1
|
Ariëns LFM, Bakker DS, Spekhorst LS, van der Schaft J, Thijs JL, Haeck I, Flinterman AE, Kamsteeg M, Schuttelaar MLA, Bruin-Weller MS. Rapid and Sustained Effect of Dupilumab on Work Productivity in Patients with Difficult-to-treat Atopic Dermatitis: Results from the Dutch BioDay Registry. Acta Derm Venereol 2021; 101:adv00573. [PMID: 34396421 PMCID: PMC9425610 DOI: 10.2340/00015555-3886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Dupilumab treatment improves signs, symptoms, and quality of life in patients with moderate-to-severe atopic dermatitis. This study evaluated the impact of dupilumab treatment on absenteeism, presenteeism, and related costs in a large multi-centre cohort of adult patients with difficult-to-treat atopic dermatitis in daily practice. Patients treated with dupilumab participating in the Dutch BioDay Registry reporting employment were included. Absenteeism, presenteeism, and related costs at baseline and during follow-up were calculated using the Work Productivity and Activity Impairment questionnaire. A total of 218 adult patients with moderate-to-severe atopic dermatitis were included. Total work impairment reduced significantly from baseline (35.5%) to week 52 (11.5%), p < 0.001. Median weekly productivity losses reduced significantly from baseline (€379.8 (140.7–780.8)) to week 52 (€0.0 (0.0–211.0), p < 0.001). In this study, dupilumab treatment demonstrated a significant improvement in work productivity and reduction in associated costs in a large cohort of patients with difficult-to-treat atopic dermatitis in daily practice.
Collapse
Affiliation(s)
- Lieneke F M Ariëns
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands. E-mail:
| | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Bakker DS, Nierkens S, Knol EF, Giovannone B, Delemarre EM, van der Schaft J, van Wijk F, de Bruin-Weller MS, Drylewicz J, Thijs JL. Confirmation of multiple endotypes in atopic dermatitis based on serum biomarkers. J Allergy Clin Immunol 2021; 147:189-198. [DOI: 10.1016/j.jaci.2020.04.062] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/07/2020] [Accepted: 04/24/2020] [Indexed: 11/30/2022]
|
3
|
Achten R, Bakker D, Ariens L, Lans A, Thijs J, van der Schaft J, de Boer J, Balak D, de Graaf M, van Luijk C, de Bruin-Weller M. Long-term follow-up and treatment outcomes of conjunctivitis during dupilumab treatment in patients with moderate-to-severe atopic dermatitis. J Allergy Clin Immunol Pract 2020; 9:1389-1392.e2. [PMID: 33038589 DOI: 10.1016/j.jaip.2020.09.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/06/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Roselie Achten
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Daphne Bakker
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Lieneke Ariens
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Amanda Lans
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Judith Thijs
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jorien van der Schaft
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joke de Boer
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Deepak Balak
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marlies de Graaf
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Chantal van Luijk
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marjolein de Bruin-Weller
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
4
|
de Beer FS, Bakker DS, Haeck I, Ariens L, van der Schaft J, van Dijk MR, de Bruin-Weller MS. Dupilumab facial redness: Positive effect of itraconazole. JAAD Case Rep 2019; 5:888-891. [PMID: 31681828 PMCID: PMC6818397 DOI: 10.1016/j.jdcr.2019.07.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Fleur S.A. de Beer
- Department of Allergology and Dermatology, University Medical Centre Utrecht, National Expertise Center for Eczema, Utrecht, The Netherlands
- Correspondence to: Fleur S.A. de Beer, MD, Department of Dermatology, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Daphne S. Bakker
- Department of Allergology and Dermatology, University Medical Centre Utrecht, National Expertise Center for Eczema, Utrecht, The Netherlands
| | - Inge Haeck
- Department of Dermatology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Lieneke Ariens
- Department of Allergology and Dermatology, University Medical Centre Utrecht, National Expertise Center for Eczema, Utrecht, The Netherlands
| | - Jorien van der Schaft
- Department of Allergology and Dermatology, University Medical Centre Utrecht, National Expertise Center for Eczema, Utrecht, The Netherlands
| | - Marijke R. van Dijk
- Department of Pathology, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Marjolein S. de Bruin-Weller
- Department of Allergology and Dermatology, University Medical Centre Utrecht, National Expertise Center for Eczema, Utrecht, The Netherlands
| |
Collapse
|
5
|
Bakker DS, Drylewicz J, Nierkens S, Knol EF, Giovannone B, Delemarre EM, van der Schaft J, Balak DMW, de Bruin-Weller MS, Thijs JL. Early identification of atopic dermatitis patients in need of systemic immunosuppressive treatment. Clin Exp Allergy 2019; 49:1641-1644. [PMID: 31520450 PMCID: PMC6973172 DOI: 10.1111/cea.13495] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/30/2019] [Accepted: 09/02/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Daphne S Bakker
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands.,Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Julia Drylewicz
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefan Nierkens
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Edward F Knol
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands.,Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Barbara Giovannone
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eveline M Delemarre
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jorien van der Schaft
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Deepak M W Balak
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marjolein S de Bruin-Weller
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Judith L Thijs
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
6
|
Ariëns LFM, van Nimwegen KJM, Shams M, de Bruin DT, van der Schaft J, van Os-Medendorp H, De Bruin-Weller M. Economic Burden of Adult Patients with Moderate to Severe Atopic Dermatitis Indicated for Systemic Treatment. Acta Derm Venereol 2019; 99:762-768. [PMID: 31073619 DOI: 10.2340/00015555-3212] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Given the introduction of new therapies targeting specific immune pathways for atopic dermatitis (AD), information on the economic burden of AD patients is needed. Direct costs (medication use and healthcare resource utilization) and costs of productivity loss were studied in 90 adult patients with AD indicated for systemic treatment. Costs were calculated for patients with controlled (Investigator Global Assessment (IGA) 0-2) and uncontrolled (IGA 3-5) disease at inclusion. Mean (95% confidence interval (95% CI)) total direct costs were €5,191 (€4,382-6,019) per patient per year (PPY), €4,401 (€3,695-5,215) for patients with controlled AD vs. €6,993 (€5,552-8,406), mean difference €2,593 (€820-4,282) (p=0.014) for patients with uncontrolled AD. Costs of productivity loss were €10,040 (€6,260-14,012) PPY for the total group, €6,886 (€4,188-10,129) PPY for patients with controlled AD vs. €13,702 (€6,124-22,996) for patients with uncontrolled AD, mean difference €6,816 (-€1,638-16,677; p=0.148). Total costs (direct costs+costs of productivity loss) were €15,231 (€11,487-19,455) PPY for the total group, €11,287 (€7,974-15,436) for patients with controlled AD vs. €20,695 (€14,068-34,564), mean difference €9,408 (-€119-19,964) (p=0.077) for patients with uncontrolled AD. Patients with AD using systemic immunosuppressive treatment incur considerable direct costs and costs of productivity loss.
Collapse
Affiliation(s)
- Lieneke F M Ariëns
- Department of Dermatology and Allergology, UMC Utrecht, 3508 GA Utrecht, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
7
|
Abstract
INTRODUCTION For many years, oral immunosuppressive drugs such as cyclosporine A, azathioprine, mycophenolic acid, and methotrexate were the only treatment options, in addition to topical treatment, in patients with severe atopic dermatitis (AD). Dupilumab, a monoclonal antibody targeting the IL-4 receptor alpha, is the first antibody-based treatment commercially available for the treatment of AD. In the near future, more antibody-based treatments and small molecules will become available in the treatment of severe AD. AREAS COVERED This review gives an overview of current and future therapies for severe AD, outlines options to optimize treatment with oral immunosuppressive drugs and gives an insight into the future of personalized treatment in AD. EXPERT OPINION Due to the heterogeneous character of AD, it is unlikely that all patients will respond equally to these newly tested drugs. We believe that biomarkers will lead to better identification of patients that will benefit from these highly specific, but expensive new treatments. In addition to a role for biomarkers in new treatments, the use of pharmacogenomic biomarkers can improve the efficacy of currently used oral immunosuppressive drugs in AD, which will still be needed for the treatment of moderate to severe AD in the coming years.
Collapse
Affiliation(s)
- Jorien van der Schaft
- a National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Judith L Thijs
- a National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Floor M Garritsen
- a National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - D Balak
- a National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Marjolein S de Bruin-Weller
- a National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology , University Medical Center Utrecht , Utrecht , The Netherlands
| |
Collapse
|
8
|
Ariëns LFM, van der Schaft J, Stades AME, van de Woestijne AA, De Bruin-Weller MS. Successful Treatment with Dupilumab in a Patient with Severe, Difficult to Treat Atopic Dermatitis: Beware of Symptomatic Adrenal Insufficiency due to Abrupt Discontinuation of Potent Topical Corticosteroids. Acta Derm Venereol 2018; 98:601-602. [PMID: 29881868 DOI: 10.2340/00015555-2936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
9
|
Ariëns LFM, Bakker DS, van der Schaft J, Garritsen FM, Thijs JL, de Bruin-Weller MS. Dupilumab in atopic dermatitis: rationale, latest evidence and place in therapy. Ther Adv Chronic Dis 2018; 9:159-170. [PMID: 30181845 DOI: 10.1177/2040622318773686] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/23/2018] [Indexed: 01/26/2023] Open
Abstract
Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases. The prevalence of AD is increasing and is currently estimated at 10-20% in adults worldwide. In the majority of patients, AD can be adequately controlled with topical treatment or ultraviolet light therapy, but there is a high unmet need for effective and safe therapeutics in patients with more severe or difficult to treat AD. During the past decade, new advances in the understanding of the underlying immune pathogenesis of AD have led to the development of new, more targeted therapies. Dupilumab, a fully human monoclonal antibody targeting the interleukin (IL)-4 receptor α, thereby blocking the IL-4 and IL-13 pathway, is one of the first biologics that has been developed for AD. Dupilumab has shown promising results in phase III trials and has recently been approved by the US Food and Drug Administration and the European Commission for the treatment of moderate to severe AD. With the approval of dupilumab, we are entering a new era of biological therapeutics in AD management. The place of dupilumab should be established in the current treatment standards. Based on current treatment guidelines and experts' opinions in the management of AD, we have built a proposal for a treatment algorithm for systemic treatment of AD in European countries.
Collapse
Affiliation(s)
- Lieneke F M Ariëns
- Department of Dermatology and Allergology, University Medical Center Utrecht, Room G02.124, 3508 GA Utrecht, The Netherlands
| | - Daphne S Bakker
- Department of Dermatology and Allergology, University Medical Center Utrecht, The Netherlands
| | - Jorien van der Schaft
- Department of Dermatology and Allergology, University Medical Center Utrecht, The Netherlands
| | - Floor M Garritsen
- Department of Dermatology and Allergology, University Medical Center Utrecht, The Netherlands
| | - Judith L Thijs
- Department of Dermatology and Allergology, University Medical Center Utrecht, The Netherlands
| | | |
Collapse
|
10
|
Bakker DS, Garritsen FM, Leavis HL, van der Schaft J, Bruijnzeel-Koomen CAFM, van den Broek MPH, de Bruin-Weller MS. Lymphopenia in atopic dermatitis patients treated with oral immunosuppressive drugs. J DERMATOL TREAT 2018. [PMID: 29526121 DOI: 10.1080/09546634.2018.1451619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Oral immunosuppressive drugs are commonly used in the treatment of atopic dermatitis (AD). In patients with autoimmune- and rheumatic diseases, these drugs have been associated with lymphopenia. Lymphopenia is related to an increased risk of opportunistic infections. The incidence of lymphopenia in patients with AD treated with oral immunosuppressive drugs is yet unknown. OBJECTIVE To evaluate the occurrence of recurrent lymphopenia in patients with AD treated with oral immunosuppressive drugs and to make recommendations for screening in daily practice. METHODS Patients with recurrent lymphopenia (i.e. >5 times lymphocyte counts below 0.8 × 109/L) during treatment with oral immunosuppressive drugs were included from our immunosuppressive drugs database and further analyzed. RESULTS A total of 360 AD patients, treated with oral immunosuppressive drugs, were screened. A recurrent lymphopenia during treatment was found in 11 patients. In 8/11 patients, recurrent lymphopenia was observed during concomitant treatment with prednisone. No serious infections were observed. CONCLUSION Lymphopenia is occasionally seen in AD patients treat with oral immunosuppressive drugs. Concomitant treatment with prednisone seems to be a risk factor. We suggest to include monitoring of lymphocyte counts in the standard follow-up for all AD patients treated with oral immunosuppressive drugs.
Collapse
Affiliation(s)
- Daphne S Bakker
- a Department of Dermatology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Floor M Garritsen
- a Department of Dermatology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Helen L Leavis
- b Department of Rheumatology and Clinical Immunology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Jorien van der Schaft
- a Department of Dermatology , University Medical Center Utrecht , Utrecht , The Netherlands
| | | | - Marcel P H van den Broek
- c Department of Clinical Pharmacy , University Medical Center Utrecht , Utrecht , The Netherlands.,d Department of Clinical Pharmacy , St Antonius Hospital , Nieuwegein , The Netherlands
| | | |
Collapse
|
11
|
Garritsen FM, van der Schaft J, de Graaf M, Hijnen DJ, Bruijnzeel-Koomen CAF, van den Broek MPH, De Bruin-Weller MS. Allopurinol Co-prescription Improves the Outcome of Azathioprine Treatment in Chronic Eczema. Acta Derm Venereol 2018; 98:373-375. [PMID: 29136268 DOI: 10.2340/00015555-2839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Floor M Garritsen
- Department of Dermatology and Allergology, University Medical Center Utrecht, Room G02.124, Post Box 85500, NL-3508 GA Utrecht, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
12
|
Simpson EL, Bruin-Weller M, Flohr C, Ardern-Jones MR, Barbarot S, Deleuran M, Bieber T, Vestergaard C, Brown SJ, Cork MJ, Drucker AM, Eichenfield LF, Foelster-Holst R, Guttman-Yassky E, Nosbaum A, Reynolds NJ, Silverberg JI, Schmitt J, Seyger MMB, Spuls PI, Stalder JF, Su JC, Takaoka R, Traidl-Hoffmann C, Thyssen JP, van der Schaft J, Wollenberg A, Irvine AD, Paller AS. When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council. J Am Acad Dermatol 2017; 77:623-633. [PMID: 28803668 DOI: 10.1016/j.jaad.2017.06.042] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 06/15/2017] [Accepted: 06/19/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although most patients with atopic dermatitis (AD) are effectively managed with topical medication, a significant minority require systemic therapy. Guidelines for decision making about advancement to systemic therapy are lacking. OBJECTIVE To guide those considering use of systemic therapy in AD and provide a framework for evaluation before making this therapeutic decision with the patient. METHODS A subgroup of the International Eczema Council determined aspects to consider before prescribing systemic therapy. Topics were assigned to expert reviewers who performed a topic-specific literature review, referred to guidelines when available, and provided interpretation and expert opinion. RESULTS We recommend a systematic and holistic approach to assess patients with severe signs and symptoms of AD and impact on quality of life before systemic therapy. Steps taken before commencing systemic therapy include considering alternate or concomitant diagnoses, avoiding trigger factors, optimizing topical therapy, ensuring adequate patient/caregiver education, treating coexistent infection, assessing the impact on quality of life, and considering phototherapy. LIMITATIONS Our work is a consensus statement, not a systematic review. CONCLUSION The decision to start systemic medication should include assessment of severity and quality of life while considering the individual's general health status, psychologic needs, and personal attitudes toward systemic therapies.
Collapse
Affiliation(s)
- Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon.
| | - Marjolein Bruin-Weller
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carsten Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' National Health Service Foundation Trust and King's College London, London, United Kingdom
| | - Michael R Ardern-Jones
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | | | - Mette Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Bieber
- Department of Dermatology and Allergy, University of Bonn, Bonn, Germany; Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | | | - Sara J Brown
- Skin Research Group, School of Medicine, University of Dundee, Dundee, United Kingdom; Department of Dermatology, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Michael J Cork
- Sheffield Dermatology Research Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
| | - Aaron M Drucker
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Lawrence F Eichenfield
- Department of Dermatology, University of California, San Diego, California; Department of Pediatrics, University of California, San Diego, California; Rady Children's Hospital, San Diego, California
| | - Regina Foelster-Holst
- Dermatology, Venereology and Allergology, University of Schleswig-Holstein, Kiel, Germany
| | | | - Audrey Nosbaum
- Department of Allergy and Clinical Immunology, University Hospital Lyon Sud, Hospices Civiles de Lyon, Lyon, France
| | - Nick J Reynolds
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; Newcastle Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Jonathan I Silverberg
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, Technische Universität Dresden, Dresden, Germany
| | - Marieke M B Seyger
- Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Phyllis I Spuls
- Department of Dermatology, Academic Medical Centre, Amsterdam, The Netherlands
| | | | - John C Su
- Department of Dermatology, Monash University, Eastern Health and Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia; Department of Paediatrics, Monash University, Eastern Health and Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
| | - Roberto Takaoka
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - Claudia Traidl-Hoffmann
- Institute of Environmental Medicine, UNIKA-T, Technical University of Munich and Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Munich, Germany; CK CARE, Christine-Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Jacob P Thyssen
- Department of Dermatology and Allergy, Herlev-Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Jorien van der Schaft
- Department of Dermatology and Allergology, University Medical Centre Utrech, Utrecht, Germany
| | - Andreas Wollenberg
- Department of Dermatology and Allergy, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Alan D Irvine
- Trinity College Dublin, National Children's Research Centre, Paediatric Dermatology Our Lady's Children's Hospital, Dublin, United Kingdom.
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
| |
Collapse
|
13
|
Garritsen FM, van der Schaft J, van den Reek JM, Politiek K, van Os-Medendorp H, van Dijk M, Hijnen DJ, de Graaf M, Bruijnzeel-Koomen CA, de Jong EM, Schuttelaar MLA, Bruin-Weller MS. Risk of Non-melanoma Skin Cancer in Patients with Atopic Dermatitis Treated with Oral Immunosuppressive Drugs. Acta Derm Venereol 2017; 97:724-730. [PMID: 28218345 DOI: 10.2340/00015555-2637] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
There is uncertainty about the risk of developing non-melanoma skin cancer (NMSC), including basal cell carcinoma and squamous cell carcinoma (SCC), in patients with atopic dermatitis (AD) treated with oral immunosuppressive drugs. A total of 557 patients with AD treated with these drugs in the University Medical Center Utrecht and Groningen, the Netherlands, were analysed. NMSC after oral immunosuppressive treatment was reported in 18 patients (3.2%). The standardized incidence ratio for developing SCC was 13.1 (95% confidence interval (95% CI) 6.5-19.7). Patients developing NMSC were older at the start of therapy (p<0.001) and data lock (p<0.001) compared with patients without NMSC. No significant differences were found in sex, cumulative days of oral immunosuppressive drugs and follow-up between these groups (p=0.42, p=0.88, and p=0.34, respectively). In interpreting these results it is important to include other factors, such as lack of association between treatment duration and tumour development and the long interval between treatment discontinuation and tumour development in some patients.
Collapse
MESH Headings
- Academic Medical Centers
- Administration, Oral
- Adult
- Aged
- Carcinoma, Basal Cell/chemically induced
- Carcinoma, Basal Cell/epidemiology
- Carcinoma, Basal Cell/immunology
- Carcinoma, Basal Cell/pathology
- Carcinoma, Squamous Cell/chemically induced
- Carcinoma, Squamous Cell/epidemiology
- Carcinoma, Squamous Cell/immunology
- Carcinoma, Squamous Cell/pathology
- Dermatitis, Atopic/diagnosis
- Dermatitis, Atopic/drug therapy
- Dermatitis, Atopic/immunology
- Drug Therapy, Combination
- Female
- Humans
- Immunocompromised Host
- Immunosuppressive Agents/administration & dosage
- Immunosuppressive Agents/adverse effects
- Incidence
- Male
- Middle Aged
- Netherlands/epidemiology
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Skin Neoplasms/chemically induced
- Skin Neoplasms/epidemiology
- Skin Neoplasms/immunology
- Skin Neoplasms/pathology
- Time Factors
- Treatment Outcome
Collapse
Affiliation(s)
- Floor M Garritsen
- Department of Dermatology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
van der Schaft J, Keijzer WW, Sanders KJG, de Groot JJC, van den Bersselaar DLCM, van Os-Medendorp H, van Doorn-Op den Akker MM, Bruijnzeel-Koomen CAFM, de Bruin-Weller MS. Is There an Additional Value of Inpatient Treatment for Patients with Atopic Dermatitis? Acta Derm Venereol 2016; 96:797-801. [PMID: 26983375 DOI: 10.2340/00015555-2410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
An inpatient treatment and education programme has been developed for patients with difficult to control atopic dermatitis (AD), with the aim of achieving adequate self-management and long-term disease control. This observational study included adult patients diagnosed with difficult to control AD, admitted for a structured inpatient treatment and education programme. The primary outcome was the Six Area, Six Sign Atopic Dermatitis (SASSAD) score. In total, 79 patients (mean ± SD age 38.8 ± 17.1 years) were included. The median duration of hospitalization was 11 days (interquartile range 8-14). The mean percentage decrease in SASSAD score between admission and discharge was 60.7%, of which 64 (81.0%) patients achieved SASSAD50. The mean percentage decrease in SASSAD score was 69.0% during follow-up, of which 63 (79.7%) patients still had a SASSAD50. In the majority of these patients with difficult to control AD the admission resulted in sustained disease control. This could be achieved by optimization of treatment with topical corticosteroids.
Collapse
Affiliation(s)
- Jorien van der Schaft
- Department of Dermatology and Allergology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
van der Schaft J, van Schaik RH, van Zuilen AD, Hijnen DJ, Berg MT, van den Broek MP, Bruijnzeel-Koomen CA, de Bruin-Weller MS. First experience with extended release tacrolimus in the treatment of adult patients with severe, difficult to treat atopic dermatitis: Clinical efficacy, safety and dose finding. J Dermatol Sci 2016; 81:66-8. [DOI: 10.1016/j.jdermsci.2015.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/08/2015] [Accepted: 10/20/2015] [Indexed: 11/30/2022]
|
16
|
van der Schaft J, van Zuilen AD, Deinum J, Bruijnzeel-Koomen CAFM, de Bruin-Weller MS. Serum creatinine levels during and after long-term treatment with cyclosporine A in patients with severe atopic dermatitis. Acta Derm Venereol 2015; 95:963-7. [PMID: 25916428 DOI: 10.2340/00015555-2125] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Safety data with respect to kidney function during long-term treatment with cyclosporine A (CsA) in patients with atopic dermatitis is limited. Data on serum creatinine levels before, during and after CsA treatment were collected in a retrospective cohort of adult patients with atopic dermatitis. The median duration of treatment of 150 patients was 280 days (interquartile range 203-528 days). There was a significant, but not clinically relevant, increase in serum creatinine compared with the baseline level after 3 weeks of treatment with CsA and stabilization during the maintenance phase at the group level. Twenty-two (14.7%) patients had a greater than 30% increase in serum creatinine (cut-off point for clinically relevant change) compared with baseline. These patients were significantly older than the patients without a 30% increase (mean ± standard deviation age 41.4 ± 15.6 vs. 33.8 ± 11.7 years (p = 0.01)). During follow-up, all patients had a less than 30% increase in serum creatinine levels compared with baseline levels. At the group level serum creatinine levels during follow-up were not significantly different from baseline.
Collapse
Affiliation(s)
- Jorien van der Schaft
- Department of Dermatology and Allergology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands.
| | | | | | | | | |
Collapse
|