzuki
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Ryosuke Takeshima
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Makoto Ito
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Ayu Watanabe
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Itsumi Mizukawa
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Shota Egawa
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Chika Chijiwa
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Azusa Hiura
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Saki Fukaya
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kotaro Hayashi
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Atsuko Fukuyasu
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Takamitsu Tanaka
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Takeko Ishikawa
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Yayoi Tada
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
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8
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Yew YW, Zhao X, Yong AMY. Safety and efficacy of dupilumab in adult atopic dermatitis in Singapore. Singapore Med J 2024:00077293-990000000-00077. [PMID: 38189411 DOI: 10.4103/singaporemedj.smj-2023-031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/29/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Dupilumab, a biologic approved for treatment of moderate-to-severe atopic dermatitis (AD), has been reported to be largely effective with minimal adverse effects. However, being a targeted therapy, its effectiveness and side effects are expected to be varied in a heterogeneous ethnic population. Currently, the majority of studies on dupilumab are based on Western populations. METHODS A retrospective cohort of 51 patients with moderate-to-severe AD treated with dupilumab at a tertiary skin institute from January 2018 to February 2020 was included. Outcome measures such as Scoring Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI) and Dermatology Quality of Life Index (DLQI) were analysed at baseline and after 16 weeks of treatment. Laboratory tests at the respective time points were also measured. RESULTS Patients treated with dupilumab showed consistent reduction in body surface area (BSA) involved, SCORAD, EASI and DLQI scores. Concurrently, serum immunoglobulin E (IgE) and absolute eosinophil count showed a downward trend at 4 months of treatment. There was a transient increase in mean serum IgE at 1 month of dupilumab treatment. Also, 42.0% and 35.3% of patients developed eye symptoms, and head and neck dermatitis, respectively, but there were no major adverse events reported. Childhood-onset AD was more likely to have improved BSA scores compared to adult-onset AD. CONCLUSIONS Our study confirms the efficacy of dupilumab with real-world data in an adult Asian population. Higher proportions of eye symptoms, and head and neck dermatitis were observed in our cohort compared to other Asian clinical cohort studies. Further studies are needed to evaluate these differences.
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Affiliation(s)
- Yik Weng Yew
- Research Division, National Skin Centre, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Xiahong Zhao
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Adeline Mei Yan Yong
- Division of Dermatology, University Medicine Cluster, National University Health System, Singapore
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9
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Del Duca E, He H, Liu Y, Pagan AD, David E, Cheng J, Carroll B, Renert-Yuval Y, Bar J, Estrada YD, Maari C, Proulx ESC, Krueger JG, Bissonnette R, Guttman-Yassky E. Intrapatient comparison of atopic dermatitis skin transcriptome shows differences between tape-strips and biopsies. Allergy 2024; 79:80-92. [PMID: 37577841 DOI: 10.1111/all.15845] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/26/2023] [Accepted: 06/24/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Our knowledge of etiopathogenesis of atopic dermatitis (AD) is largely derived from skin biopsies, which are associated with pain, scarring and infection. In contrast, tape-stripping is a minimally invasive, nonscarring technique to collect skin samples. METHODS To construct a global AD skin transcriptomic profile comparing tape-strips to whole-skin biopsies, we performed RNA-seq on tape-strips and biopsies taken from the lesional skin of 20 moderate-to-severe AD patients and the skin of 20 controls. Differentially expressed genes (DEGs) were defined by fold-change (FCH) ≥2.0 and false discovery rate <0.05. RESULTS We detected 4104 (2513 Up; 1591 Down) and 1273 (546 Up; 727 Down) DEGs in AD versus controls, in tape-strips and biopsies, respectively. Although both techniques captured dysregulation of key immune genes, tape-strips showed higher FCHs for innate immunity (IL-1B, IL-8), dendritic cell (ITGAX/CD11C, FCER1A), Th2 (IL-13, CCL17, TNFRSF4/OX40), and Th17 (CCL20, CXCL1) products, while biopsies showed higher upregulation of Th22 associated genes (IL-22, S100As) and dermal cytokines (IFN-γ, CCL26). Itch-related genes (IL-31, TRPV3) were preferentially captured by tape-strips. Epidermal barrier abnormalities were detected in both techniques, with terminal differentiation defects (FLG2, PSORS1C2) better represented by tape-strips and epidermal hyperplasia changes (KRT16, MKI67) better detected by biopsies. CONCLUSIONS Tape-strips and biopsies capture overlapping but distinct features of the AD molecular signature, suggesting their respective utility for monitoring specific AD-related immune, itch, and barrier abnormalities in clinical trials and longitudinal studies.
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Affiliation(s)
- Ester Del Duca
- Department of Dermatology, and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Dermatology, University of Magna Graecia, Catanzaro, Italy
| | - Helen He
- Department of Dermatology, and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Ying Liu
- Department of Dermatology, and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Angel D Pagan
- Department of Dermatology, and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Eden David
- Department of Dermatology, and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Julia Cheng
- Department of Dermatology, and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Britta Carroll
- Department of Dermatology, and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Yael Renert-Yuval
- Department of Dermatology, and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Laboratory for Investigative Dermatology, The Rockefeller University, New York City, New York, USA
| | - Jonathan Bar
- Department of Dermatology, and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Yeriel D Estrada
- Department of Dermatology, and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | | | | | - James G Krueger
- Laboratory for Investigative Dermatology, The Rockefeller University, New York City, New York, USA
| | | | - Emma Guttman-Yassky
- Department of Dermatology, and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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10
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Dekkers C, van der Wal MM, van den Noort L, Bakker DS, de Bruin-Weller M, van Wijk F. IgE levels in patients with atopic dermatitis steadily decrease during treatment with dupilumab regardless of dose interval. Clin Exp Allergy 2023; 53:1222-1225. [PMID: 37700483 DOI: 10.1111/cea.14384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 09/14/2023]
Affiliation(s)
- Coco Dekkers
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Marlot van der Wal
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Leonie van den Noort
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Daphne S Bakker
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marjolein de Bruin-Weller
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Femke van Wijk
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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11
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Miyamoto S, Imai Y, Matsutani M, Nagai M, Yamanishi K, Kanazawa N, Nishiumi S. Exploration of Metabolite Biomarkers to Predict the Efficacy of Dupilumab Treatment for Atopic Dermatitis. DISEASE MARKERS 2023; 2023:9013756. [PMID: 37946797 PMCID: PMC10632056 DOI: 10.1155/2023/9013756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/28/2023] [Accepted: 10/10/2023] [Indexed: 11/12/2023]
Abstract
Dupilumab (DUP) is the first biological agent used treating atopic dermatitis (AD). Notwithstanding its high cost, the type of patient group for which the drug is effective remains unclear. In this retrospective study, we aimed to identify novel and reliable biomarkers which can be measured before DUP administration and to predict the efficacy of DUP. Serum samples from 19 patients with AD treated with DUP were analysed by metabolome analysis using gas chromatography-mass spectrometry. Total 148 metabolites were detected, and the relative values of the metabolites were compared between the patient group that achieved 75% improvement in Eczema Area and Severity Index 16 weeks after administration of DUP (high responders: HR; n = 11) and that did not (low responders: LR; n = 8). The HR and LR groups had significant differences in the relative values of the eight metabolites (lactic acid, alanine, glyceric acid, fumaric acid, nonanoic acid, ribose, sorbitol, and ornithine), with ribose emerging as the best. Furthermore, we evaluated the serum concentrations of ribose and found that ribose may be a useful metabolite biomarker for predicting the efficacy of DUP in AD.
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Affiliation(s)
- Shoko Miyamoto
- Department of Dermatology, Hyogo Medical University, 1-1, Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
- Department of Dermatology Institute of Biomedical Sciences, Tokushima University Graduate School, 2-50-1, Kuramoto-cho, Tokushima, Tokushima 770-8503, Japan
| | - Yasutomo Imai
- Department of Dermatology, Hyogo Medical University, 1-1, Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
- Imai Adult and Pediatric Dermatology Clinic, 5-1-1, Ebie, Fukushima-ku, Osaka, Osaka 553-0001, Japan
- Department of Dermatology, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie 514-8507, Japan
| | - Masako Matsutani
- Department of Dermatology, Hyogo Medical University, 1-1, Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Makoto Nagai
- Department of Dermatology, Hyogo Medical University, 1-1, Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Kiyofumi Yamanishi
- Department of Dermatology, Hyogo Medical University, 1-1, Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
- Department of Dermatology, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie 514-8507, Japan
| | - Nobuo Kanazawa
- Department of Dermatology, Hyogo Medical University, 1-1, Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Shin Nishiumi
- Department of Omics Medicine, Hyogo Medical University, 1-1, Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
- Department of Biosphere Sciences, School of Human Sciences, Kobe College, 4-1, Okadayama, Nishinomiya, Hyogo 662-8505, Japan
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12
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Dubini M, Benzecry V, Rivolta F, Sangalli A, Marzano AV, Pravettoni V, Tavecchio S, Ferrucci SM. Asthma improvement in patients treated with dupilumab for severe atopic dermatitis. FRONTIERS IN ALLERGY 2023; 4:1223657. [PMID: 37753208 PMCID: PMC10518613 DOI: 10.3389/falgy.2023.1223657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
Introduction Atopic dermatitis (AD) is considered a systemic type 2 immune driven disease, and it is associated to many atopic comorbidities including asthma. The aim of our study was to prospectively evaluate the respiratory outcomes in patients with persistent allergic asthma treated with dupilumab due to severe AD (sAD). Methods We enrolled eligible patients with sAD for dupilumab treatment from September 2018 to December 2020. We then selected the subgroup of patients sensitized to perennial allergens. Dupilumab's efficacy and safety on AD and comorbid asthma were assessed at baseline, one month, four months, and then every 4 months up to one year. Results A total of 437 patients with sAD were enrolled for dupilumab treatment due to sAD, and 273 reached 48 weeks of therapy. Respiratory outcomes were evaluated in the 85 asthmatic patients with positivity only to perennial allergens. Our patients showed statistically and clinically significant improvement in asthma control (Asthma Control Test and Asthma Control Questionnaire) and airway obstruction parameters (FEV1), in addition to the expected AD-related skin outcomes. Specifically, a significant improvement was achieved at the fourth month of dupilumab therapy, and this trend was maintained up to twelve months, regardless of asthma severity. Conclusions Our results showed the overall improvement of the clinical picture that dupilumab offers for patients with severe AD and persistent allergic asthma of any severity, highlighting the importance of a global multidisciplinary approach of type 2 driven disease.
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Affiliation(s)
- Marco Dubini
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valentina Benzecry
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Rivolta
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Sangalli
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Valerio Pravettoni
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Simona Tavecchio
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Silvia Mariel Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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13
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Liu B, Song X, Liao S, Luan T, Zhao Z. Comparison of Efficacy of Baricitinib and Dupilumab in the Treatment of Chinese Moderate-To-Severe Atopic Dermatitis: A Retrospective Study. Int Arch Allergy Immunol 2023; 184:966-974. [PMID: 37245505 DOI: 10.1159/000530394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/22/2023] [Indexed: 05/30/2023] Open
Abstract
INTRODUCTION The treatment of atopic dermatitis (AD) patients with insufficient response or intolerance to topical medication remains clinical challenges, and there is a paucity of head-to-head trials comparing the efficacy of novel biological agents such as JAK inhibitor and antibody. METHODS To compare the efficacy of selective JAK1/JAK2 inhibitor baricitinib and interleukin-4 monoclonal antibody dupilumab in the treatment of patients with moderate-to-severe AD, a retrospective cohort study method was adopted. Clinical data from June 2020 to April 2022 were systematically reviewed. Eligible patients who received baricitinib or dupilumab were screened according to the following inclusion criteria: (1) age ≥ 18 years; (2) moderate-to-severe AD: baseline investigator global assessment (IGA) score ≥ 3, baseline eczema area and severity index (EASI) score ≥ 16; (3) poor response or intolerance to at least one topical drug in the past 6 months; (4) no topical glucocorticoids were used in the past 2 weeks and no systematic treatment was given in the past 4 weeks. Patients of the baricitinib group were treated with oral baricitinib in doses of 2 mg per day for 16 weeks, and patients of the dupilumab group were treated with standardized use of dupilumab for 16 weeks, with the initial 600 mg subcutaneous injection and the following 300 mg subcutaneous injection every 2 weeks. The clinical efficacy score indexes including the IGA score, EASI score, and Itch Numeric Rating Scale (NRS) score. These scores at 0, 2, 4, 8, 12, and 16 weeks after the start of treatment were collected. RESULTS A total of 54/45 patients treated with baricitinib/dupilumab were included. There was no significant difference in the decrease of all scores between the two groups at the 4th week (p > 0.05). There was no difference in the EASI score and Itch NRS score (p > 0.05), but the IGA score of the baricitinib group was lower at the 16th week (Z = 4.284, p < 0.001). Within the first 4 weeks, the Itch NRS score of the baricitinib group decreased rapidly, but with the prolongation of treatment time, there was no significant difference between the two groups at the 16th week (Z = 1.721, p = 0.085). CONCLUSIONS The efficacy of baricitinib at a dose of 2 mg daily was similar to dupilumab, and the improvement in pruritus was significantly faster in the early stage of treatment (the first 4 weeks) than that of dupilumab.
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Affiliation(s)
- Bo Liu
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China,
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China,
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China,
| | - Xiaoting Song
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Shuanglu Liao
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Tingting Luan
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Zuotao Zhao
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
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14
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Zinellu A, Sucato F, Piras V, Addis GM, Biondi G, Montesu MA, Mangoni AA, Carru C, Pirina P, Paliogiannis P, Fois AG, Satta R. Blood Cells Count Derived Inflammation Indexes as Predictors of Early Treatment Response to Dupilumab in Patients with Moderate-to-Severe Atopic Dermatitis. J Clin Med 2023; 12:jcm12062104. [PMID: 36983107 PMCID: PMC10056555 DOI: 10.3390/jcm12062104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/22/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
Derived inflammatory indexes from routine hematological parameters might be useful for predicting early-response vs. late/non-response to dupilumab, the first biological agent approved for moderate-to-severe atopic dermatitis (AD). We tested this hypothesis by retrospectively investigating the association between pre-specified baseline inflammatory indexes and dupilumab response (≥50% reduction in the Eczema Area and Severity Index, EASI 50) at 4 and 16 weeks in a consecutive series of 66 AD patients (38 males and 28 females). Forty-six patients (69.7%) were early-responders at 4 weeks, whereas the remaining twenty (30.3%) were late/non-responders at 16 weeks. In logistic regression, the platelet-to-lymphocyte ratio (PLR) was independently associated with early-response (OR = 1.0159, 95% CI 1.0005 to 1.0315, p = 0.0426). The predictive performance of PLR and other derived indexes towards early-response was further improved by their combination with serum IgE concentrations, with a maximum AUC value for the combined systemic immune inflammation index (SII)-IgE of 0.797 (95% CI = 0.677 to 0.884, p < 0.0001). Derived inflammatory indexes, particularly SII-IgE, might be useful to identify early-responders to dupilumab and develop alternative treatment protocols for late/non-responders.
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Affiliation(s)
- Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Federica Sucato
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Viviana Piras
- Dermatology Unit, Department of Medical Sciences and Public Health, AOU Cagliari, 09123 Cagliari, Italy
| | - Gian Mario Addis
- Dermatology Unit, Department of Medical Care of San Francesco Hospital, 08100 Nuoro, Italy
| | - Gabriele Biondi
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Maria Antonia Montesu
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Arduino A Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia
- Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Bedford Park, Adelaide 5042, Australia
| | - Ciriaco Carru
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Pietro Pirina
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | | | - Alessandro G Fois
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Rosanna Satta
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
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15
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Vittrup I, Krogh NS, Larsen HHP, Elberling J, Skov L, Ibler KS, Jemec GBE, Mortz CG, Bach RO, Bindslev-Jensen C, Dalager MG, Egeberg A, Agner T, Deleuran M, Vestergaard C, Thyssen JP. A nationwide 104 weeks real-world study of dupilumab in adults with atopic dermatitis: Ineffectiveness in head-and-neck dermatitis. J Eur Acad Dermatol Venereol 2023; 37:1046-1055. [PMID: 36606551 DOI: 10.1111/jdv.18849] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/29/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Evaluation of effectiveness and safety of new systemic treatments for atopic dermatitis (AD) after approval is important. There are few published data exceeding 52-week therapy with dupilumab. OBJECTIVES To examine the safety, effectiveness and drug survival of dupilumab in a Danish nationwide cohort with moderate-to-severe AD up to 104 weeks exposure. METHODS We included 347 adult patients with AD who were treated with dupilumab and registered in the SCRATCH registry during 2017-2022. RESULTS At all visits, we observed improvement in AD severity measured by Eczema Area and Severity Index (EASI) [median (IQR)]. EASI score at baseline was 18.0 (10.6-25.2), at week 4: 6.5 (3.5-11.6), at week 16: 3.7 (1.2-6.2), at week 52: 2.0 (0.8-3.6), at week 104: 1.7 (0.8-3.8). While drug survival was high (week 52: 90%; week 104: 86%), AD in the head-and-neck area remained present in most patients at high levels; proportion with head-and-neck AD at baseline was 76% and 68% at week 104. 35% of patients reported any AE. Conjunctivitis was the most frequent (25% of all patients) and median time to first registration of conjunctivitis was 201 days. CONCLUSIONS While 2-year drug survival was 86%, dupilumab was unable to effectively treat AD in the head-and-neck area, and conjunctivitis was found in 25% of patients.
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Affiliation(s)
- Ida Vittrup
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | | | - Henrik Hedegaard Pliess Larsen
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Jesper Elberling
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Lone Skov
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Kristina Sophie Ibler
- Department of Dermatology, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark
| | - Charlotte G Mortz
- Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark
| | - Rasmus Overgaard Bach
- Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark
| | | | | | - Alexander Egeberg
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Tove Agner
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Mette Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jacob Pontoppidan Thyssen
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
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16
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Makowska K, Nowaczyk J, Blicharz L, Waśkiel-Burnat A, Czuwara J, Olszewska M, Rudnicka L. Immunopathogenesis of Atopic Dermatitis: Focus on Interleukins as Disease Drivers and Therapeutic Targets for Novel Treatments. Int J Mol Sci 2023; 24:ijms24010781. [PMID: 36614224 PMCID: PMC9820829 DOI: 10.3390/ijms24010781] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 01/04/2023] Open
Abstract
Atopic dermatitis is a chronic, recurrent inflammatory skin disorder manifesting by eczematous lesions and intense pruritus. Atopic dermatitis develops primarily as a result of an epidermal barrier defect and immunological imbalance. Advances in understanding these pathogenetic hallmarks, and particularly the complex role of interleukins as atopic dermatitis drivers, resulted in achieving significant therapeutic breakthroughs. Novel medications involve monoclonal antibodies specifically blocking the function of selected interleukins and small molecules such as Janus kinase inhibitors limiting downstream signaling to reduce the expression of a wider array of proinflammatory factors. Nevertheless, a subset of patients remains refractory to those treatments, highlighting the complexity of atopic dermatitis immunopathogenesis in different populations. In this review, we address the immunological heterogeneity of atopic dermatitis endotypes and phenotypes and present novel interleukin-oriented therapies for this disease.
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17
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Swindell WR, Bojanowski K, Chaudhuri RK. Isosorbide Fatty Acid Diesters Have Synergistic Anti-Inflammatory Effects in Cytokine-Induced Tissue Culture Models of Atopic Dermatitis. Int J Mol Sci 2022; 23:ijms232214307. [PMID: 36430783 PMCID: PMC9696169 DOI: 10.3390/ijms232214307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2022] Open
Abstract
Atopic dermatitis (AD) is a chronic disease in which epidermal barrier disruption triggers Th2-mediated eruption of eczematous lesions. Topical emollients are a cornerstone of chronic management. This study evaluated efficacy of two plant-derived oil derivatives, isosorbide di-(linoleate/oleate) (IDL) and isosorbide dicaprylate (IDC), using AD-like tissue culture models. Treatment of reconstituted human epidermis with cytokine cocktail (IL-4 + IL-13 + TNF-α + IL-31) compromised the epidermal barrier, but this was prevented by co-treatment with IDL and IDC. Cytokine stimulation also dysregulated expression of keratinocyte (KC) differentiation genes whereas treatment with IDC or IDL + IDC up-regulated genes associated with early (but not late) KC differentiation. Although neither IDL nor IDC inhibited Th2 cytokine responses, both compounds repressed TNF-α-induced genes and IDL + IDC led to synergistic down-regulation of inflammatory (IL1B, ITGA5) and neurogenic pruritus (TRPA1) mediators. Treatment of cytokine-stimulated skin explants with IDC decreased lactate dehydrogenase (LDH) secretion by more than 50% (more than observed with cyclosporine) and in vitro LDH activity was inhibited by IDL and IDC. These results demonstrate anti-inflammatory mechanisms of isosorbide fatty acid diesters in AD-like skin models. Our findings highlight the multifunctional potential of plant oil derivatives as topical ingredients and support studies of IDL and IDC as therapeutic candidates.
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Affiliation(s)
- William R. Swindell
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- Correspondence:
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18
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Yu L, Li L. Potential biomarkers of atopic dermatitis. Front Med (Lausanne) 2022; 9:1028694. [PMID: 36465933 PMCID: PMC9712451 DOI: 10.3389/fmed.2022.1028694] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/31/2022] [Indexed: 11/12/2023] Open
Abstract
Atopic dermatitis (AD) is a chronic, recurrent inflammatory skin disease with a wide range of heterogeneity. Accurate biomarkers or predictors are the keys to instructing personalized tailored precise treatment. The development of technology such as transcriptomics, genomics, and proteomics provides novel insights into the possibility to find potential biomarkers. Meanwhile, emerging minimally invasive methods such as tape stripping were used to reveal different profiles of patients' skin without biopsy. Several potential biomarkers or predictors have been found. In this review, we summarized the current development of potential biomarkers of AD. Nitric oxide synthase 2/inducible nitric oxide synthase (NOS2/iNOS), human beta-defensin-2 (hBD-2), and matrix metalloproteinases 8/9 (MMP8/9) may be the candidate biomarkers for AD diagnosis. Filaggrin (FLG) gene mutation increased the occurrence risk of AD. Fatty-acid-binding protein 5 (FABP5) may serve as an effective biomarker for the atopic march (AM). Squamous cell carcinoma antigen 2 (SCCA2), serum thymus and activation-regulated chemokine (TARC), cutaneous T-cell-attracting chemokine (CTACK), eosinophil-derived neurotoxin (EDN), macrophage-derived chemokine (MDC), lactate dehydrogenase (LDH), and interleukin (IL)-18 can be the candidate biomarkers for disease severity monitoring. IL-17, IL-23, IL-33, and indoleamine 2,3-dioxygenase (IDO1) can be used as predictive biomarkers for AD comorbidities. LDH, TARC, pulmonary and activation-regulated chemokine (PARC), periostin, IL-22, eotaxin-1/3, and IL-8 may be the candidate biomarkers for monitoring treatment effects. There are still unmet needs and a long way to go for more convenient, non-invasive, and effective predictors and biomarkers to better guide personalized precise treatment.
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Affiliation(s)
- Ling Yu
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Dermatology, Henan Provincial People’s Hospital, Zhengzhou, China
- Department of Dermatology, Zhengzhou University People’s Hospital, Zhengzhou, China
| | - Linfeng Li
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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19
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Foley P, Kerdraon YA, Hogden JP, Shumack S, Spelman L, Sebaratnam DF, Su CS, Katelaris CH. Dupilumab-associated ocular surface disease: An interdisciplinary decision framework for prescribers in the Australian setting. Australas J Dermatol 2022; 63:421-436. [PMID: 36125089 PMCID: PMC9826507 DOI: 10.1111/ajd.13924] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND/OBJECTIVES Dupilumab-associated ocular surface disease (DAOSD) is of particular relevance in patients with atopic dermatitis (AD). Guidance on DAOSD assessment and management in the Australian setting is needed to reduce its impact and minimise disruption to treatment. METHODS A systematic review of the literature was undertaken to identify data pertaining to the incidence, pathophysiology, risk factors and management of DAOSD. A critical review of this literature was used to inform a decision framework for dupilumab-prescribers and develop a graded severity scoring tool to guide appropriate management options. RESULTS DAOSD typically emerges within 4 months of commencing dupilumab and the occurrence of new events diminishes over time. The reported incidence varies widely depending on the nature and source of the data: 8.6-22.1% (clinical trials programme), 0.5-70% (real-world data; differences in study size, duration of follow-up, ophthalmologist intervention, use of prophylaxis). Occurrence increases with AD severity and in patients with prior history of ocular disease; pathophysiology is still to be fully characterised. Management options have evolved over time and include lubricants/artificial tears, corticosteroids, calcineurin inhibitors, antihistamines, anti-inflammatory agents and antimicrobial agents. Current therapies aim to resolve symptoms or reduce severity to levels sufficiently tolerable to enable continuation of dupilumab therapy. CONCLUSIONS Recommendations for DAOSD assessment and management include identification of high-risk patients, vigilance for red flags (keratoconus, herpetic and bacterial keratitis), regular assessment of symptom severity (before and during dupilumab therapy), conservative management of mild DAOSD by the prescribing physician and ophthalmologist referral for collaborative care of moderate-severe DAOSD and high-risk patients.
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Affiliation(s)
- Peter Foley
- Department of DermatologySt Vincent’s Hospital MelbourneFitzroyVictoriaAustralia,Department of MedicineThe University MelbourneMelbourneVictoriaAustralia,Skin Health InstituteMelbourneVictoriaAustralia
| | - Yves A. Kerdraon
- Save Sight Institute, Sydney Medical SchoolThe University of SydneySydneyNew South WalesAustralia
| | | | - Stephen Shumack
- Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia,Department of DermatologyRoyal North Shore HospitalSydneyNew South WalesAustralia
| | - Lynda Spelman
- Specialist Connect ServicesBrisbaneQueenslandAustralia,Queensland Institute of DermatologyBrisbaneQueenslandAustralia
| | - Deshan F. Sebaratnam
- Department of DermatologyLiverpool HospitalLiverpoolNew South WalesAustralia,Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Charles S. Su
- Orbit, Plastic and Lacrimal UnitRoyal Victorian Eye and Ear HospitalMelbourneVictoriaAustralia,Victoria Parade Surgery CentreMelbourneVictoriaAustralia
| | - Constance H. Katelaris
- Clinical Immunology and Allergy UnitWestern Sydney University, Campbelltown HospitalSydneyNew South WalesAustralia
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20
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Zhou B, Dong J, Liang S, Shang S, Li L. The changes of IgE levels in type 2 inflammatory diseases after treatment of dupilumab: a systematic review and meta-analysis. Expert Rev Clin Pharmacol 2022; 15:1233-1242. [PMID: 36045562 DOI: 10.1080/17512433.2022.2120469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Dupilumab is approved for multiple type 2 inflammatory diseases. In the treatment procedure, the changes of IgE levels need further analysis. We evaluated the changes of IgE levels through a meta-analysis, aiming to provide a more comprehensive result. RESEARCH DESIGN AND METHODS Databases were searched to select eligible publications. After being included, study quality was assessed. The standardized mean difference (SMD) was used as an evaluation. RESULTS Seven studies were included. At week 4, the level of IgE did not decrease significantly, with SMD=-0.12 (95%CI: -0.31, 0.07) (P>0.05). At week 8, 12, 16, 24 and 52, the level of IgE decreased significantly, which was SMD=-0.26 (95%CI: -0.48, -0.03); -0.25 (95%CI: -0.32, -0.18); -0.49 (95%CI: -0.65, -0.33); -0.30 (95%CI: -0.38, -0.22); -0.40 (95%CI: -0.48, -0.32) (P<0.05). In AD studies, with the increase of IgE levels, due to the decrease in the total dose of dupilumab, the efficacy index showed a decreasing trend. CONCLUSIONS Levels of IgE can be significantly decreased in patients with dupilumab treatment. In AD patients, the efficacy was related to total dose; for patients with high IgE levels, efficacy may be better with the dose increased.
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Affiliation(s)
- Boyang Zhou
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jialin Dong
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Surong Liang
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shuai Shang
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Linfeng Li
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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21
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Chiricozzi A, Gori N, Narcisi A, Balato A, Gambardella A, Ortoncelli M, Marzano AV, Balestri R, Palazzo G, Pellegrino M, Romanelli M, Tripepi G, Peris K, Costanzo A. Effectiveness and Safety of Upadacitinib in the Treatment of Moderate-Severe Atopic Dermatitis: A Multicentric, Prospective, Real-World, Cohort Study. Drugs R D 2022; 22:245-252. [PMID: 35922713 PMCID: PMC9362214 DOI: 10.1007/s40268-022-00396-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/21/2022] Open
Abstract
Background The efficacy and safety of upadacitinib in atopic dermatitis (AD) have been defined in clinical trials, but no real-world data are currently available. We aimed to assess the safety and effectiveness of upadacitinib in a real-world AD patient cohort that mostly included patients who failed the available systemic therapies, including dupilumab. Methods Prospective cohort study collecting data on upadacitinib-treated AD adult patients completing at least 16 weeks of therapy. Results Forty-three patients showed rapid and marked response to upadacitinib with significant reduction of all disease severity scores since the first follow-up visit. At week 16, Eczema Area and Severity Index (EASI) 75, EASI 90, and EASI 100 response was observed in 97.5%, 82.1%, and 69.2% of patients, respectively. EASI 90 response reflected the achievement of a clear or almost clear condition (POEM 0-2), self-evaluated by 79.5% of patients. Patients’ quality of life improved as suggested by the achievement of DLQI 0/1 by 38.5% of patients at week 4, and by 76.9% at week 16. Conclusion Elevated effectiveness and favorable safety of upadacitinib were confirmed in patients unresponsive to dupilumab, who were not included in upadacitinib trials.
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Affiliation(s)
- Andrea Chiricozzi
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy. .,Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Niccolò Gori
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.,Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandra Narcisi
- Dermatology, Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy.,Skin Pathology Laboratory, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Anna Balato
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Michela Ortoncelli
- Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | | | | | | | | | - Giovanni Tripepi
- Istituto di Fisiologia Clinica del CNR, Sede di Reggio Calabria, Calabria, Italy
| | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.,Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Costanzo
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.,Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
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22
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Chronic Pruritus in Atopic Patients Treated with Dupilumab: Real Life Response and Related Parameters in 354 Patients. Pharmaceuticals (Basel) 2022; 15:ph15070883. [PMID: 35890180 PMCID: PMC9318403 DOI: 10.3390/ph15070883] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/16/2022] [Accepted: 07/15/2022] [Indexed: 02/07/2023] Open
Abstract
Chronic pruritus is a major symptom of atopic dermatitis (AD). Its etiopathogenesis is complex, and an understanding of the driving factors of its pathogenesis allows for the development of new molecule-targeted therapies. Dupilumab, targeting and blocking interleukin-4 (IL-4) and interleukin-13 (IL-13) molecules, has shown great efficacy in treating AD symptoms such chronic itching. We performed a retrospective observational study to evaluate possible chronic-itch-related characteristics and parameters in 356 AD patients who received dupilumab. The objective of the study was to evaluate the factors associated with the level of pruritus reported by patients at each of the 1575 detections in the form of the peak pruritus numerical rating scale (NRSpp) and sleep disturbance numerical rating scale (NRSsd). We focused on: the eczema area and severity index (EASI), dermatology life quality index (DLQI), patient-oriented eczema measure (POEMS), eosinophilia, L-lactate dehydrogenase (LDH), immunoglobulin E (IgE) and the time from the start of dupilumab therapy. NRSpp fell from 8.6 (sd 1.7) at baseline to 1.7 (sd 2.3) at 36 months and NRSsd from 7 (sd 3) to 0. Regarding the parameters that correlate with NRSpp, all the parameters analysed were significantly correlated except for eosinophils (p = 0.136). In the multivariate analysis, both considering and not considering treatment duration, the parameters were correlated (p < 0.001); EASI, DLQI, POEM, and LDH significantly correlated with NRSpp (p < 0.001 for each, except for LDH p = 0.003); while IgE tot lost significance (p = 0.337). Similar results were obtained for the parameters correlating with NRSsd. Our results confirm the efficacy of dupilumab on pruritus. The use of questionnaires such as DLQI and POEM is advisable in clinical practice and is adequate for assessing the impact of itching on AD. The low correlation of IgE and eosinophils, the ambiguity of LDH levels with the level of pruritus, and a poor clinical validity and unclear correlation with disease severity suggest a progressive abandonment of monitoring of these values.
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23
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Gael M, Adam T, Mariano-Bourin M, Bursztejn AC. Efficacy of dupilumab in chronic prurigo and chronic idiopathic pruritus: A systematic review of current evidence and analysis of response predictors. J Eur Acad Dermatol Venereol 2022; 36:1541-1551. [PMID: 35569006 DOI: 10.1111/jdv.18221] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 04/21/2022] [Indexed: 11/28/2022]
Abstract
Dupilumab has demonstrated a great reduction on chronic pruritus that is the hallmark of atopic dermatitis (AD). Underscoring relevant pathogenesis similarities emerging from AD, chronic idiopathic pruritus (CIP) and chronic prurigo (CP), several authors suggested the beneficial role of dupilumab in these conditions. The evidence on this subject is limited with no precise data available. In this study, we carried out a systematic literature review in order to evaluate the efficacy of dupilumab on both pruritus and skin manifestations in the two largest retrospective cohorts of patients with CP and CIP and tried to identify potential response predictors. Electronic searches were conducted on 4 databases. Our primary outcome was the improvement in pruritus measured by a reduction in patient's reported numerical rating scale of itch (NRSI) by > 4. Secondary outcomes included: proportion of patients with complete response at the end of treatment, reduction in the number of lesions by the Investigator Global Assessment (IGA), improvement in numerical rating scale of sleep (NRSS), improvement in quality of life measured by the Dermatology Life Quality Index (DLQI), time until patient perceived any improvement (Time-First) and time until patient reported absence of pruritus (Time-Final). Descriptive statistics were calculated for each demographic and clinical variable. Univariate logistic regression analyses were conducted to explore association between response to dupilumab and potential predictive factors. We included 25 articles in the analysis, counting a total of 153 patients. Based on CP patients' cohort (n=132), the mean NRSI at baseline was 8.79 ±0.86 and the NRSI final was 2.32 ±1.27. The mean time to first improvement was 5.18 ±3.13 weeks, while the time to complete improvement of pruritus (Time-final) was 13.6 ±12.0 weeks. Ninety patients out of 109 (83%) noticed improvement in pruritus before 4 weeks of dupilumab therapy. At the end of treatment, 18 patients out of 126 (14%) had a complete remission of pruritus and 110 patients out of 123 (89%) had a reduction of NRSI > 4. The reduction in NRSI was significantly greater in patients improving before 4 weeks of treatment (6.57 ±1.71) compared to patients improving in more than 4 weeks (5.49 ±1.39, p<0.001). Patients with history of AD and those who have been previously treated with cyclosporine or methotrexate had a significantly lower reduction in NRSI (e.g. 6.05 ±1.34 vs 7.08 ±1.90 p<0.01 for non-associated AD patients). Based on CIP patient's cohort (n=21), the mean NRSI at baseline was 8.33 ±0.80 and the NRSI final was 0.95 ±0.59. The mean time to first improvement was 2 ±0 weeks, while the time to complete improvement (Time-final) was 14.6 ±10 weeks. At the end of treatment, 3 patients out of 21 (14%) had a complete remission of pruritus and 100% of patients had a reduction of NRSI > 4. No serious treatment-emergent adverse events were reported. The most common adverse event was mild conjunctivitis (13 cases). We highlight the importance of one early sign of improvement as predictor of the future response to dupilumab: the improvement before 4 weeks of treatment that leads significantly to a greater final reduction in NRSI. Furthermore, patients with the presence or history of atopy appear to be less responsive to dupilumab than non-atopic patients and develop more side effects, in particular conjunctivitis.
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Affiliation(s)
- M Gael
- Department of Dermatology, CHRU de Nancy, 6 rue du Morvan, 54500 Vandœuvre lès, Nancy, France
| | - T Adam
- Department of Allergology, CHRU de Nancy, 6 rue du Morvan, 54500 Vandœuvre lès, Nancy, France
| | - M Mariano-Bourin
- Department of Dermatology, CHRU de Nancy, 6 rue du Morvan, 54500 Vandœuvre lès, Nancy, France
| | - A C Bursztejn
- Department of Dermatology, CHRU de Nancy, 6 rue du Morvan, 54500 Vandœuvre lès, Nancy, France
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24
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Eichenfield LF, Armstrong A, Guttman-Yassky E, Lio PA, Chen CC, Hines DM, McGuiness CB, Ganguli S, Delevry D, Sierka D, Mallya UG. Real-World Effectiveness of Dupilumab in Atopic Dermatitis Patients: Analysis of an Electronic Medical Records Dataset. Dermatol Ther (Heidelb) 2022; 12:1337-1350. [PMID: 35543920 PMCID: PMC9209584 DOI: 10.1007/s13555-022-00731-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/12/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction While the efficacy of dupilumab for the treatment of adults with moderate-to-severe atopic dermatitis (AD) has been demonstrated in several clinical trials, patients in such trials may not necessarily reflect the real-world clinical practice setting. This study evaluated the real-world effectiveness of dupilumab in adults with moderate-to-severe AD based on physician global assessment, percent body surface area affected, and patient-reported itch. Methods From Modernizing Medicine’s Electronic Medical Assistant dermatology-specific electronic medical records, adults (≥ 18 years) were identified with a diagnosis of AD and ≥ 1 dupilumab prescription (index event) between 1 April 2017 and 31 January 2019. Three cohorts were identified based on 3-month pre-index (1) Investigator Global Assessment (IGA) score ≥ 3, (2) an itch severity numerical rating scale (NRS) score ≥ 3, and (3) body surface area (BSA) affected ≥ 10%. Changes from pre-index on the outcome within each cohort were evaluated at 4 months post-index. Patients were also stratified for evaluation of outcomes by baseline demographic (sex, age) and prior AD treatments (topical therapy only or no treatment, any systemic therapy). Results More than 70% of the 435 AD patients with baseline IGA score ≥ 3 improved to an IGA score of ≤ 2 at month 4 post-dupilumab initiation, including 42.8% who achieved IGA 0/1 (clear/minimal). Among 112 patients with a pre-index itch severity NRS ≥ 3, scores were reduced from mean (SD) 7.0 (2.4) pre-index to 2.8 (2.8) at month 4 (p < 0.0001); 70.5% of patients had a reduction ≥ 3 points. In the BSA cohort (n = 387), affected BSA was significantly reduced from a pre-index mean (SD) of 39.3% (26.1%) to 16.3% (21.2%) at month 4 (p < 0.0001). Significant improvements in IGA, itch NRS, and BSA were observed regardless of demographic (age and sex) or clinical characteristics such as treatment history (all p < 0.0001 compared with pre-index). Conclusions Consistent with outcomes observed in clinical trials, patients treated with dupilumab in real-world clinical settings achieved clinically meaningful improvements in severity and extent of AD and severity of itch comparable to those reported in clinical trials at a similar time point.
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Affiliation(s)
- Lawrence F Eichenfield
- Departments of Dermatology and Pediatrics, University of California, San Diego School of Medicine, 3020 Children's Way, Mail Code 5092, San Diego, CA, 92123, USA.
| | - April Armstrong
- Department of Dermatology, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
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25
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Gu C, Yuemeng W, Luo Y, Wang S, Yin H, Gao Y, Wang C, Yao X, Li W. Real-world efficacy and safety of dupilumab in Chinese patients with atopic dermatitis: a single-centre, prospective, open-label study. J Eur Acad Dermatol Venereol 2022; 36:1064-1073. [PMID: 35344634 DOI: 10.1111/jdv.18109] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/02/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dupilumab, an antibody against interleukin-4 receptor α, has demonstrated elegant efficacy and safety profiles in patients with moderate-to-severe atopic dermatitis (AD). However, the efficacy of dupilumab varies among AD patients, and compared with the Caucasian population, the data of dupilumab for Asian people, especially Chinese AD patients, is very limited. OBJECTIVE To investigate the efficacy and safety of dupilumab for AD in a real-world Chinese single-centre prospective cohort. METHODS We enrolled 138 moderate-to-severe AD patients receiving dupilumab treatment at Huashan Hospital, Shanghai, China in this 16-week, single-centre, prospective, open-label study. The patients were evaluated at baseline, 2, 4, 8, and 16 weeks after first dupilumab administration for multiple physician- and patient-reported outcome measures. Blood eosinophil counts and total serum IgE were measured. RESULTS There were early and sustained improvement in all the efficacy measures evaluated after dupilumab administration. 64.5% AD patients achieved an improvement of ≥75% in the Eczema Area and Severity Index from baseline, and 60.9% patients achieved the Investigator's Global Assessment 0/1(or a reduction of ≥ 2 points from baseline) at week 16. The trunk demonstrated the most significantly decreased efficacy score (median decreased 96.24% [interquartile range, 89.04 to 100.00%]) compared with other body sites. Female [adjusted OR:2.12, 95% CI: 0.79 - 5.74] and BMI < 24 [3.03; 1.19 - 7.68] were identified as potential predictive factors of good response; while age > 60 [0.57; 0.10 - 3.28] predicted poor response. Adverse events were reported by 34.1% patients, and facial erythema (13.0%) and ocular symptoms (10.9%) were the most common. CONCLUSIONS Dupilumab demonstrated favorable efficacy and well-tolerated safety in Chinese AD patients in real-world practice.
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Affiliation(s)
- Chaoying Gu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, 200040, P. R. China
| | - Wu Yuemeng
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, 200040, P. R. China
| | - Yang Luo
- Department of Allergy and Rheumatology, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210042, P. R. China
| | - Shangshang Wang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, 200040, P. R. China
| | - Huibin Yin
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, 200040, P. R. China
| | - Yingxia Gao
- Department of Allergy and Rheumatology, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210042, P. R. China
| | - Ce Wang
- Department of Biostatistics, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Xu Yao
- Department of Allergy and Rheumatology, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210042, P. R. China
| | - Wei Li
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, 200040, P. R. China
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26
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Achten RE, Van Luijk C, Van der Rijst L, Bakker D, Spekhorst L, Zuithoff N, Schuttelaar M, Romeijn G, Voorberg A, Kamsteeg M, Haeck I, De Graaf M, Thijs J, De Boer J, De Bruin-Weller M. Identification of Risk Factors for Dupilumab-associated Ocular Surface Disease in Patients with Atopic Dermatitis. Acta Derm Venereol 2022; 102:adv00666. [PMID: 35098318 PMCID: PMC9558326 DOI: 10.2340/actadv.v102.1128] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
This study identified risk factors for the development of dupilumab-associated ocular surface disease in patients with moderate-to-severe atopic dermatitis in a large prospective daily practice cohort. Data from the Dutch BioDay Registry were used to assess the risk of developing dupilumab-associated ocular surface disease, by performing univariate and multivariate logistic regression analyses. A total of 469 patients were included, of which 152/469 (32.4%) developed dupilumab-associated ocular surface disease. Multivariate analysis showed a statistically significant association of the development of dupilumab-associated ocular surface disease with a history of any eye disease (history of self-reported episodic acute allergic conjunctivitis excluded) combined with the use of ophthalmic medication at the start of dupilumab (odds ratio 5.16, 95% confidence interval 2.30–11.56, p < 0.001). In conclusion, a history of any eye disease (history of self-reported episodic acute allergic conjunctivitis excluded) combined with the use of ophthalmic medication at baseline was associated with the development of dupilumab-associated ocular surface disease in patients with atopic dermatitis.
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Affiliation(s)
- Roselie E Achten
- Department of Dermatology and Allergology, University Medical Center Utrecht, Heidelberglaan 100, NL-3584 CX Utrecht, the Netherlands.
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27
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Miniotti M, Lazzarin G, Ortoncelli M, Mastorino L, Ribero S, Leombruni P. Impact on health-related quality of life and symptoms of anxiety and depression after 32 weeks of Dupilumab treatment for moderate-to-severe atopic dermatitis. Dermatol Ther 2022; 35:e15407. [PMID: 35218275 PMCID: PMC9286472 DOI: 10.1111/dth.15407] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/28/2021] [Accepted: 02/23/2022] [Indexed: 12/02/2022]
Abstract
Dupilumab is the first biological agent approved for treatment of moderate‐to‐severe atopic dermatitis (AD). Evidence of Dupilumab effectiveness on psychological outcomes beyond 16 weeks of treatment from real‐life settings is lacking. To evaluate the effectiveness of Dupilumab treatment up to 32 weeks, focusing health‐related quality of life and psychological outcome of patients with moderate‐to‐severe AD. An observational prospective cohort study was conducted in a real‐life setting at an Italian tertiary centre. Assessment of outcome measures was carried out at baseline, after 16 and 32 weeks of treatment. A total of 171 patients were included. EASI‐75 and EASI‐90 were achieved in 85% and 60% of the participants, respectively, after 16 weeks, and in 89.6% and 69.8% after 32 weeks of treatment. Significant improvements (p < 0.001; r = 0.57–0.95) were found after 16 weeks for each outcome considered, including clinician and patient‐reported measures of AD severity and scales of health‐related quality of life and psychological morbidity, and maintained up to 32 weeks. Further analysis revealed that patients' quality of life was more associated with the subjective perception of disease severity rather than objective measures and suggested a possible different response to treatment based on the age of AD onset. Dupilumab was confirmed to be rapid, effective and safe in patients with moderate‐to‐severe AD. Its positive impact on psychological outcomes up to 32 weeks was ascertained here, adding new evidence on the need to consider subjective factors affecting patients' perception of disease severity in evaluating the response to treatment.
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Affiliation(s)
- Marco Miniotti
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin
| | - Giulia Lazzarin
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin
| | | | - Luca Mastorino
- Medical Science Department, Dermatology Clinic, University of Turin
| | - Simone Ribero
- Medical Science Department, Dermatology Clinic, University of Turin
| | - Paolo Leombruni
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin
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28
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Inaba Y, Kanazawa N, Muraoka K, Yariyama A, Kawaguchi A, Kunimoto K, Kaminaka C, Yamamoto Y, Tsujioka K, Yoshida A, Yanagi T, Jinnin M. Dupilumab Improves Pruritus in Netherton Syndrome: A Case Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030310. [PMID: 35327681 PMCID: PMC8946880 DOI: 10.3390/children9030310] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 11/30/2022]
Abstract
The patient was a 26-year-old male. He had red and scaling skin of the entire body since birth, as well as an elevated level of serum IgE. Genetic testing revealed a mutation in the SPINK5 gene, which had confirmed the diagnosis with Netherton syndrome. He has had significant pruritis since birth, and subsequently had symptoms of sleeping disorders and concentration difficulty throughout the day. Since treatment with various antihistamines were not effective, we administered dupilumab and found that it was effective in immediate elimination of pruritus and gradual reduction of the rash. Dupilumab has been administered for one year without any adverse events or recurrence of symptoms. Although studies have previously described cases who used dupilumab for Netherton syndrome, reported effects have been limited or transient. Additional studies are needed to confirm the effect of dupilumab for Netherton syndrome, which currently lack any effective treatment strategies.
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Affiliation(s)
- Yutaka Inaba
- Department of Dermatology, Wakayama Medical University, Wakayama 641-0012, Japan; (K.M.); (A.Y.); (A.K.); (K.K.); (C.K.); (Y.Y.); (M.J.)
- Correspondence: (Y.I.); (N.K.)
| | - Nobuo Kanazawa
- Department of Dermatology, Wakayama Medical University, Wakayama 641-0012, Japan; (K.M.); (A.Y.); (A.K.); (K.K.); (C.K.); (Y.Y.); (M.J.)
- Department of Dermatology, Hyogo College of Medicine, Nishinomiya 663-8501, Japan
- Correspondence: (Y.I.); (N.K.)
| | - Kyoko Muraoka
- Department of Dermatology, Wakayama Medical University, Wakayama 641-0012, Japan; (K.M.); (A.Y.); (A.K.); (K.K.); (C.K.); (Y.Y.); (M.J.)
- Department of Dermatology, Japanese Red Cross Society Wakayama Medical Center, Wakayama 640-8558, Japan;
| | - Azusa Yariyama
- Department of Dermatology, Wakayama Medical University, Wakayama 641-0012, Japan; (K.M.); (A.Y.); (A.K.); (K.K.); (C.K.); (Y.Y.); (M.J.)
| | - Ami Kawaguchi
- Department of Dermatology, Wakayama Medical University, Wakayama 641-0012, Japan; (K.M.); (A.Y.); (A.K.); (K.K.); (C.K.); (Y.Y.); (M.J.)
| | - Kayo Kunimoto
- Department of Dermatology, Wakayama Medical University, Wakayama 641-0012, Japan; (K.M.); (A.Y.); (A.K.); (K.K.); (C.K.); (Y.Y.); (M.J.)
| | - Chikako Kaminaka
- Department of Dermatology, Wakayama Medical University, Wakayama 641-0012, Japan; (K.M.); (A.Y.); (A.K.); (K.K.); (C.K.); (Y.Y.); (M.J.)
| | - Yuki Yamamoto
- Department of Dermatology, Wakayama Medical University, Wakayama 641-0012, Japan; (K.M.); (A.Y.); (A.K.); (K.K.); (C.K.); (Y.Y.); (M.J.)
| | - Kaoru Tsujioka
- Department of Dermatology, Japanese Red Cross Society Wakayama Medical Center, Wakayama 640-8558, Japan;
| | - Akira Yoshida
- Department of Pediatrics, Japanese Red Cross Society Wakayama Medical Center, Wakayama 640-8558, Japan;
| | - Teruki Yanagi
- Department of Dermatology, Hokkaido University, Sapporo 060-8638, Japan;
| | - Masatoshi Jinnin
- Department of Dermatology, Wakayama Medical University, Wakayama 641-0012, Japan; (K.M.); (A.Y.); (A.K.); (K.K.); (C.K.); (Y.Y.); (M.J.)
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Li Y, Lu J, Chen R, Wang Y, Ding Y, Xu S, Zou Y, Yi X, Shi Y. The efficacy and safety of Dupilumab for the Treatment of Atopic Dermatitis Among Chinese Patients in Clinical Practice: A Single-Center Retrospective Study. Dermatol Ther 2022; 35:e15385. [PMID: 35174593 DOI: 10.1111/dth.15385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 11/27/2022]
Abstract
Little real-work data regarding the efficacy and safety of dupilumab in the treatment of atopic dermatitis (AD) is available at present. To assess the efficacy and safety of dupilumab at 12 weeks in the treatment of AD in clinical routine clinical practice. Retrospective, single-centre study of adult patients with moderate to severe AD treated with dupilumab for 12 weeks in China. In total, 60 patients (48 male, 12 female; mean age:53.2 ± 15.6) were enrolled in this retrospective study. These patients exhibited a mean AD disease course of 10.6 years (6.0), 30% exhibited a family history of allergies, and 31 (51.7%) had one or more allergic comorbidities. Following dupilumab treatment for 12 weeks, 83.3% and 42% of patients had achieved EASI-50 and EASI-75, respectively. Overall, adverse events(AEs) were reported by 15% of patients, with the most common being conjunctivitis, injection site reactions, and herpes simplex virus infections. Laboratory testing after 12 weeks revealed pronounced decreases in both circulating eosinophil counts [from 0.6(0.1-2.8) to 0.3(0.1-9.7) 10^/L] and total IgE concentrations [from 327(2.46-2500) to 230(47.6-2200) U/ml] in these patients. These real-world data reaffirm the safety and efficacy of dupilumab as a treatment for moderate-to-severe AD among Chinese patients in clinical practice. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ying Li
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China.,Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Jiajing Lu
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China.,Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Rongfen Chen
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China.,Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Yu Wang
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China.,Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Yangfeng Ding
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China.,Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Shuang Xu
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China.,Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Ying Zou
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China.,Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Xuemei Yi
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China.,Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
| | - Yuling Shi
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China.,Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
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30
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Neagu N, Dianzani C, Avallone G, Dell'Aquila C, Morariu SH, Zalaudek I, Conforti C. Dupilumab ocular side effects in patients with atopic dermatitis: a systematic review. J Eur Acad Dermatol Venereol 2022; 36:820-835. [PMID: 35122335 DOI: 10.1111/jdv.17981] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 01/05/2022] [Indexed: 11/29/2022]
Abstract
Atopic dermatitis (AD) is a chronic, inflammatory skin disorder that most frequently occurs in children, but it can also affect adults. Even though most AD cases can be managed with topical treatments, moderate-to-severe forms require systemic therapies. Dupilumab is the first human monoclonal antibody approved for the treatment of AD. Its action is through IL-4 receptor alpha subunit inhibition, thus blocking IL-4 and IL-13 signaling pathways. It has been shown to be an effective, well tolerated therapy for AD, as well as for asthma, chronic rhinosinusitis with nasal polyposis (CRSwNP) and eosinophilic esophagitis (EoE). However, an increasing incidence of Dupilumab-induced ocular surface disease (DIOSD) has been reported in patients treated with Dupilumab, as compared to placebo. The aim of this study was to summarize scientific data regarding DIOSD in AD patients treated with Dupilumab. A search of PubMed and clinicaltrials.gov databases was performed. There was no limit to study design. All AD cases were moderate-to-severe. DIOSD was either dermatologist-, allergist-, or ophtalmologist-assessed. Evidence shows that DIOSD occurs most frequently in patients with atopic dermatitis and not in other skin conditions, neither in patients with asthma, CRSwNP, nor EoE who are on Dupilumab treatment. Further studies are warranted in order to establish a causal relationship between Dupilumab and ocular surface disease. Nevertheless, ophtalmological evaluations prior to Dupilumab initiation can benefit AD patients with previous ocular pathology or current ocular symptomatology. Also, patch testing for ocular allergic contact dermatitis might be advantageous in patients with a history of allergic conjunctivitis. Furthermore, TARC, IgE and circulating eosinophils levels might be important biomarkers for a baseline assessment of future candidates to Dupilumab treatment. However, TARC measurements should be resumed for research purposes only.
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Affiliation(s)
- N Neagu
- State Clinic of Dermatology, Mureș County Hospital, Tîrgu Mureș, Romania
| | - C Dianzani
- Plastic and Reconstructive Surgery Unit, Medico University of Rome, Campus Bio, Rome, Italy
| | - G Avallone
- Medical Sciences Department, Section of Dermatology, University of Turin, Turin, Italy
| | - C Dell'Aquila
- Department of Medical, Surgical Sciences and Health, Eye Clinic, University of Trieste, Trieste, Italy
| | - S-H Morariu
- State Clinic of Dermatology, Mureș County Hospital, Tîrgu Mureș, Romania
| | - I Zalaudek
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
| | - C Conforti
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
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31
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Erbağcı E, Demirel Öğüt N, Yıldırım SK, Hapa FA. Is Dupilumab Effective in Adult-Onset Atopic Dermatitis: Real-life Experience of 16 Patients. J Cosmet Dermatol 2022; 21:4852-4857. [PMID: 35100490 DOI: 10.1111/jocd.14821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Dupilumab is approved for the treatment of atopic dermatitis (AD). However, there are few studies demonstrating its efficacy and safety, particularly in the treatment of adult-onset AD. OBJECTIVE The aim of this study is to evaluate the real-life experience regarding the efficacy and safety of dupilumab in the treatment of adult-onset AD. METHODS This study is a case series in retrospective design. Patients with the diagnosis of adult-onset AD, using dupilumab at standard dose for at least 3 months were included in the study. Demographic and laboratory data of the cases, data regarding to dupilumab treatment were recorded. The eczema area severity index (EASI) and the visual analog scale (VAS) for itch were used to evaluate treatment efficacy. RESULTS A total of 16 patients, 6 female and 10 male, were included. The median age was 41 years, the median age of the disease onset was 37.5 years, the median duration of the disease was 90 months. The median duration of the dupilumab treatment was 10.5 months. The mean percent reduction from baseline in EASI score was 85.8 ± 12.2 at 3 months, 90.7 ± 9.3 at 6 months, and 93.1 ± 5 at 12 months. The mean percent reduction from baseline in VAS itch score was 82.2 ± 8.6 at 3 months. Acute vestibular neuritis developed in one patient during the dupilumab therapy and resolved with anti-inflammatory therapy. CONCLUSION Dupilumab seems to be highly effective and safe in the treatment of adult-onset AD. Present study is important as it is the first study to evaluate this patient group specifically.
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Affiliation(s)
- Ece Erbağcı
- Uşak University Training and Research Hospital, Department of Dermatology and Venereology, Uşak, Turkey
| | - Neslihan Demirel Öğüt
- Uşak University Training and Research Hospital, Department of Dermatology and Venereology, Uşak, Turkey
| | - Sema Koç Yıldırım
- Uşak University Training and Research Hospital, Department of Dermatology and Venereology, Uşak, Turkey
| | - Fatma Aslı Hapa
- İzmir Demokrasi University Buca Seyfi Demirsoy Training and Research Hospital, Department of Dermatology and Venereology, İzmir, Turkey
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Torres T, Paiva-Lopes MJ, Gonçalo M, Claro C, Oliveira M, Gomes J, Vieira AP, Amoedo P, Alpalhão M, Nogueira M, Santiago F, Henrique M, Amaro C, Esteves T, Alves J, Cerejeira D, Mendes-Bastos P, Pestana M, Ramos L, Rocha J, Carvalho R, Teixeira L, Selores M, Mota A, Filipe P. Dupilumab for atopic dermatitis: a real-world portuguese multicenter retrospective study. J DERMATOL TREAT 2022; 33:2554-2559. [PMID: 35083945 DOI: 10.1080/09546634.2022.2035309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction: Atopic dermatitis (AD) is a difficult-to-treat inflammatory skin disease with a high impact on patients' quality of life. Dupilumab, an IL-4 and IL-13 inhibitor, was the first monoclonal antibody approved for the treatment of moderate-to-severe AD and is currently approved in patients aged 6 or older.Methods: This is a nationwide, multicenter, retrospective, 48-week study designed by the Portuguese Group of AD to assess real-world efficacy and safety of dupilumab for the treatment of AD.Results: A total of 169 patients were enrolled, with a mean disease duration of 22.75 (±11.98) years. The percentage of patients achieving an improvement of at least 75% in Eczema Area and Severity Index (EASI) compared to baseline (EASI75 response) at weeks 12 and 48 was 67.6% and 74.1%, respectively. In the same timepoints, 25.0% and 44.1% achieved an EASI90 response. Patient-reported outcome measures also improved throughout the study period. Regarding safety, 32.0% of the patients developed adverse events, with conjunctivitis (26.6%), persistent facial erythema (4.7%), and arthritis/arthralgia (3.6%) as the more frequently reported.Conclusion: Data from real-world populations are crucial to guide clinicians in their daily decisions. This study provides data demonstrating that dupilumab is an effective and safe therapeutic option for AD.
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Affiliation(s)
- T Torres
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - M J Paiva-Lopes
- Department of Dermatology, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal.,CEDOC, Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - M Gonçalo
- Department of Dermatology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal.,Clinic of Dermatology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - C Claro
- Department of Dermatology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - M Oliveira
- Department of Dermatology, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - J Gomes
- Department of Dermatology, Hospital de Braga, Braga, Portugal
| | - A P Vieira
- Department of Dermatology, Hospital de Braga, Braga, Portugal
| | - P Amoedo
- Department of Dermatology, Centro Hospitalar Universitário de São João EPE, Porto, Portugal
| | - M Alpalhão
- Department of Dermatology, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal.,Dermatology University Clinic, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,Dermatology Research Unit, IMM João Lobo Antunes, University of Lisbon, Lisbon, Portugal
| | - M Nogueira
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - F Santiago
- Department of Dermatology, Centro Hospitalar Leiria-Pombal, Leiria, Portugal
| | - M Henrique
- Department of Dermatology, Centro Hospitalar Leiria-Pombal, Leiria, Portugal
| | - C Amaro
- Department of Dermatology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - T Esteves
- Department of Dermatology, Hospital Central do Funchal, Madeira, Portugal
| | - J Alves
- Department of Dermatology, Hospital Garcia de Orta, Almada, Portugal
| | - D Cerejeira
- Department of Dermatology, Hospital Garcia de Orta, Almada, Portugal
| | - P Mendes-Bastos
- Dermatology Center, Hospital CUF Descobertas, Lisboa, Portugal
| | - M Pestana
- Department of Dermatology, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - L Ramos
- Department of Dermatology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - J Rocha
- Department of Dermatology, Hospital de Pedro Hispano, Matosinhos, Portugal
| | - R Carvalho
- Department of Dermatology, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal.,Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - L Teixeira
- Center for Health Technology and Services Research (CINTESIS), Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS.UP), Porto, Portugal
| | - M Selores
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - A Mota
- Department of Dermatology, Centro Hospitalar Universitário de São João EPE, Porto, Portugal.,Faculty of Medicine, University of Porto, CINTESIS, Porto, Portugal
| | - P Filipe
- Department of Dermatology, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal.,Dermatology University Clinic, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,Dermatology Research Unit, IMM João Lobo Antunes, University of Lisbon, Lisbon, Portugal
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Roh YS, Choi J, Sutaria N, Kwatra SG. Itch: Epidemiology, clinical presentation, and diagnostic workup. J Am Acad Dermatol 2022; 86:1-14. [PMID: 34428534 PMCID: PMC8678917 DOI: 10.1016/j.jaad.2021.07.076] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/24/2021] [Accepted: 07/28/2021] [Indexed: 01/03/2023]
Abstract
Itch, or pruritus, is the uncomfortable sensation underlying the desire to scratch. Itch is a very common complaint in the general population that can result from dermatologic, systemic (eg, renal, hepatobiliary, endocrine), paraneoplastic, neuropathic, and psychogenic etiologies. Chronic itch is associated with significant sleep disturbances and profoundly reduces overall quality of life. Certain populations, including elderly and African Americans, are at increased risk of experiencing heightened burden of itch. Because of the variable clinical presentation and wide-ranging etiologies, itch presents a challenge for clinicians. The initial evaluation should include a complete blood count, with differential, hepatic, renal, and thyroid function testing along with diabetes screening. Further testing should be guided by history and physical examination findings. There should be a heightened concern for underlying malignancy in individuals older than 60 years of age who have a history of liver disease and diffuse itch less than 12 months of duration. For individuals with chronic pruritus of unknown origin, increased blood eosinophils may serve as a biomarker of T helper cell type 2 polarization and response to immunomodulator therapies. In this first part of a 2-part continuing medical education series, we describe the broader epidemiology and specific conditions associated with itch and the clinical presentation and diagnostic workup for patients with itch.
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Affiliation(s)
- Youkyung S. Roh
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Justin Choi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nishadh Sutaria
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shawn G. Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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34
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Kamata M, Tada Y. A Literature Review of Real-World Effectiveness and Safety of Dupilumab for Atopic Dermatitis. JID INNOVATIONS 2021; 1:100042. [PMID: 34909737 PMCID: PMC8659403 DOI: 10.1016/j.xjidi.2021.100042] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/01/2021] [Accepted: 07/14/2021] [Indexed: 02/08/2023] Open
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease with pruritus, characterized by recurrent eczema with exacerbations and remissions. AD impairs patients’ QOL and places a heavy burden on patients. Recently, dupilumab, an anti–IL-4Rα antibody, was approved for the treatment of patients with moderate-to-severe AD who are refractory to topical agents and/or conventional systemic therapy. Clinical trials of dupilumab for AD demonstrated high efficacy and tolerable safety profiles. Furthermore, real-world evidence of dupilumab for AD is accumulating. Most of these data show favorable effectiveness and safety profile; however, they also clarified issues, including conjunctivitis and facial redness. There are still a certain number of patients with significant failure. In this article, we review real-world evidence of dupilumab for AD, identify concerns specific to dupilumab, and discuss unmet needs and issues to be addressed in the future.
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Key Words
- AA, alopecia areata
- AD, atopic dermatitis
- CsA, cyclosporin A
- EASI, Eczema Area and Severity Index
- HSV, herpes simplex virus
- IGA, Investigator’s Global Assessment
- LDH, lactate dehydrogenase
- TCS, topical corticosteroid
- Th, T helper type
- q2w, every other week
- qw, weekly
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Affiliation(s)
- Masahiro Kamata
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Yayoi Tada
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
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35
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Jang DH, Heo SJ, Kook HD, Lee DH, Jung HJ, Park MY, Ahn J. A 52 weeks dupilumab treatment for moderate to severe atopic dermatitis in Korea: long-term efficacy and safety in real world. Sci Rep 2021; 11:23539. [PMID: 34876623 PMCID: PMC8651808 DOI: 10.1038/s41598-021-02950-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/24/2021] [Indexed: 11/09/2022] Open
Abstract
Previously, we have reported short term effectiveness and safety of dupilumab in Korea. In this study, we are trying to report the long-term effectiveness and safety of dupilumab in Korea. Ninety-nine patients with moderate to severe AD were analyzed. They were evaluated using Eczema Area and Severity Index (EASI), Numerical Rating Scale (NRS), Patient Oriented Eczema Measure (POEM), and Dermatology Quality of Life Index (DLQI) at baseline, week 16, 32 and 52. Efficacy outcomes showed higher improvement at 52 weeks compared with 16 weeks; high percentual reductions in EASI (88.1%), peak pruritus NRS (65.6%), POEM (67.2%), and DLQI (69.0%) compared to baseline. Proportion of patients achieving EASI 75 and 90 were 90.2% and 53.7%. POEM and DLQI had high correlation with clinical measured outcomes. In the analysis for the factors affecting achievement of EASI 90, female gender (OR 2.5), eosinophilia (OR 0.2) and elevated LDH (OR 0.07) were significantly associated. Most frequent adverse events included facial erythema (19.2%) and conjunctivitis (17.2%), which were mild/moderate and resolved during treatment. In conclusion, dupilumab treatment for 52 weeks in Korean patients with moderate-to-severe AD confirmed long term effectiveness and safety.
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Affiliation(s)
- Dong Hyek Jang
- Department of Dermatology, National Medical Center, 245 Eulji-ro, Jung-gu, Seoul, 04564, Korea
| | - Seok Jae Heo
- Department of Biostatistics and Computing, Yonsei University Graduate School, Seoul, Korea
| | - Hyung Don Kook
- Department of Dermatology, National Medical Center, 245 Eulji-ro, Jung-gu, Seoul, 04564, Korea
| | - Dong Heon Lee
- Department of Dermatology, National Medical Center, 245 Eulji-ro, Jung-gu, Seoul, 04564, Korea
| | - Hye Jung Jung
- Department of Dermatology, National Medical Center, 245 Eulji-ro, Jung-gu, Seoul, 04564, Korea
| | - Mi Yeon Park
- Department of Dermatology, National Medical Center, 245 Eulji-ro, Jung-gu, Seoul, 04564, Korea
| | - Jiyoung Ahn
- Department of Dermatology, National Medical Center, 245 Eulji-ro, Jung-gu, Seoul, 04564, Korea.
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36
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Long-Term Narrowband UV-B Efficacy in Moderate to Severe Atopic Dermatitis. Dermatitis 2021; 33:282-286. [DOI: 10.1097/der.0000000000000810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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37
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Lee Y, Kim ME, Nahm DH. Real Clinical Practice Data of Monthly Dupilumab Therapy in Adult Patients With Moderate-to-Severe Atopic Dermatitis: Clinical Efficacy and Predictive Markers for a Favorable Clinical Response. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2021; 13:733-745. [PMID: 34486258 PMCID: PMC8419649 DOI: 10.4168/aair.2021.13.5.733] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/25/2021] [Accepted: 03/15/2021] [Indexed: 11/30/2022]
Abstract
Purpose Dupilumab is recommended to be administered biweekly to treat adult patients with moderate-to-severe atopic dermatitis (AD). Real clinical practice data on the clinical efficacy of monthly dupilumab therapy are limited. We analyzed real clinical practice data on the clinical efficacy of monthly dupilumab therapy and predictive markers for favorable clinical responses to the therapy. Methods Medical records of 57 adult patients with moderate-to-severe AD who received dupilumab therapy every 4 weeks for 16 weeks were analyzed retrospectively. Eczema Area and Severity Index (EASI) were recorded at baseline and week 16. Clinical responses to monthly dupilumab therapy were defined as the proportion of patients with decreased EASI scores of at least 50% or 75% from baseline at week 16 (EASI-50 or EASI-75). Blood eosinophil counts and serum lactate dehydrogenase (LDH) levels were measured at baseline and week 16. Results Monthly dupilumab therapy showed EASI-50 and EASI-75 clinical responses in 48 (84.2%) and 27 (47.4%) of 57 patients at week 16, respectively. The percentage decrease in EASI scores from baseline at week 16 was significantly inversely correlated with baseline blood eosinophil count (correlation coefficient [r] = −0.405, P = 0.002) and baseline serum LDH level (r = −0.466, P < 0.001). The EASI-75 response rate was higher in patients with low (< 500/µL, 73.3%) than in those with high (≥ 500/µL, 37.5%) baseline blood eosinophil counts (P = 0.032), and was higher in patients with low (< 400 U/L, 55.6%) than those with high (≥ 400 U/L, 10.0%) baseline serum LDH levels (P = 0.013). Conclusions Monthly dupilumab therapy was clinically effective in adult patients with moderate-to-severe AD in real clinical practice. Baseline blood eosinophil count and serum LDH level could be predictive markers for clinical response to dupilumab therapy.
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Affiliation(s)
- Youngsoo Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Myoung-Eun Kim
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Dong-Ho Nahm
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
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Kim SM, Park CO. Does Monthly Dupilumab Therapy Maintain its Clinical Efficacy in Moderate-to-Severe Atopic Dermatitis? ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2021; 13:681-683. [PMID: 34486254 PMCID: PMC8419646 DOI: 10.4168/aair.2021.13.5.681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 08/01/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Su Min Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Ook Park
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea.
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Bakker DS, van der Wal MM, Heeb LE, Giovannone B, Asamoah M, Delemarre EM, Drylewicz J, Nierkens S, Boyman O, de Bruin-Weller MS, Thijs JL, van Wijk F. Early and Long-Term Effects of Dupilumab Treatment on Circulating T-Cell Functions in Patients with Moderate-to-Severe Atopic Dermatitis. J Invest Dermatol 2021; 141:1943-1953.e13. [DOI: 10.1016/j.jid.2021.01.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 12/21/2020] [Accepted: 01/11/2021] [Indexed: 12/16/2022]
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40
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Nettis E, Ferrucci SM, Pellacani G, Di Leo E, Argenziano G, Foti C, Rongioletti F, Patruno C, Ortoncelli M, Macchia L, Tavecchio S, Bonzano L, Di Bona D, Calabrese G, Fabbrocini G. Dupilumab in atopic dermatitis: predictors of treatment outcome and time to response. J Eur Acad Dermatol Venereol 2021; 35:e896-e898. [PMID: 34310749 DOI: 10.1111/jdv.17541] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/14/2021] [Accepted: 07/16/2021] [Indexed: 01/09/2023]
Affiliation(s)
- E Nettis
- Allergist and Dermatologist, Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari - Aldo Moro, Bari, Italy
| | - S M Ferrucci
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - G Pellacani
- Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - E Di Leo
- Section of Allergy and Clinical Immunology, Unit of Internal Medicine, 'F. Miulli' Hospital, Acquaviva delle Fonti, Italy
| | - G Argenziano
- Dermatology Unit, University of Campania, Naples, Italy
| | - C Foti
- Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, Bari, Italy
| | - F Rongioletti
- Dermatology Clinic, University Vita Salute S. Raffaele, Milan, Italy
| | - C Patruno
- Unit of Dermatology, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - M Ortoncelli
- Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy
| | - L Macchia
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari - Aldo Moro, Bari, Italy
| | - S Tavecchio
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - L Bonzano
- Dermatology Unit, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - D Di Bona
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari - Aldo Moro, Bari, Italy
| | - G Calabrese
- Dermatology Unit, University of Campania, Naples, Italy
| | - G Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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The evaluation of dupilumab treatment response in atopic dermatitis patients. North Clin Istanb 2021; 8:145-149. [PMID: 33851078 PMCID: PMC8039099 DOI: 10.14744/nci.2020.42375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 11/08/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: This study aims to demonstrate real-life effectiveness of dupilumab treatment in moderate-to-severe atopic dermatitis patients. METHODS: The 14 patients diagnosed with moderate-to-severe atopic dermatitis were included in this study. All of the patients started dupilumab treatment in our faculty between October 2019 and October 2020. The patients were evaluated at the beginning of the treatment and after 12 weeks of treatments. The baseline scoring atopic dermatitis (SCORAD) scores, the total immunoglobulin E (IgE) levels, and the visual analog scale (VAS) of 0–10 points for itch intensity compared with the post-treatment scores. RESULTS: The SCORAD scores, the serum total IgE levels, and the VAS itch scores of the patients receiving dupilumab treatment dropped significantly following 12 weeks of dupilumab treatment. No significant correlation was demonstrated between the initial SCORAD scores and the serum total IgE values. Besides, no correlation was shown to exist in the reduction of the SCORAD and the serum total IgE values after dupilumab treatment. CONCLUSION: Dupilumab treatment showed significant improvement in disease severity with remarkable reduction in serum total IgE levels.
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Renert-Yuval Y, Thyssen JP, Bissonnette R, Bieber T, Kabashima K, Hijnen D, Guttman-Yassky E. Biomarkers in atopic dermatitis-a review on behalf of the International Eczema Council. J Allergy Clin Immunol 2021; 147:1174-1190.e1. [PMID: 33516871 PMCID: PMC11304440 DOI: 10.1016/j.jaci.2021.01.013] [Citation(s) in RCA: 155] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/22/2020] [Accepted: 01/15/2021] [Indexed: 12/13/2022]
Abstract
Atopic dermatitis (AD) is a common yet complex skin disease, posing a therapeutic challenge with increasingly recognized different phenotypes among variable patient populations. Because therapeutic response may vary on the basis of heterogeneous clinical and molecular phenotypes, a shift toward precision medicine approaches may improve AD management. Herein, we will consider biomarkers as potential instruments in the toolbox of precision medicine in AD and will review the process of biomarker development and validation, the opinion of AD experts on the use of biomarkers, types of biomarkers, encompassing biomarkers that may improve AD diagnosis, biomarkers reflecting disease severity, and those potentially predicting AD development, concomitant atopic diseases, or therapeutic response, and current practice of biomarkers in AD. We found that chemokine C-C motif ligand 17/thymus and activation-regulated chemokine, a chemoattractant of TH2 cells, has currently the greatest evidence for robust correlation with AD clinical severity, at both baseline and during therapy, by using the recommendations, assessment, development, and evaluation approach. Although the potential of biomarkers in AD is yet to be fully elucidated, due to the complexity of the disease, a comprehensive approach taking into account both clinical and reliable, AD-specific biomarker evaluations would further facilitate AD research and improve patient management.
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Affiliation(s)
- Yael Renert-Yuval
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY
| | - Jacob P Thyssen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Robert Bissonnette
- Department of Dermatology, Innovaderm Research, Montreal, Quebec, Canada
| | - Thomas Bieber
- Department of Dermatology and Allergy, Christine Kühne-Center for Allergy Research and Education, University of Bonn, Bonn, Germany
| | - Kenji Kabashima
- Department of Dermatology, Kyoto University School of Medicine, Kyoto, Japan
| | - DirkJan Hijnen
- Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Emma Guttman-Yassky
- Laboratory of Inflammatory Skin Diseases, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY.
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Gori N, Chiricozzi A, Malvaso D, D'Urso DF, Caldarola G, De Simone C, Peris K. Successful Combination of Systemic Agents for the Treatment of Atopic Dermatitis Resistant to Dupilumab Therapy. Dermatology 2021; 237:535-541. [PMID: 33477153 DOI: 10.1159/000512890] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/03/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Dupilumab, a monoclonal antibody inhibiting the signaling pathway of IL-4/IL-13, was shown to be safe and effective in the treatment of moderate/severe atopic dermatitis (AD) in several clinical trials and real-life experiences, with only a small percentage of patients showing to be resistant or to lose disease control. OBJECTIVES In this study, we investigated the effectiveness and safety in combining dupilumab with systemic agents or phototherapy in patients experiencing an inadequate response to dupilumab. METHODS This retrospective, monocentric, observational study consecutively included patients aged >18 years, with moderate-severe AD, under treatment with dupilumab. In this cohort of patients, we analyzed data of subjects who experienced an inadequate response to dupilumab, even when combined with topical corticosteroids, and for whom an additional systemic treatment or phototherapy was combined to dupilumab. RESULTS In this study, we included a total population of 69 patients treated with dupilumab. In 12/69 patients (17.4%) showing an inadequate response to dupilumab, a combined treatment consisting of dupilumab plus methylprednisolone (n = 5), cyclosporine (n = 4), methotrexate (n = 2), or narrow band-UVB (n = 1) was administered. Overall, after 8 weeks of combined therapy, the majority of patients (11 of 12) obtained an improvement of signs and symptoms of AD. Patients treated with combined therapy did not experience any adverse events, neither did they withdraw treatment because of the occurrence of adverse events. CONCLUSIONS This study suggests that the combination of dupilumab with a conventional drug or phototherapy may represent a valid therapeutic choice, maintaining a good safety profile in AD patients recalcitrant to dupilumab monotherapy.
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Affiliation(s)
- Niccolò Gori
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Dermatologia, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Chiricozzi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Dermatologia, Rome, Italy, .,Università Cattolica del Sacro Cuore, Rome, Italy,
| | - Dalma Malvaso
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Dermatologia, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Dario Francesco D'Urso
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Dermatologia, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Clara De Simone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Dermatologia, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ketty Peris
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Dermatologia, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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Patruno C, Napolitano M, Argenziano G, Peris K, Ortoncelli M, Girolomoni G, Offidani A, Ferrucci SM, Amoruso GF, Rossi M, Stingeni L, Malara G, Grieco T, Foti C, Gattoni M, Loi C, Iannone M, Talamonti M, Stinco G, Rongioletti F, Pigatto PD, Cristaudo A, Nettis E, Corazza M, Guarneri F, Amerio P, Esposito M, Belloni Fortina A, Potenza C, Fabbrocini G. Dupilumab therapy of atopic dermatitis of the elderly: a multicentre, real-life study. J Eur Acad Dermatol Venereol 2021; 35:958-964. [PMID: 33332697 DOI: 10.1111/jdv.17094] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/20/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Treatment of moderate-to-severe atopic dermatitis (AD) in the elderly may be challenging, due to side-effects of traditional anti-inflammatory drugs and to comorbidities often found in this age group. Furthermore, efficacy and safety of innovative drugs such as dupilumab are not yet well known. OBJECTIVES A multicentre retrospective, observational, real-life study on the efficacy and safety of dupilumab was conducted in a group of patients aged ≥65 years and affected by severe AD. Their main clinical features were also examined. METHODS Data of elderly patients with severe (EASI ≥24) AD treated with dupilumab at label dosage for 16 weeks were retrospectively collected. Treatment outcome was assessed by comparing objective (EASI) and subjective (P-NRS, S-NRS and DLQI) scores at baseline and after 16 weeks of treatment. RESULTS Two hundred and seventy-six patients were enrolled in the study. They represented 11.37% of all patients with severe AD. Flexural eczema was the most frequent clinical phenotype, followed by prurigo nodularis. The coexistence of more than one phenotype was found in 63/276 (22.82%) subjects. Data on the 16-week treatment with dupilumab were available for 253 (91.67%) patients. Efficacy of dupilumab was demonstrated by a significant reduction of all the scores. No statistically significant difference regarding efficacy was found in elderly patients when compared to the group of our AD patients aged 18-64 years, treated with dupilumab over the same period. Furthermore, only 18 (6.52%) patients discontinued the drug due to inefficacy. Sixty-one (22.51%) patients reported adverse events, conjunctivitis and flushing being the most frequent. One (0.36%) patient only discontinued dupilumab due to an adverse event. CONCLUSIONS Therapy with dupilumab led to a significant improvement of AD over a 16-week treatment period, with a good safety profile. Therefore, dupilumab could be considered as an efficacious and safe treatment for AD also in the elderly.
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Affiliation(s)
- C Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - M Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - G Argenziano
- Dermatology Unit, University of Campania, Naples, Italy
| | - K Peris
- Dermatology, University of the Sacred Heart, Rome, Italy.,Fondazione Policlinico Universitario A.Gemelli, IRCCS, Rome, Italy
| | - M Ortoncelli
- Dermatology Clinic, University of Turin, Turin, Italy
| | - G Girolomoni
- Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy
| | - A Offidani
- Dermatology Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - S M Ferrucci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - G F Amoruso
- AO Cosenza, UOC Dermatologia, Cosenza, Italy
| | - M Rossi
- UO Dermatologia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - L Stingeni
- Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - G Malara
- Struttura Complessa di Dermatologia, Grande Ospedale Metropolitano 'Bianchi Melacrino Morelli', Reggio Calabria, Italy
| | - T Grieco
- Dermatology Unit, Sapienza University of Rome, Rome, Italy
| | - C Foti
- Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - M Gattoni
- Dermatologic Department, S. Andrea Hospital Vercelli, Vercelli, Italy
| | - C Loi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - M Iannone
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - M Talamonti
- Dermatology Unit, Policlinico Tor Vergata, Department of Systemic Medicine, Tor Vergata University of Rome, Rome, Italy
| | - G Stinco
- Department of Medicine, Institute of Dermatology, University of Udine, Udine, Italy
| | - F Rongioletti
- Unit of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - P D Pigatto
- Department of Medical, Surgical and Odontoiatric Science, IRCCS Ospedale Ortopedico Galeazzi, Milano, Italy
| | - A Cristaudo
- San Gallicano Dermatologic Institute IRCCS, Rome, Italy
| | - E Nettis
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari - Aldo Moro, Bari, Italy
| | - M Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - F Guarneri
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - P Amerio
- Dermatologic Clinic, SS. Annunziata Hospital, Chieti, Italy
| | - M Esposito
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - A Belloni Fortina
- Unit of Dermatology, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - C Potenza
- Dermatology Unit 'Daniele Innocenzi', Department of MEDICO-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Terracina, Italy
| | - G Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
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Kreeshan FC, Al-Janabi A, Warren RB, Hunter HJA. Real-World Experience and Laboratory Monitoring of Dupilumab in Patients with Moderate to Severe Atopic Dermatitis in a Tertiary Centre. Dermatol Ther (Heidelb) 2020; 11:149-160. [PMID: 33315229 PMCID: PMC7859021 DOI: 10.1007/s13555-020-00469-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Dupilumab is a biologic therapy approved for treatment of moderate to severe atopic dermatitis (AD). Our objective was to assess the real-world effectiveness, safety and laboratory monitoring practices for dupilumab in a tertiary centre. METHODS A retrospective review of medical records of all patients receiving dupilumab between September 2017 and October 2019 was undertaken. Eczema Area and Severity Index (EASI) and Dermatology Life Quality Index (DLQI) were collected at weeks 0, 12-16 and 26-30. Data on laboratory tests undertaken for dupilumab screening and monitoring were also collected. RESULTS At 12-16 weeks, 58.9% and 37.3% of patients achieved ≥ EASI 75 and ≥ EASI 90, respectively (n = 156). Ninety-four patients underwent further analysis at weeks 26-30 with those achieving ≥ EASI 75 increasing from 61.7% (12-16 weeks) to 75.31%, and EASI 90 increasing from 35.8% (12-16 weeks) to 49.8%. The most common side effects were eye symptoms occurring in 43.1% of patients, with 16.3% developing conjunctivitis. The mean treatment duration was 255 days, during which an average of three sets of blood tests were performed (n = 149). Of all laboratory abnormalities recorded, 24% started after initiation of dupilumab, and 93% were classified as 'mild'. Dupilumab was not documented as causative in any of the cases, nor was treatment stopped on account of laboratory abnormalities. CONCLUSION Dupilumab provides an effective and safe treatment option for patients with AD. Clinical response continued to improve past 16 weeks in this real-world population. No laboratory abnormalities were felt to be secondary to dupilumab; screening and monitoring tests did not influence dupilumab prescribing.
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Affiliation(s)
- Firas Constantin Kreeshan
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, M6 8HD, UK.
| | - Ali Al-Janabi
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, M6 8HD, UK
| | - Richard Bruce Warren
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, M6 8HD, UK
| | - Hamish John Alexander Hunter
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, M6 8HD, UK
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Husein-ElAhmed H, Steinhoff M. Dupilumab in prurigo nodularis: a systematic review of current evidence and analysis of predictive factors to response. J DERMATOL TREAT 2020; 33:1547-1553. [DOI: 10.1080/09546634.2020.1853024] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Husein Husein-ElAhmed
- Department of Dermatology and Venereology, Hospital de Baza, Granada, Spain
- Hamad Medical Corporation, Translational Research Institute, Doha, Qatar
| | - Martin Steinhoff
- Hamad Medical Corporation, Translational Research Institute, Doha, Qatar
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, College of Medicine, Doha, Qatar
- Medical School, Qatar University, Doha, Qatar
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
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Bidirectional association between atopic dermatitis, conjunctivitis, and other ocular surface diseases: A systematic review and meta-analysis. J Am Acad Dermatol 2020; 85:453-461. [PMID: 33253849 DOI: 10.1016/j.jaad.2020.11.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/31/2020] [Accepted: 11/13/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Conjunctivitis and several other ocular surface diseases (OSDs) have been linked to atopic dermatitis (AD) and its treatment. OBJECTIVES To examine the association between AD, conjunctivitis, and other OSDs. METHODS A systematic review and meta-analysis was performed. Two authors independently searched EMBASE, PubMed, SCOPUS, and Web of Science and performed title/abstract and full-text review and data abstraction. Pooled random-effects prevalence and odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. RESULTS The search yielded 5719 nonduplicate articles; 134 were included in the quantitative analysis. AD was associated with conjunctivitis compared to reference individuals (OR, 2.78; 95% CI, 2.33-3.32); the prevalences of conjunctivitis in patients with AD and reference individuals were 31.7% (95% CI, 27.7-35.9) and 13.3% (95% CI, 11.0-15.7), respectively. Keratoconus (OR, 3.71; 95% CI, 1.99-6.94) and ocular herpes simplex (OR, 3.65; 95% CI 2.04-6.51) were also associated with AD. LIMITATIONS Disease definitions differed and often relied on self-reports. Few studies provided data concerning AD phenotype or OSDs other than conjunctivitis. CONCLUSIONS Conjunctivitis is the most common ocular comorbidity in AD. Signs and symptoms of conjunctivitis and other OSDs in AD may be underreported, making proactive inquiry and examination by physicians treating patients with AD important.
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Nettis E, Patella V, Lombardo C, Detoraki A, Macchia L, Di Leo E, Carbonara M, Canonica GW, Bonzano L. Efficacy of dupilumab in atopic comorbidities associated with moderate-to-severe adult atopic dermatitis. Allergy 2020; 75:2653-2661. [PMID: 32424957 DOI: 10.1111/all.14338] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/15/2020] [Accepted: 03/31/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Dupilumab is an anti-IL-4Rα antibody used in the treatment of patients with moderate-to-severe atopic dermatitis (msAD). This study explored the potential benefit of dupilumab in perennial allergic rhinoconjunctivitis (PAR) and perennial allergic asthma (PAA) caused by indoor allergens in adults with msAD. METHODS This multicentric, prospective, observational, real-life study included adult patients with msAD who had been treated with dupilumab in 16 Italian care centres. Efficacy outcomes regarding AD, PAR and PAA were collected at baseline and 16 weeks. Safety was also assessed. RESULTS We enrolled 123 patients with msAD. Between baseline and 16 weeks of treatment, the following measurements decreased statistically significantly: Eczema Area and Severity Index, SCOring AD, Patient-Oriented Eczema Measure, pruritus score, sleep score, Dermatology Life Quality Index and IgE. Dupilumab treatment in patients with comorbid PAR (n = 41) was associated with significant improvements in PAR disease control (measured using a Rhinitis Control Scoring System) and in PAR Quality of life (QoL) (measured using the Rhinoconjunctivitis QoL Questionnaire scores). In 32 patients with comorbid PAA, dupilumab significantly improved PAA control (measured using the Asthma Control Test and five-item Asthma Control Questionnaire scores) and disease-related QoL (measured using the Asthma QoL Questionnaire scores). Thirty-five patients (28.5%) developed conjunctivitis during the study period. CONCLUSION These results support the benefits of dupilumab for adult patients with PAR and/or PAA associated with msAD.
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Affiliation(s)
- Eustachio Nettis
- Department of Emergency and Organ Transplantation School and Chair of Allergology and Clinical Immunology University of Bari ‐ Aldo Moro Bari Italy
| | - Vincenzo Patella
- Division of Allergy and Clinical Immunology Department of Medicine ASL Salerno Santa Maria della Speranza" Hospital Salerno Italy
| | - Carla Lombardo
- Division of Dermatology "U.O. Multizonale APSS" Santa Chiara Hospital Trento Italy
| | - Aikaterini Detoraki
- Department of Internal Medicine and Clinical Pathology Azienda Ospedaliera Universitaria Federico II Naples Italy
| | - Luigi Macchia
- Department of Emergency and Organ Transplantation School and Chair of Allergology and Clinical Immunology University of Bari ‐ Aldo Moro Bari Italy
| | - Elisabetta Di Leo
- Section of Allergy and Clinical Immunology Unit of Internal Medicine‐"F. Miulli" HospitalAcquaviva delle Fonti Bari Italy
| | | | - Giorgio W. Canonica
- Humanitas University Head Personalized Medicine Asthma & Allergy Clinic‐Humanitas Research Hospital‐IRCCS Milano Italy
| | - Laura Bonzano
- Dermatology Unit Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
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Dupilumab shows long-term effectiveness in a large cohort of treatment-refractory atopic dermatitis patients in daily practice: 52-Week results from the Dutch BioDay registry. J Am Acad Dermatol 2020; 84:1000-1009. [PMID: 32946967 DOI: 10.1016/j.jaad.2020.08.127] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 08/27/2020] [Accepted: 08/30/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Real-life data on long-term effectiveness and safety of dupilumab in atopic dermatitis patients are limited. OBJECTIVE To study 52-week effectiveness and safety of dupilumab in a prospective multicenter cohort of adult patients with treatment-refractory atopic dermatitis. METHODS Patients treated with dupilumab and participating in the Dutch BioDay registry were included. Clinical effectiveness and safety were evaluated. RESULTS Two hundred ten atopic dermatitis patients were included. Mean percentage change in Eczema Area and Severity Index score after 16 weeks was -70.0% (standard deviation 33.2%) and further decreased to -76.6% (standard deviation 30.6%) by week 52. A greater than or equal to 75% improvement in the score was achieved by 59.9% of individuals by week 16 and by 70.3% by week 52. The most reported adverse effect was conjunctivitis (34%). Limited patients (17; 8.1%) discontinued dupilumab treatment. LIMITATIONS Because of the lack of a control group and observational design, factors of bias may have been induced. CONCLUSION Treatment with dupilumab resulted in a rapid improvement in clinical outcome measures, and effectiveness further improved during the 52-week follow-up period.
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50
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Fourzali K, Golpanian RS, Yosipovitch G. Dupilumab use in atopic dermatitis and beyond in skin diseases. Immunotherapy 2020; 12:1221-1235. [PMID: 32892674 DOI: 10.2217/imt-2020-0175] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Atopic dermatitis (AD) is a chronic inflammatory condition that affects 5-10% of adults and 9-18% of children and its pathology is rooted in the Th-2-mediated immune response. Dupilumab is a fully human IgG4 monoclonal antibody that targets the IL-4 receptor alpha subunit that is endogenously bound by the Th-2 cytokines IL-4 and IL-13. Successful clinical trials of dupilumab showing marked improvements in clinical signs of AD, patient reported symptoms and quality of life measures led to its approval for clinical use for moderate-to-severe AD in 2017. This review details the current body of evidence on the drug's mechanism of action, pharmacology, clinical efficacy and safety as well as post market and real world use.
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Affiliation(s)
- Kayla Fourzali
- Dr Phillip Frost Department of Dermatology & Cutaneous Surgery & Miami Itch Center, University of Miami Miller School of Medicine, 1600 NW 10th Ave, RMSB 2023, Miami, FL 33136, USA
| | - Rachel Shireen Golpanian
- Dr Phillip Frost Department of Dermatology & Cutaneous Surgery & Miami Itch Center, University of Miami Miller School of Medicine, 1600 NW 10 Ave, RMSB 2023, Miami, FL 33136, USA
| | - Gil Yosipovitch
- Dr Phillip Frost Department of Dermatology & Cutaneous Surgery & Miami Itch Center, University of Miami Miller School of Medicine, 1600 NW 10 Ave, RMSB 2023, Miami, FL 33136, USA
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