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Thevan J, Schmauch E, Nilsson J, Guillet CF, Boesch A, Krähenbühl L, Meier-Schiesser B, Schmid-Grendelmeier P, Kündig T, Kolios AGA. Fast Itch Relief during Dupilumab Predicts Clinical Efficacy in Bullous Pemphigoid: A Retrospective Cohort Study. Dermatology 2024:1-8. [PMID: 39074468 DOI: 10.1159/000540590] [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: 02/13/2024] [Accepted: 07/23/2024] [Indexed: 07/31/2024] Open
Abstract
INTRODUCTION Dupilumab has emerged as a promising treatment option for bullous pemphigoid (BP). Rapid identification of responders could avoid the need for additional immunosuppressive treatments that are associated with increased morbidity and mortality. METHODS To investigate the course of itch as an early indicator of treatment response, data of 12 BP patients treated with dupilumab at the University Hospital of Zurich were retrospectively evaluated. Disease severity was assessed by bullous pemphigoid disease area index (BPDAI) and pruritus by a numeric rating scale (NRS, 0-10) at baseline; days 1, 3, 14; months 1, 2; and the last follow-up. RESULTS A total of 8/12 patients (67%) had complete response, and 4/12 patients (33%) had partial response during dupilumab treatment. Notably, a highly significant reduction of pruritus (p < 0.0001) was observed already on day 1 with further improvement at later time points. Moreover, fast relief of itch could predict treatment response with a significant correlation to clinical response on day 14 (Spearman correlation R 0.70, p value 0.025), with a positive but non-significant trend on day 3 (R 0.63, p value 0.091). Additionally, 92% (11/12 patients) were on dupilumab monotherapy at the last follow-up without any concomitant systemic or topical treatment for BP. CONCLUSIONS The rapid and significant decline in BP-associated pruritus observed with dupilumab correlated significantly with disease remission. Early evaluation of pruritus response could change how BP is treated in the future and avoid additional immunosuppressive treatment in BP.
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Affiliation(s)
- Jeivicaa Thevan
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland,
| | - Eloi Schmauch
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- A.I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Jakob Nilsson
- Department of Immunology, University Hospital Zurich, Zurich, Switzerland
| | | | - Andrea Boesch
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Lukas Krähenbühl
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Peter Schmid-Grendelmeier
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Thomas Kündig
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Antonios G A Kolios
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Guttman-Yassky E, Facheris P, Gomez-Arias PJ, Del Duca E, Da Rosa JC, Weidinger S, Bissonnette R, Armstrong AW, Seneschal J, Eyerich K, Estrada YD, Bose SN, Xu D, Chen A, Tatulych S, Güler E, Chan G, Page KM, Kerkmann U. Effect of abrocitinib on skin biomarkers in patients with moderate-to-severe atopic dermatitis. Allergy 2024; 79:1258-1270. [PMID: 38108208 DOI: 10.1111/all.15969] [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: 05/09/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND This is the first report on the effects of abrocitinib, a Janus kinase 1-selective inhibitor, on the expression of skin biomarkers in patients with moderate-to-severe atopic dermatitis (AD). METHODS JADE MOA (NCT03915496) was a double-blind Phase 2a trial. Adults were randomly assigned 1:1:1 to receive monotherapy with once-daily abrocitinib 200 mg, abrocitinib 100 mg, or placebo for 12 weeks. The primary endpoint was change from baseline in markers of inflammation (matrix metalloproteinase [MMP]-12), epidermal hyperplasia (keratin-16 [KRT16]), T-helper 2 (Th2) immune response (C-C motif chemokine ligand [CCL]17, CCL18, and CCL26), and Th22 immune response (S100 calcium binding protein A8, A9, and A12 [S100A8, S100A9, and S100A12]) in skin through 12 weeks. RESULTS A total of 46 patients received abrocitinib 200 mg (n = 14), abrocitinib 100 mg (n = 16), or placebo (n = 16). Abrocitinib improved AD clinical signs and reduced itch. Gene expression of MMP-12, KRT16, S100A8, S100A9, and S100A12 was significantly decreased from baseline with abrocitinib 200 mg (at Weeks 2, 4, and 12) and abrocitinib 100 mg (at Weeks 4 and 12) in a dose-dependent manner. Abrocitinib 200 mg resulted in significant decreases from baseline in CCL17 expression at Week 12 and CCL18 expression at Weeks 2, 4, and 12; no significant decreases were observed for CCL26. CONCLUSIONS Alongside improvements in clinical signs and symptoms of AD, 12 weeks of abrocitinib treatment resulted in downregulation of genes associated with inflammation, epidermal hyperplasia, and Th2 and Th22 immune responses in the skin of patients with moderate-to-severe AD.
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Affiliation(s)
- Emma Guttman-Yassky
- Icahn School of Medicine at Mount Sinai Medical Center, New York, New York, USA
| | - Paola Facheris
- Icahn School of Medicine at Mount Sinai Medical Center, New York, New York, USA
| | | | - Ester Del Duca
- Icahn School of Medicine at Mount Sinai Medical Center, New York, New York, USA
| | - Joel Correa Da Rosa
- Icahn School of Medicine at Mount Sinai Medical Center, New York, New York, USA
| | | | | | | | - Julien Seneschal
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hospital Saint-André, Bordeaux, France
- Bordeaux University, CNRS UMR 5164, Immunoconcept, Bordeaux, France
| | | | - Yeriel D Estrada
- Icahn School of Medicine at Mount Sinai Medical Center, New York, New York, USA
| | - Swaroop N Bose
- Icahn School of Medicine at Mount Sinai Medical Center, New York, New York, USA
| | - Dan Xu
- Pfizer Inc., San Diego, California, USA
| | | | | | | | - Gary Chan
- Pfizer Inc., Groton, Connecticut, USA
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Lu X, Wang W, Wang Y, Huan C, Yang Y. The relationship between umbilical cord blood IL-22 level and infantile eczema at 42 days. Front Pediatr 2024; 12:1376706. [PMID: 38606371 PMCID: PMC11007124 DOI: 10.3389/fped.2024.1376706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/21/2024] [Indexed: 04/13/2024] Open
Abstract
Background The occurrence of eczema is related to helper T 22 (Th22) cytokine disorder, and Th22 mainly secretes interleukin-22 (IL-22). This study aims to investigate the predictive value of umbilical cord blood IL-22 levels on the onset of eczema in infants within 42 days. Study design The study selected 157 full-term healthy neonates born between September 2020 and May 2021. Cord blood was collected immediately after birth to determine IL-22 levels, and the infants were followed up for 42 days to assess the incidence of eczema. Results Among the 157 infants who completed the 42-day follow-up, 86 developed eczema and 71 did not. The level of IL-22 in the umbilical cord blood of the eczema group was lower than that of the non-eczema group (p < 0.05). Additionally, the incidence of eczema in children whose Family history of allergy was significantly higher than in the group without eczema (p < 0.05). Logistic regression analysis indicated that low cord blood IL-22 levels and a family history of allergies were independent risk factors for eczema (p < 0.05). The ROC curve of cord blood IL-22 levels and infant eczema showed that the cut-off value is 36.362 pg/ml, the area under the curve (AUC) is 0.613, the standard error is 0.045, the 95% CI is 0.526-0.701, the sensitivity is 63.4%, and the specificity is 57.0%. Therefore, there is a certain correlation between cord blood IL-22 levels and the incidence of infant eczema. Conclusions Low IL-22 levels in umbilical cord blood may be linked to the development of infant eczema within 42 days, indicating a potential predictive value, although this value appears to be limited.
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Affiliation(s)
- Xujun Lu
- Department of Pediatrics, Air Force Medical University Air Force Medical Center, PLA, Beijing, China
| | - Wenge Wang
- Department of Pediatrics, Air Force Medical University Air Force Medical Center, PLA, Beijing, China
| | - Yang Wang
- Department of Preventive Medicine, Wanshou Road Community Health Service Centre, Beijing, China
| | - Chuo Huan
- Department of Pediatrics, Air Force Medical University Air Force Medical Center, PLA, Beijing, China
| | - Yue Yang
- Department of Pediatrics, Air Force Medical University Air Force Medical Center, PLA, Beijing, China
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Tietz J, Gunde T, Warmuth S, Weinert C, Brock M, Simonin A, Hess C, Johansson M, Spiga F, Muntwiler S, Wickihalder B, Mahler D, Diem D, Zeberer J, Heiz R, Flückiger N, Shiraishi N, Miyake Y, Takahashi N, Fehrholz M, Bertolini M, Lichtlen P, Urech D, Snell D. A Bispecific, Tetravalent Antibody Targeting Inflammatory and Pruritogenic Pathways in Atopic Dermatitis. JID INNOVATIONS 2024; 4:100258. [PMID: 38375189 PMCID: PMC10875227 DOI: 10.1016/j.xjidi.2024.100258] [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: 10/03/2023] [Revised: 12/21/2023] [Accepted: 12/26/2023] [Indexed: 02/21/2024] Open
Abstract
Inhibition of IL-4/IL-13 signaling has dramatically improved the treatment of atopic dermatitis (AD). However, in many patients, clinical responses are slow to develop and remain modest. Indeed, some symptoms of AD are dependent on IL-31, which is only partially reduced by IL-4/IL-13 inhibition. Thus, there is an unmet need for AD treatments that concomitantly block IL-4/IL-13 and IL-31 pathways. We engineered NM26-2198, a bispecific tetravalent antibody designed to accomplish this task. In reporter cell lines, NM26-2198 concomitantly inhibited IL-4/IL-13 and IL-31 signaling with a potency comparable with that of the combination of an anti-IL-4Rα antibody (dupilumab) and an anti-IL-31 antibody (BMS-981164). In human PBMCs, NM26-2198 inhibited IL-4-induced upregulation of CD23, demonstrating functional binding to FcγRII (CD32). NM26-2198 also inhibited the secretion of the AD biomarker thymus and activation-regulated chemokine (TARC) in blood samples from healthy human donors. In male cynomolgus monkeys, NM26-2198 exhibited favorable pharmacokinetics and significantly inhibited IL-31-induced scratching at a dose of 30 mg/kg. In a repeat-dose, good laboratory practice toxicology study in cynomolgus monkeys, no adverse effects of NM26-2198 were observed at a weekly dose of 125 mg/kg. Together, these results justify the clinical investigation of NM26-2198 as a treatment for moderate-to-severe AD.
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Affiliation(s)
| | - Tea Gunde
- Numab Therapeutics AG, Zürich, Switzerland
| | | | | | | | | | | | | | | | | | | | | | - Dania Diem
- Numab Therapeutics AG, Zürich, Switzerland
| | | | - Robin Heiz
- Numab Therapeutics AG, Zürich, Switzerland
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