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Stander S, Kim BS, Guillemin I, Rhoten S, Wratten S, Brookes E, O'Malley JT, Bansal A, Msihid J, Thomas R, Bahloul D. Estimating meaningful change thresholds for Skin Pain-Numeric Rating Scale, Sleep-Numeric Rating Scale and Dermatology Life Quality Index in patients with prurigo nodularis. J Eur Acad Dermatol Venereol 2024. [PMID: 38329222 DOI: 10.1111/jdv.19800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/21/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Prurigo nodularis (PN) is characterized by intensely itchy nodules/lesions and skin pain, which can have a substantial impact on health-related quality of life (HRQoL). Treatment benefits on such symptoms and impacts are best assessed in trials using patient-reported outcome (PROs) instruments such as Skin Pain Numerical Rating Scale (NRS), Sleep-NRS and Dermatology Life Quality Index (DLQI). However, no guidance exists for interpreting meaningful changes in scores using these PROs in patients with PN. OBJECTIVES The main objective was to derive within-patient (responder definition) and between-group improvement thresholds for interpreting Skin Pain-NRS, Sleep-NRS and DLQI total scores in patients with PN. The measurement properties of the three PROs were also evaluated. METHODS Intention-to-treat (ITT), blinded and pooled data were used from the Phase 3 PRIME (NCT04183335) and PRIME2 (NCT04202679) studies evaluating the efficacy of dupilumab in adult patients with PN. Anchor- and distribution-based methods were applied to derive responder definition and between-group thresholds for Skin Pain-NRS, Sleep-NRS and DLQI. Data were additionally used to examine the instrument measurement properties, including reliability, validity and responsiveness. RESULTS A total of 311 patients (mean age 49.5 years, 65.3% female) were included in the pooled ITT population. The within-patient improvement threshold for Skin Pain-NRS was estimated as 4.0 points, 2.0 points for Sleep-NRS and 9.0 points for DLQI total score. A 1.5-point improvement in Skin Pain-NRS scores, 1.0-point in Sleep-NRS and 4.0-point in DLQI indicated a between-group meaningful change. Adequate to good psychometric properties were demonstrated for all three instruments. CONCLUSIONS The results of this study can aid interpretation of Skin Pain-NRS, Sleep-NRS and DLQI scores in patients with PN in both clinical trials and clinical practice to better understand and treat PN-related skin pain and the impact of PN on sleep quality and HRQoL.
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Affiliation(s)
- S Stander
- University Clinic Münster, Münster, Germany
| | - B S Kim
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - S Rhoten
- IQVIA, San Francisco, California, USA
| | | | | | | | - A Bansal
- Regeneron, Tarrytown, New York, USA
| | | | - R Thomas
- Regeneron, Tarrytown, New York, USA
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Zhao Y, Wu L, Lu Q, Gao X, Zhu X, Yao X, Li L, Li W, Ding Y, Song Z, Liu L, Dang N, Zhang C, Liu X, Gu J, Wang J, Geng S, Liu Q, Guo Y, Dong L, Su H, Bai L, O'Malley JT, Luo J, Laws E, Mannent L, Ruddy M, Amin N, Bansal A, Ota T, Wang M, Zhang J. The efficacy and safety of dupilumab in Chinese patients with moderate-to-severe atopic dermatitis: a randomized, double-blind, placebo-controlled study. Br J Dermatol 2021; 186:633-641. [PMID: 34358343 PMCID: PMC9298048 DOI: 10.1111/bjd.20690] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dupilumab is an antibody against interleukin 4 receptor α, used in treating atopic dermatitis (AD). OBJECTIVES To evaluate the efficacy and safety of dupilumab in adult Chinese patients with moderate-to-severe AD. METHODS In this randomized, double-blind, placebo-controlled, parallel-group, phase III study, conducted between December 2018 and February 2020, patients with AD received dupilumab (300mg) or placebo once every 2 weeks for 16 weeks, and were followed up for 12 weeks. The primary efficacy endpoint was the proportion of patients with both Investigator's Global Assessment (IGA) score of 0-1 and a reduction from baseline of ≥2 points at week 16. RESULTS Overall, 165 patients (mean age: 30.6 years; 71.5% male) were randomized: 82 to dupilumab and 83 to placebo. At week 16, 26.8% of patients in the dupilumab group and 4.8% of patients in the placebo group achieved the primary endpoint (difference, 22.0%; 95% confidence interval [CI], 11.37-32.65%; p<0.0001). Compared with placebo, higher proportions of patients in the dupilumab group achieved ≥75% reduction in the Eczema Area and Severity Index score (57.3% vs 14.5%; difference, 42.9%; 95% CI, 29.75-55.97%; p<0.0001) and had ≥3-point (52.4% vs 9.6%; difference, 42.8%; 95% CI, 30.26-55.34%; p<0.0001) and ≥4-point (39.0% vs 4.8%; difference, 34.2%; 95% CI, 22.69-45.72%; p<0.0001) reductions in weekly average daily peak daily pruritus numerical rating scale scores. The incidence of TEAEs during the treatment period was similar in the two groups. The incidence of conjunctivitis, allergic conjunctivitis, and injection site reaction was higher in the dupilumab group than in the placebo group. CONCLUSIONS In adult Chinese patients, dupilumab was effective in improving the signs and symptoms of AD and demonstrated a favorable safety profile.
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Affiliation(s)
- Y Zhao
- Peking University People's Hospital, Beijing, China
| | - L Wu
- Hangzhou First People's Hospital, Hangzhou, China
| | - Q Lu
- The Second Xiangya Hospital of Central South University, Changsha, China
| | - X Gao
- The First Hospital of China Medical University, Shenyang, China
| | - X Zhu
- Wuxi Second People's Hospital, Jiangsu, China
| | - X Yao
- Hospital for skin diseases, Institute of Dermatology, Chinese Academy of medical sciences, Nanjing, China
| | - L Li
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - W Li
- Huashan Hospital, Fudan University, Shanghai, China
| | - Y Ding
- Shanghai Skin Disease Hospital, Shanghai, China
| | - Z Song
- The Southwest Hospital of AMU, Chongqing, China
| | - L Liu
- Peking University First Hospital, Beijing, China
| | - N Dang
- Jinan Central Hospital, Jinan, China
| | - C Zhang
- Peking University Third Hospital, Beijing, China
| | - X Liu
- University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - J Gu
- Changhai Hospital of Shanghai, Shanghai, China
| | - J Wang
- Ningbo No.2 Hospital, Ningbo, China
| | - S Geng
- The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Q Liu
- Tianjin Medical University General Hospital, Tianjin, China
| | - Y Guo
- Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - L Dong
- Research & Development, Sanofi, Shanghai, China
| | - H Su
- Research & Development, Sanofi, Shanghai, China
| | - L Bai
- Research & Development, Sanofi, Shanghai, China
| | | | - J Luo
- Research & Development, Sanofi, Indianapolis, USA
| | - E Laws
- Research & Development, Sanofi, Bridgewater, USA
| | - L Mannent
- Research & Development, Sanofi, Paris, France
| | - M Ruddy
- Research & Development, Regeneron, New York, USA
| | - N Amin
- Research & Development, Regeneron, New York, USA
| | - A Bansal
- Research & Development, Regeneron, New York, USA
| | - T Ota
- Research & Development, Regeneron, New York, USA
| | - M Wang
- Medical, Sanofi China, Shanghai, China
| | - J Zhang
- Peking University People's Hospital, Beijing, China
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Cork MJ, Thaçi D, Eichenfield LF, Arkwright PD, Sun X, Chen Z, Akinlade B, Boklage S, Guillemin I, Kosloski MP, Kamal MA, O'Malley JT, Patel N, Graham NMH, Bansal A. Dupilumab provides favourable long-term safety and efficacy in children aged ≥ 6 to < 12 years with uncontrolled severe atopic dermatitis: results from an open-label phase IIa study and subsequent phase III open-label extension study. Br J Dermatol 2020; 184:857-870. [PMID: 32969489 PMCID: PMC8247037 DOI: 10.1111/bjd.19460] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2020] [Indexed: 02/06/2023]
Abstract
Background Children aged ≥ 6 to < 12 years with severe atopic dermatitis (AD) have limited treatment options. In a 16‐week, randomized, placebo‐controlled, phase III trial in children, dupilumab, a monoclonal antibody inhibiting interleukin (IL)‐4/IL‐13 signalling, significantly improved signs and symptoms with acceptable safety; longer‐term safety and efficacy data are lacking. Objectives To report the pharmacokinetic profile and long‐term safety and efficacy of dupilumab in children (aged ≥ 6 to < 12 years) with severe AD. Methods Children (aged ≥ 6 to < 12 years) with severe AD were enrolled in a global, multicentre, phase IIa, open‐label, ascending‐dose, sequential cohort study and subsequent open‐label extension (OLE) study. Patients received single‐dose dupilumab 2 or 4 mg kg−1 followed by 8‐week pharmacokinetic sampling, then 2 or 4 mg kg−1 weekly for 4 weeks (phase IIa), followed by the same weekly regimen (OLE). Primary endpoints were dupilumab concentration–time profile and treatment‐emergent adverse events (TEAEs); secondary assessments included Eczema Area and Severity Index (EASI) and Peak Pruritus Numeric Rating Scale (PP‐NRS) score. Results Of 38 children enrolled, 37 completed phase IIa and 33 continued to the OLE. Nonlinear, target‐mediated pharmacokinetics characterized dupilumab concentrations (week 24–48 mean serum concentrations: 2 mg kg−1, 61–77 mg L−1; 4 mg kg−1, 143–181 mg L−1). TEAEs were mostly mild to moderate and transient; none led to treatment discontinuation. The most commonly reported TEAEs were nasopharyngitis (2 mg kg−1, 47%; 4 mg kg−1, 56%) and AD exacerbation (29% and 13%, respectively). Single‐dose dupilumab rapidly improved AD with further improvements through week 52. Mean EASI and PP‐NRS improved by −37%/−33% and −17%/−20% at week 2 (phase IIa) and −92%/−84% and −70%/−58% at week 52 (OLE), respectively. Conclusions These safety and efficacy results support the use of dupilumab as a continuous long‐term treatment for children aged ≥ 6 to < 12 years with severe AD. What is already known about this topic?Severe atopic dermatitis (AD) has a marked negative impact on patient quality of life and can cause financial burden owing to a lack of effective treatments. Dupilumab significantly improved signs and symptoms of AD with an acceptable safety profile in a 16‐week randomized, double‐blind, placebo‐controlled phase III study in children aged ≥ 6 to < 12 years with severe AD.
What does this study add?This study extends information on the safety, efficacy and pharmacokinetic profile of dupilumab treatment for up to 52 weeks in children aged ≥ 6 to < 12 years with severe AD. The results support the use of dupilumab as a continuous long‐term treatment for children aged ≥ 6 to < 12 years with severe AD.
Linked Comment: Sibbald. Br J Dermatol 2021; 184:792–793.
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Affiliation(s)
- M J Cork
- Sheffield Dermatology Research, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Sheffield Children's Hospital Clinical Research Facility, Sheffield, UK
| | - D Thaçi
- Institute and Comprehensive Center of Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - L F Eichenfield
- Departments of Dermatology, University of California San Diego School of Medicine, San Diego, CA, USA
| | - P D Arkwright
- Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK
| | - X Sun
- Regeneron Pharmaceuticals, Inc., Basking Ridge, NJ, USA
| | - Z Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - B Akinlade
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - S Boklage
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - M P Kosloski
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - M A Kamal
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | | | - N M H Graham
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - A Bansal
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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Wu PZ, Liberman LD, Bennett K, de Gruttola V, O'Malley JT, Liberman MC. Primary Neural Degeneration in the Human Cochlea: Evidence for Hidden Hearing Loss in the Aging Ear. Neuroscience 2018; 407:8-20. [PMID: 30099118 DOI: 10.1016/j.neuroscience.2018.07.053] [Citation(s) in RCA: 211] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 07/25/2018] [Accepted: 07/30/2018] [Indexed: 01/18/2023]
Abstract
The noise-induced and age-related loss of synaptic connections between auditory-nerve fibers and cochlear hair cells is well-established from histopathology in several mammalian species; however, its prevalence in humans, as inferred from electrophysiological measures, remains controversial. Here we look for cochlear neuropathy in a temporal-bone study of "normal-aging" humans, using autopsy material from 20 subjects aged 0-89 yrs, with no history of otologic disease. Cochleas were immunostained to allow accurate quantification of surviving hair cells in the organ Corti and peripheral axons of auditory-nerve fibers. Mean loss of outer hair cells was 30-40% throughout the audiometric frequency range (0.25-8.0 kHz) in subjects over 60 yrs, with even greater losses at both apical (low-frequency) and basal (high-frequency) ends. In contrast, mean inner hair cell loss across audiometric frequencies was rarely >15%, at any age. Neural loss greatly exceeded inner hair cell loss, with 7/11 subjects over 60 yrs showing >60% loss of peripheral axons re the youngest subjects, and with the age-related slope of axonal loss outstripping the age-related loss of inner hair cells by almost 3:1. The results suggest that a large number of auditory neurons in the aging ear are disconnected from their hair cell targets. This primary neural degeneration would not affect the audiogram, but likely contributes to age-related hearing impairment, especially in noisy environments. Thus, therapies designed to regrow peripheral axons could provide clinically meaningful improvement in the aged ear.
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Affiliation(s)
- P Z Wu
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA 02114, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA 02115, USA; Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - L D Liberman
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA 02114, USA
| | - K Bennett
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
| | - V de Gruttola
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
| | - J T O'Malley
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA 02114, USA
| | - M C Liberman
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA 02114, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA 02115, USA.
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