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Silverberg JI, Wollenberg A, Reich A, Thaçi D, Legat FJ, Papp KA, Stein Gold L, Bouaziz JD, Pink AE, Carrascosa JM, Rewerska B, Szepietowski JC, Krasowska D, Havlíčková B, Kalowska M, Magnolo N, Pauser S, Nami N, Sauder MB, Jain V, Padlewska K, Cheong SY, Fleuranceau Morel P, Ulianov L, Piketty C. Nemolizumab with concomitant topical therapy in adolescents and adults with moderate-to-severe atopic dermatitis (ARCADIA 1 and ARCADIA 2): results from two replicate, double-blind, randomised controlled phase 3 trials. Lancet 2024; 404:445-460. [PMID: 39067461 DOI: 10.1016/s0140-6736(24)01203-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/17/2024] [Accepted: 06/04/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Nemolizumab, an interleukin (IL)-31 receptor subunit α antagonist, inhibits the IL-31 pathway of itch and skin inflammation in atopic dermatitis. Two international phase 3 studies were done to assess the efficacy and safety of nemolizumab in atopic dermatitis. In this Article we report results for the 16-week initial treatment period of both trials. METHODS ARCADIA 1 and ARCADIA 2 were identical 48-week randomised, double-blind, placebo-controlled phase 3 trials in adult and adolescent participants (aged ≥12 years) with moderate-to-severe atopic dermatitis, associated pruritus, and inadequate response to topical steroids. Participants were enrolled from 281 clinics, hospitals, and academic centres in 22 countries across both trials, and were randomly assigned (2:1) to receive nemolizumab 30 mg subcutaneously (baseline loading dose 60 mg) or matching placebo once every 4 weeks with background topical corticosteroids (TCS) with or without topical calcineurin inhibitors (TCI; ie, TCS-TCI background treatment). Randomisation was done via interactive response technology and stratified by baseline disease and pruritus severity. Study staff and participants were masked throughout the study, with outcome assessors masked until database lock. Coprimary endpoints at week 16 post-baseline were Investigator's Global Assessment (IGA) success (score of 0 [clear skin] or 1 [almost clear skin] with a ≥2-point improvement from baseline) and at least 75% improvement in Eczema Area and Severity Index score from baseline (EASI-75 response). Outcome rates were compared between groups with the Cochran-Mantel-Haenszel test adjusting for randomisation strata. The key secondary endpoints were the proportion of participants with Peak Pruritus Numerical Rating Scale (PP-NRS) score improvement of at least 4 points at weeks 1, 2, 4, and 16; PP-NRS score below 2 at weeks 4 and 16; Sleep Disturbance Numerical Rating Scale score improvement of at least 4 points at week 16; EASI-75 response plus PP-NRS score improvement of at least 4 points at week 16; and IGA success plus PP-NRS score improvement of at least 4 points at week 16. Efficacy analyses were done on an intention-to-treat basis; safety analyses included all participants who received one dose of nemolizumab or placebo. Both studies are completed (ClinicalTrials.gov: ARCADIA 1, NCT03985943 and ARCADIA 2, NCT03989349). FINDINGS Between Aug 9, 2019, and Nov 2, 2022, 1728 participants were enrolled across both trials: 1142 were allocated to nemolizumab plus TCS-TCI (620 in ARCADIA 1 and 522 in ARCADIA 2) and 586 to placebo plus TCS-TCI (321 in ARCADIA 1 and 265 in ARCADIA 2). ARCADIA 1 included 500 (53%) male participants and 441 (47%) female participants, and ARCADIA 2 included 381 (48%) male participants and 406 (52%) female participants. Mean age ranged from 33·3 (SD 15·6) years to 35·2 (17·0) years across the treatment groups. Both trials met the coprimary endpoints; at week 16, a greater proportion of participants receiving nemolizumab plus TCS-TCI versus placebo plus TCS-TCI had IGA success (ARCADIA 1: 221 [36%] of 620 vs 79 [25%] of 321, adjusted percentage difference 11·5% [97·5% CI 4·7-18·3], p=0·0003; ARCADIA 2: 197 [38%] of 522 vs 69 [26%] of 265, adjusted difference 12·2% [4·6-19·8], p=0·0006) and an EASI-75 response (ARCADIA 1: 270 [44%] vs 93 [29%], adjusted difference 14·9% [7·8-22·0], p<0·0001; ARCADIA 2: 220 [42%] vs 80 [30%], adjusted difference 12·5% [4·6-20·3], p=0·0006). Significant benefits were observed with nemolizumab for all key secondary endpoints including improvement in itch, as early as week 1, and sleep improvement by week 16. The safety profile was similar between nemolizumab plus TCS-TCI and placebo plus TCS-TCI. In the safety sets, 306 (50%) of 616 participants (ARCADIA 1) and 215 (41%) of 519 participants (ARCADIA 2) who received nemolizumab plus TCS-TCI had at least one treatment-emergent adverse event (serious treatment-emergent adverse events in six [1%] and 13 [3%], respectively); and 146 (45%) of 321 (ARCADIA 1) and 117 (44%) of 263 (ARCADIA 2) who received placebo plus TCS-TCI had at least one treatment-emergent adverse event (serious treatment-emergent adverse events in four [1%] and three [1%], respectively). Ten serious treatment-emergent adverse events possibly related to nemolizumab were reported in five (1%) participants in ARCADIA 2. No deaths occurred. INTERPRETATION Nemolizumab plus TCS-TCI was efficacious and showed statistically and clinically significant improvements in inflammation and itch in adults and adolescents with moderate-to-severe atopic dermatitis. Nemolizumab might offer a valuable extension of current therapies if approved. FUNDING Galderma.
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Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Andreas Wollenberg
- Department of Dermatology and Allergy, Ludwig-Maximilian University of Munich, Munich, Germany; Department of Dermatology and Allergy, University Hospital Augsburg, Augsburg, Germany
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszów, Poland
| | - Diamant Thaçi
- Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - Franz J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Kim A Papp
- Probity Medical Research and Alliance Clinical Trials, Waterloo, ON, Canada; Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Linda Stein Gold
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Jean-David Bouaziz
- Department of Dermatology, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | - Andrew E Pink
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - José Manuel Carrascosa
- Department of Dermatology, Hospital Universitari Germans Trias I Pujol, Autonomous University of Barcelona, IGTP, Badalona, Spain
| | | | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland
| | - Dorota Krasowska
- Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | | | | | - Nina Magnolo
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | | | - Navid Nami
- Dermatology Clinical Trials, Newport Beach, CA, USA
| | - Maxwell B Sauder
- Probity Medical Research, Waterloo, ON, Canada; Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vipul Jain
- Probity Medical Research, Waterloo, ON, Canada; Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON, Canada; Allergy Research Canada, Niagara Falls, ON, Canada
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Ronconi G, Dondi L, Calabria S, Dondi L, Pedrini A, Esposito I, Scattareggia M, Rogliani P, Trimarchi M, Costanzo A, Patruno C, Naldi L, Martini N. Italian healthcare resource consumptions and direct costs of adults with atopic dermatitis before and after dupilumab treatment. Ital J Dermatol Venerol 2024; 159:417-424. [PMID: 39069839 DOI: 10.23736/s2784-8671.24.07833-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
BACKGROUND Atopic dermatitis (AD) is a heterogeneous disease, associated with comorbidities, and high healthcare consumptions and costs. This study assessed the burden before and after treatment with dupilumab in adults with severe AD from 2018 to 2020, from the perspective of the Italian National Health Service (SSN). METHODS From Fondazione Ricerca e Salute's administrative healthcare database (~5 million inhabitants/year), adults treated with dupilumab from 09/01/2018 to 31/12/2020 (index date) and a five-year lookback were identified. Age, sex and comorbidities at baseline, concomitant drugs, overnight hospitalizations, outpatient specialist services and direct costs charged to the SSN one year before/after index date were assessed. RESULTS Of 337 adults treated with dupilumab (5.8x100,000 adult inhabitants/2019; 8.0x100,000/2020; 55% males; mean age 43±19), 68% (228/337) had ≥12-month follow-up available. Asthma was a common comorbidity (23% patients). Rates of patients treated with nearly all concomitant AD-related therapies reduced from 12 months before to 12 months after dupilumab treatment: antibacterials (from 59% to 50%), systemic corticosteroids (55% to 29%), antihistamines (54% to 38%) and cyclosporine (52% to 7%). A similar trend was observed among patients with asthma as comorbidity. Within 12 months before/after dupilumab, patients hospitalized halved from 14% to 7%, and patients receiving outpatient specialist care reduced from 72% to 65%. Annual mean direct total costs per patient treated with dupilumab charged to the SSN, net of dupilumab cost, were €1384 and €773, before and after dupilumab dispensation, respectively. CONCLUSIONS Before dupilumab, observed patients had higher healthcare resource consumptions and direct SSN costs than after dupilumab.
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Affiliation(s)
- Giulia Ronconi
- Research and Health Foundation, Fondazione ReS (Ricerca e Salute), Rome, Italy
| | - Letizia Dondi
- Research and Health Foundation, Fondazione ReS (Ricerca e Salute), Rome, Italy
| | - Silvia Calabria
- Research and Health Foundation, Fondazione ReS (Ricerca e Salute), Rome, Italy -
| | - Leonardo Dondi
- Research and Health Foundation, Fondazione ReS (Ricerca e Salute), Rome, Italy
| | - Antonella Pedrini
- Research and Health Foundation, Fondazione ReS (Ricerca e Salute), Rome, Italy
| | | | | | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Matteo Trimarchi
- Department of Otolaryngology-Head and Neck Surgery, Ente Ospedaliero Cantonale, Regional Hospital of Lugano, University of Italian Switzerland, Lugano, Switzerland
| | - Antonio Costanzo
- Unit of Dermatology, Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Cataldo Patruno
- Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Luigi Naldi
- Dermatology Department, S. Bortolo Hospital, Vicenza, Italy
| | - Nello Martini
- Research and Health Foundation, Fondazione ReS (Ricerca e Salute), Rome, Italy
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Bhatt DM, Singh A, Madke B, Jangid SD, Sree Ramya T. Pharmacological Trends in the Management of Atopic Dermatitis: A Comprehensive Review. Cureus 2024; 16:e64302. [PMID: 39130865 PMCID: PMC11316685 DOI: 10.7759/cureus.64302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Accepted: 07/11/2024] [Indexed: 08/13/2024] Open
Abstract
Atopic dermatitis (AD) is a prevalent, chronic inflammatory skin condition characterized by pruritus, erythema, and impaired skin barrier function. AD management presents significant challenges due to its complex pathophysiology involving immune dysregulation and genetic predispositions. While traditional therapies, such as topical corticosteroids and emollients, remain foundational, their limitations have spurred the development of novel pharmacological approaches. This comprehensive review explores current pharmacological trends in the management of AD, focusing on emerging therapies that target specific immunological pathways. Biologic agents, including monoclonal antibodies against interleukin (IL)-4, IL-13, and IL-31 receptors, offer targeted mechanisms to modulate immune responses implicated in AD pathogenesis. Janus kinase (JAK) and phosphodiesterase-4 (PDE-4) inhibitors represent another class of promising therapies, providing alternatives for patients resistant to conventional treatments. The review synthesizes evidence from clinical trials and studies to evaluate these pharmacological agents' efficacy and safety profiles. Considerations for personalized medicine approaches, including biomarkers for treatment response prediction and genotype-based therapies, are discussed to highlight the potential for tailored treatment strategies in AD management. In conclusion, this review underscores the evolving landscape of pharmacological interventions for AD, emphasizing the need for continued research to address unmet clinical needs and optimize patient outcomes. By delineating current advancements and future directions, this review aims to inform clinical practice and guide future research endeavours in dermatology.
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Affiliation(s)
- Drishti M Bhatt
- Dermatology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Adarshlata Singh
- Dermatology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Bhushan Madke
- Dermatology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shivani D Jangid
- Dermatology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Talasila Sree Ramya
- Dermatology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Brooks SG, Yosipovitch G. Unmet needs in treating itch: reaching beyond eczema. J DERMATOL TREAT 2024; 35:2351487. [PMID: 38945542 DOI: 10.1080/09546634.2024.2351487] [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: 04/01/2024] [Accepted: 04/29/2024] [Indexed: 07/02/2024]
Abstract
PURPOSE Pruritus is an unpleasant sensation that creates the urge to scratch. In many chronic conditions, relentless pruritus and scratching perpetuates a vicious itch-scratch cycle. Uncontrolled itch can detrimentally affect quality of life and may lead to sleep disturbance, impaired concentration, financial burden, and psychological suffering. Recent strides have been made to develop guidelines and investigate new therapies to treat some of the most common severely pruritic conditions, however, a large group of diseases remains underrecognized and undertreated. The purpose of this article is to provide a comprehensive review of the challenges hindering the treatment of pruritus. METHODS An online search was performed using PubMed, Web of Science, Google Scholar, and ClinicalTrials.gov from 1994 to 2024. Included studies were summarized and assessed for quality and relevance in treating pruritus. RESULTS Several barriers to treating pruritus emerged, including variable presentation, objective measurement of itch, and identifying therapeutic targets. Itch associated with autoimmune conditions, connective tissue diseases, genodermatoses, cutaneous T-cell lymphoma, and pruritus of unknown origin were among the etiologies with the greatest unmet needs. CONCLUSION Treating pruritus poses many challenges and there are many itchy conditions that have no yet been addressed. There is an urgent need for large-scale controlled studies to investigate potential targets for these conditions and novel therapies.
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Affiliation(s)
- Sarah G Brooks
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
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Amerio P, Ferrucci SM, Galluzzo M, Napolitano M, Narcisi A, Levi A, Di Fino S, Palladino C, Patruno C, Rossi M. A Multidisciplinary Approach Is Beneficial in Atopic Dermatitis. Dermatol Ther (Heidelb) 2024; 14:1443-1455. [PMID: 38811470 PMCID: PMC11169114 DOI: 10.1007/s13555-024-01185-1] [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: 04/18/2024] [Accepted: 05/10/2024] [Indexed: 05/31/2024] Open
Abstract
Atopic dermatitis (AD) is a highly heterogeneous chronic inflammatory skin disorder that is frequently associated with a plethora of comorbidities. AD is, therefore, considered a systemic disease impacted by a considerable burden and leading to poor quality of life, especially in patients with moderate-to-severe disease. Since atopic and non-atopic comorbidities can further worsen the disease course, accurate establishment of the patient's individual intrinsic risk profile and needs is crucial and may help in guiding the selection of the best treatment option. Better quality of care for patients with AD can be delivered through a multidisciplinary team led by a dermatologist, for comprehensive patient management. The implementation of a multidisciplinary approach for AD could enhance the delivery of optimised and safe treatments, improve the standard of care and patient outcomes in the short and long term, and prevent or delay the lifelong impact of uncontrolled AD. Understanding the unmet needs, assessing correctly the patient risk profile and enhancing the shared patient-physician decision-making process can lead to disease control and quality-of-life improvement, especially in the context of the introduction of newer treatment for AD. This narrative review is a call for more data to establish standardised patient profiles and multidisciplinary strategies in AD management. In view on the fast-evolving treatments for AD, this review aims at highlighting the importance of a multidisciplinary approach to a comprehensive assessment and holistic care in patients with moderate-to-severe AD.
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Affiliation(s)
- Paolo Amerio
- Dermatology Unit, Department of Medicine and Aging Science, University of Chieti Pescara, 66100, Chieti, Italy
| | - Silvia Mariel Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Galluzzo
- Dermatology Unit, Fondazione Policlinico "Tor Vergata", Rome, Italy
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Maddalena Napolitano
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.
| | | | | | | | | | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Mariateresa Rossi
- Department of Clinical and Experimental Sciences, Dermatology Unit, University of Brescia, Brescia, Italy
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Argenziano G, Mercuri SR, Savoia P, Amerio P, Fortina AB, Bongiorno MR, De Felici Del Giudice MB, Parodi A, Pimpinelli N, Stingeni L, Ortoncelli M, Stinco G, Gualberti G, Levi A, Scuderi V, Bianchi L, Malara G. Burden of Disease in the Real-Life Setting of Patients with Atopic Dermatitis: Italian Data From the MEASURE-AD Study. Dermatol Pract Concept 2024; 14:dpc.1401a79. [PMID: 38048260 PMCID: PMC10868859 DOI: 10.5826/dpc.1401a79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2023] [Indexed: 12/06/2023] Open
Abstract
INTRODUCTION Atopic dermatitis (AD) is a chronic inflammatory skin disease that negatively impacts the quality of life and work productivity of patients. OBJECTIVES We sought to evaluate the real-world burden of AD patients in Italy. METHODS This sub-analysis of the MEASURE-AD multicountry study conducted between December 2019-2020 included patients diagnosed with moderate-to-severe AD eligible for or receiving systemic therapy in the previous 6 months. During a single visit, physician and patient-reported questionnaires were used. RESULTS A total of 118 adult patients were enrolled and 57.6% (N = 68) of patients had moderate-to-severe AD at the time of enrolment according to the Eczema Area and Severity Index. Sleep disorders interfered with daily function in the previous week in 58.5% (N = 69) of patients, pruritus was severe in 50% (N = 59) and 42.4% (N = 50) reported a flare lasting >7 days in the previous 6 months. According to the Dermatology Quality of Life Index, 37.3% (N = 44) of patients reported a severe impact of AD and approximately 10% had clinical depression/anxiety. Current drug therapy was considered inadequate in controlling AD in 26.3% (N=31) of patients. Work activity impairment was 38.6±31.7% and monthly AD-related expenses were 148.6±134.6 Euros per patient. CONCLUSIONS This real-life study documents a high burden of disease in patients with moderate-severe AD in Italy.
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Affiliation(s)
- Giuseppe Argenziano
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Paola Savoia
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Paolo Amerio
- Dermatologic Clinic, Department of Medicine and Aging Science and Dermatologic Clinic, University "G. d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - Anna Belloni Fortina
- Unit of Pediatric Dermatology, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Maria Rita Bongiorno
- Section of Dermatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | | | - Aurora Parodi
- Division of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa Italy and Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Nicola Pimpinelli
- Dermatology Unit, Department Health Sciences, University of Florence, Florence, Italy
| | - Luca Stingeni
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Michela Ortoncelli
- Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy
| | | | | | - Anna Levi
- AbbVie SrL, Campoverde di Latina, Italy
| | | | - Luca Bianchi
- Dermatology Unit, Tor Vergata University Hospital, Rome, Italy
| | - Giovanna Malara
- UOC of Dermatology, Grande Ospedale Metropolitano "Bianchi Melacrino Morelli", Reggio Calabria, Italy
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Colombo D, Rigoni C, Cantù A, Carnevali A, Filippetti R, Franco T, Grassi A, Loi C, Mazzotta A, Patroi I, Raone B, Tomassini MA, Amoruso A, Pane M, Damiani G. Probiotics and Prebiotics Orally Assumed as Disease Modifiers for Stable Mild Atopic Dermatitis: An Italian Real-Life, Multicenter, Retrospective, Observational Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2080. [PMID: 38138183 PMCID: PMC10744411 DOI: 10.3390/medicina59122080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023]
Abstract
The role of the skin-gut axis in atopic dermatitis (AD) remains a subject of debate, limiting non-pharmacological interventions such as probiotics and prebiotics. To improve understanding of their potential as a monotherapy for stable mild cases, we conducted a real-life, multicenter, retrospective observational study in Italy. We administered three selected bacteria (Bifidobacterium animalis subsp. lactis BS01, Lactiplantibacillus plantarum LP14, and Lacticaseibacillus rhamnosus LR05) orally to patients with mild atopic dermatitis without a placebo control group, following up for 12 weeks. Clinical assessments using the Scoring Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI), and Three-Item Severity (TIS) score were conducted on 144 enrolled patients (average age: 25.1 ± 17.6 years). Notably, both pruritus and AD-related lesions (erythema, edema/papules, excoriation) exhibited significant clinical and statistical improvement (p < 0.001) after 12 weeks of exclusive probiotic and prebiotic use. These preliminary results suggest a potential link between the skin-gut microbiome and support the rationale for using specific probiotics and prebiotics in mild AD, even for maintenance, to reduce flares and dysbiosis.
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Affiliation(s)
- Delia Colombo
- Independent Researcher, Private Practice, Via Livigno 6, 20158 Milan, Italy;
| | - Corinna Rigoni
- Independent Researcher, Private Practice, Corso Monteforte 40, 20122 Milan, Italy;
| | - Alessandra Cantù
- Independent Researcher, Private Practice, Via Domodossola 9/A, 20145 Milan, Italy;
| | - Antonello Carnevali
- Independent Researcher, Private Practice, Str. Colomba Pecorari 32/a, 06134 Perugia, Italy;
| | | | - Tiziana Franco
- Independent Researcher, Private Practice, Viao Veio, 04100 Latina, Italy;
| | - Alessandra Grassi
- Independent Researcher, Private Practice, Via Coletti 19, 00191 Rome, Italy;
| | - Camilla Loi
- Independent Researcher, Private Practice, Via X Settembre 1943 7 and 9, 40011 Anzola dell’Emilia, Italy;
| | - Annamaria Mazzotta
- Independent Researcher, Private Practice, Viale di Villa Massimo 48, 00161 Rome, Italy;
| | - Ivona Patroi
- Independent Researcher, Private Practice, Via del Tritone 102, 00187 Rome, Italy;
| | - Beatrice Raone
- Independent Researcher, Private Practice, Via Ruggero Leoncavallo 5, 40137 Bologna, Italy;
| | | | - Angela Amoruso
- Independent Researcher, Probiotical Research srl, Via Mattei 3, 28100 Novara, Italy; (A.A.); (M.P.)
| | - Marco Pane
- Independent Researcher, Probiotical Research srl, Via Mattei 3, 28100 Novara, Italy; (A.A.); (M.P.)
| | - Giovanni Damiani
- Department of Biomedical, Surgical and Dental Sciences University of Milan, 20122 Milan, Italy
- Department of Pharmaceutical and Pharmacological Sciences, PhD Degree Program in Pharmacological Sciences, University of Padua, 35122 Padua, Italy
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Mesjasz A, Kołkowski K, Wollenberg A, Trzeciak M. How to Understand Personalized Medicine in Atopic Dermatitis Nowadays? Int J Mol Sci 2023; 24:ijms24087557. [PMID: 37108720 PMCID: PMC10145758 DOI: 10.3390/ijms24087557] [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: 03/11/2023] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
Atopic dermatitis (AD) is a heterogeneous disease in terms of its phenotypical, barrier, and immunological presentation. Emerging therapies are undoubtedly contributing to a new chapter in the treatment of AD, bringing an excellent possibility of individualization, and thereby creating a tailored approach. The two most promising substance groups are biological drugs (dupilumab, tralokinumab, lebrikizumab, nemolizumab) and Janus kinase inhibitors (JAKis) (baricitinib, upadacitinib, and abrocitinib). The vision that certain well-defined phenotypes and endotypes, as well as personal preferences, may guide the future treatment of AD is both tempting and appealing, but not yet reality. The accessibility of new drugs such as biologics and small molecules has opened up the discussion regarding personalized medicine, referring to the complex nature of AD as well as the experiences from clinical trials and real-world evidence. We have now reached the point of creating new strategies and AD treatment goals by increasing the amount of new information concerning the efficacy and safety of new drugs. This article has reviewed the novel treatment options for AD in the light of the heterogeneity of this disease and proposes a broader vision on the strategy of personalized treatment of AD.
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Affiliation(s)
- Alicja Mesjasz
- Dermatological Students Scientific Association, Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdansk, 80-214 Gdansk, Poland
| | - Karol Kołkowski
- Dermatological Students Scientific Association, Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdansk, 80-214 Gdansk, Poland
| | - Andreas Wollenberg
- Department of Dermatology, Venereology and Allergology, University Hospital, Ludwig Maximilian University, Frauenlobstr. 9-11, 80337 Munich, Germany
- Department of Dermatology, Free University Brussels, University Hospital Brussels, Bd de la Plaine 2, 1050 Brussels, Belgium
| | - Magdalena Trzeciak
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdansk, 80-214 Gdansk, Poland
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Multiplex Proteomic Evaluation in Inborn Errors with Deregulated IgE Response. Biomedicines 2023; 11:biomedicines11010202. [PMID: 36672710 PMCID: PMC9855860 DOI: 10.3390/biomedicines11010202] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/23/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
(1) Background: Atopic dermatitis constitutes one of the most common inflammatory skin manifestations of the pediatric population. The onset of many inborn errors occurs early in life with an AD-like picture associated with a deregulated IgE response. The availability of proteomic tests for the simultaneous evaluation of hundreds of molecules allows for more precise diagnosis in these cases. (2) Methods: Comparative genomic hybridization microarray (Array-CGH) analysis and specific IgE evaluation by using allergenic microarray (ISAC) and microarray (ALEX2) systems were performed. (3) Results: Proteomic investigations that use multiplex methods have proven to be extremely useful to diagnose the sensitization profile in inborn errors with deregulated IgE synthesis. Four patients with rare diseases, such as recessive X-linked ichthyosis (RXLI, OMIM 308100), Comel-Netherton syndrome (NS, OMIM256500), monosomy 1p36 syndrome (OMIM: 607872), and a microduplication of Xp11.4 associated with extremely high levels of IgE: 7.710 kU/L, 5.300 kU/L, 1.826 kU/L, and 10.430 kU/L, respectively, were evaluated by micro- and macroarray multiplex methods. Polyreactivity to both environmental and food allergens was observed in all cases, including the first described case of association of X-chromosome microduplication and HIE. (4) Conclusions: Extensive use of proteomic diagnostics should be included among the procedures to be implemented in inborn errors with hyper-IgE.
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