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Ardern-Jones MR, Brown SJ, Flohr C, Hossain P, Irvine AD, Johnston GA, Lane M, Langan SM, Laws P, O'Driscoll D, O'Kane D, Payne A, Petrof G, Pink AE, Rauz S, Robbie S, Gore SK, Shah M, Woolf RT, Wang C, Tumbeva S, Mohd Mustapa MF. An expert consensus on managing dupilumab-related ocular surface disorders in people with atopic dermatitis 2024. Br J Dermatol 2024; 191:865-885. [PMID: 39236226 DOI: 10.1093/bjd/ljae344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 07/28/2024] [Indexed: 09/07/2024]
Abstract
Atopic dermatitis (AD) is the most common inflammatory skin condition and affects people of all ages. New therapies, including the monoclonal antibody therapy dupilumab, offer excellent efficacy. However, in clinical trials, and emphasized in real-world observations, an unexpected increased frequency of ocular adverse effects has become apparent. The effectiveness of dupilumab and the unpredictability of ocular adverse effects mean that clinicians need guidance on counselling patients prior to treatment and on managing them if adverse effects arise. The British Association of Dermatologists (BAD) and Royal College of Ophthalmologists collaborated on this consensus guidance on managing dupilumab-related ocular surface disorders (DROSD). A multidisciplinary group was formed of adult and paediatric dermatologists and ophthalmologists with expertise in DROSD, patient representatives and the BAD Clinical Standards Unit. A literature search was conducted and the results reviewed. All recommendations were reviewed, discussed and voted on. The recommendations pertain to dermatology and ophthalmology management, and apply to people of all ages, unless otherwise stated. Importantly, initiation of dupilumab for AD should not be delayed for most eye disorders except acute new problems (e.g. infections) or potentially severe conditions (e.g. a history of corneal transplant; ophthalmology advice should be sought first). There is insufficient evidence to recommend lubricant drops prophylactically. Dermatologists should assess eye complaints to diagnose DROSD; a severity grading system is provided. DROSD management differs slightly in those aged < 7 years, as ocular complications may affect neuro-ocular development. Therefore, irrespectively of DROSD severity, this population should be referred for ophthalmology advice. In those aged ≥ 7 years, dermatologists should feel confident to trial treatment and reserve ophthalmology advice for severe or nonresponding cases. Discussion about dupilumab withdrawal should be prompted by a significant impact on quality of life, threat to sight, or other complications. Although dupilumab is a highly effective agent for treating AD, the risk of ocular adverse effects should not inhibit clinicians or patients from using it, but clinicians should be aware of them. If a patient develops DROSD, there are clear pathways to assess severity and offer initial management. Where this is ineffective, dermatologists should assess the urgency and seek advice from or initiate referral to ophthalmology. While the evidence reviewed for these guidelines reflects the extensive literature on dupilumab, we believe our advice has relevance for ocular surface disorders in patients with AD treated with tralokinumab and lebrikizumab.
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Affiliation(s)
- Michael R Ardern-Jones
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
- Department of Dermatology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Sara J Brown
- Department of Dermatology, Royal Infirmary of Edinburgh, Lauriston Place, Edinburgh EH3 9EN,UK
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road, Edinburgh EH4 2XU, UK
| | - Carsten Flohr
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
- King's College London, London WC2R 2LS, UK
| | - Parwez Hossain
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
- Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Alan D Irvine
- Clinical Medicine, Trinity College Dublin, Dublin D02 PN40, Ireland
| | - Graham A Johnston
- Department of Dermatology, University Hospitals of Leicester NHS Trust, Leicester LE2 0TA, UK
| | - Mark Lane
- Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham B18 7QH, UK
| | - Sinéad M Langan
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Philip Laws
- Department of Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds LS7 4SA, UK
| | - Daniel O'Driscoll
- Department of Dermatology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Department of Dermatology, Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Donal O'Kane
- Department of Dermatology, Belfast Health and Social Care Trust, Belfast BT9 7AB, UK
| | | | - Gabriela Petrof
- Department of Dermatology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK
| | - Andrew E Pink
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
| | - Saaeha Rauz
- Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham B18 7QH, UK
| | - Scott Robbie
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK
| | - Sri K Gore
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK
| | - Mili Shah
- Department of Dermatology, Liverpool University Hospitals NHS Trust, Liverpool L13 4LB, UK
| | - Richard T Woolf
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
| | - Chenxi Wang
- Clinical Standards Unit, British Association of Dermatologists, Willan House, London W1T 5HQ, UK
| | - Stoyana Tumbeva
- Clinical Standards Unit, British Association of Dermatologists, Willan House, London W1T 5HQ, UK
| | - M Firouz Mohd Mustapa
- Clinical Standards Unit, British Association of Dermatologists, Willan House, London W1T 5HQ, UK
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Metko D, Alkofide M, Abu-Hilal M. A real-world study of dupilumab in patients with atopic dermatitis including patients with malignancy and other medical comorbidities. JAAD Int 2024; 15:5-11. [PMID: 38371662 PMCID: PMC10869314 DOI: 10.1016/j.jdin.2024.01.002] [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: 01/09/2024] [Indexed: 02/20/2024] Open
Abstract
Background Dupilumab is a monoclonal antibody approved for the treatment of moderate-to-severe atopic dermatitis (MtS-AD). Various clinical trials have established the effectiveness and safety of dupilumab for the treatment MtS-AD; however, the real-world experiences of patients treated with dupilumab with malignancy and other comorbidities are lacking. Objective To assess the real-life effectiveness and safety of dupilumab in the treatment of MtS-AD within Canadian adult patient population, including those with other significant comorbidities such as malignancy. Methods In this retrospective study, records of adult patients diagnosed with MtS-AD, with a Physician Global Assessment (PGA) score of 3 or 4, and treated with dupilumab for 52 weeks were reviewed and collected. Results A total of 155 adult patients with atopic dermatitis (AD) treated with dupilumab were included in the study. Asthma was the most common comorbidity. One hundred twenty-three (80%) patients received either phototherapy and/or at least 1 systemic agent (methotrexate and cyclosporine) before initiation of dupilumab. PGA score of 0 or 1 was achieved by 64% of patients at week 52. Adverse effects including injection site reactions, ocular surface disease, facial and neck redness, and arthropathy occurred in 6%, 10%, 8%, and 6% of patients, respectively. Three patients continued receiving dupilumab throughout pregnancy, all maintaining PGA score of 0 or 1 with no impact on pregnancy, delivery, or the newborn. Twelve patients with prior or active malignancy were included, with no reported negative impact on malignancy. Conclusion Dupilumab is an effective and safe option for patients with AD in real life, including patients with malignancy and other medical comorbidities.
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Affiliation(s)
- Dea Metko
- Michael G. DeGroote School of Medicine, Hamilton, Canada
| | - Maha Alkofide
- Division of Dermatology, McMaster University, Hamilton, Canada
| | - Mohannad Abu-Hilal
- Michael G. DeGroote School of Medicine, Hamilton, Canada
- Division of Dermatology, McMaster University, Hamilton, Canada
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Kim RW, Lam M, Abuabara K, Simpson EL, Drucker AM. Targeted Systemic Therapies for Adults with Atopic Dermatitis: Selecting from Biologics and JAK Inhibitors. Am J Clin Dermatol 2024; 25:179-193. [PMID: 38216802 DOI: 10.1007/s40257-023-00837-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/14/2024]
Abstract
Therapeutic options for people with moderate or severe atopic dermatitis refractory to topical therapy have rapidly expanded in recent years. These new targeted immunomodulatory agents-biologics and Janus kinase (JAK) inhibitors-have each demonstrated high levels of efficacy and acceptable safety in mostly placebo-controlled clinical trials for atopic dermatitis, but there is no universally applicable algorithm to help choose between them for a given patient. Hence, patients and physicians should utilize shared decision making, discussing efficacy, safety, mode of delivery, monitoring, costs, speed of onset, and other factors to reach individualized treatment decisions. In this review, we try to aid shared decision making by summarizing the efficacy, safety, and monitoring of biologics and oral JAK inhibitors for adults with atopic dermatitis. Network meta-analyses suggest that higher doses of abrocitinib and upadacitinib are more effective than biologics. They also show that, among biologics, dupilumab is likely more effective than tralokinumab and lebrikizumab. Biologics are generally considered safer than JAK inhibitors, although concerns about JAK inhibitors are mainly extrapolated from older generation JAK inhibitors used in higher-risk populations. We also outline evidence and considerations for choosing and using systemic immunomodulatory treatments for special populations including pregnant individuals, those with human immunodeficiency virus (HIV), hepatitis B and C, end stage kidney disease, and older adults.
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Affiliation(s)
- Richard W Kim
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Megan Lam
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Katrina Abuabara
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
- Division of Epidemiology and Biostatistics, University of California, Berkeley School of Public Health, Berkeley, CA, USA
| | - Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - Aaron M Drucker
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Medicine and Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
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Orfali RL, Lorenzini D, Bressan A, Tanaka AA, Cerqueira AMMD, Hirayama ADS, Ramos AMC, Proença CC, Silva CMDR, Laczynski CMM, Carneiro FR, Duarte G, Hans Filho G, Gonçalves HDS, Melo LPD, Azulay-Abulafia L, Weber MB, Rivitti-Machado MC, Zaniboni MC, Ogawa M, Pires MC, Ianhez M, Felix PAO, Bonamigo R, Takaoka R, Lazzarini R, Cestari S, Mayor SAS, Cestari T, Oliveira ZNPD, Spuls PI, Gerbens LAA, Aoki V. Consensus on the therapeutic management of atopic dermatitis ‒ Brazilian Society of Dermatology: an update on phototherapy and systemic therapy using e-Delphi technique. An Bras Dermatol 2023; 98:814-836. [PMID: 37302894 PMCID: PMC10589461 DOI: 10.1016/j.abd.2023.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/04/2023] [Accepted: 04/09/2023] [Indexed: 06/13/2023] Open
Abstract
This publication is an update of the "Consensus on the therapeutic management of atopic dermatitis - Brazilian Society of Dermatology" published in 2019, considering the novel, targeted-oriented systemic therapies for atopic dermatitis. The initial recommendations of the current consensus for systemic treatment of patients with atopic dermatitis were based on a recent review of scientific published data and a consensus was reached after voting. The Brazilian Society of Dermatology invited 31 experts from all regions of Brazil and 2 international experts on atopic dermatitis who fully contributed to the process. The methods included an e-Delphi study to avoid bias, a literature search and a final consensus meeting. The authors added novel approved drugs in Brazil and the indication for phototherapy and systemic therapy for AD. The therapeutical response to systemic treatment is hereby reported in a suitable form for clinical practice and is also part of this updated manuscript.
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Affiliation(s)
- Raquel Leao Orfali
- Department of Dermatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Daniel Lorenzini
- Department of Dermatology, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Aline Bressan
- Department of Dermatology, Hospital Universitário Pedro Ernesto, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Anber Ancel Tanaka
- Department of Dermatology, Hospital Universitário Evangélico Mackenzie, Curitiba, PR, Brazil
| | | | - André da Silva Hirayama
- Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Andréa Machado Coelho Ramos
- Department of Dermatology, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Carolina Contin Proença
- Dermatology Clinic, Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Gleison Duarte
- Department of Dermatology, Instituto Bahiano de Imunoterapia, Salvador, BH, Brazil
| | - Gunter Hans Filho
- Department of Dermatology, Hospital Universitário Maria Aparecida Pedrossian, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Heitor de Sá Gonçalves
- Department of Health, National Reference Center in Sanitary Dermatology Dona Libânia, Fortaleza, CE, Brazil
| | - Ligia Pessoa de Melo
- Department of Dermatology, Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil; Health Department, Hospital Otávio de Freitas, Recife, PE, Brazil
| | - Luna Azulay-Abulafia
- Department of Dermatology, Hospital Universitário Pedro Ernesto, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Professor Rubem David Azulay Institute of Dermatology, Santa Casa de Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Maria Cecília Rivitti-Machado
- Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Department of Dermatology, Universidade Metropolitana de Santos, Santos, SP, Brazil
| | - Mariana Colombini Zaniboni
- Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marília Ogawa
- Department of Dermatology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Mario Cezar Pires
- Department of Dermatology, Complexo Hospitalar Padre Bento, Guarulhos, SP, Brazil; Department of Dermatology, State Public Servant Hospital, São Paulo, SP, Brazil
| | - Mayra Ianhez
- Department of Dermatology, Hospital for Tropical Diseases, Goiânia, GO, Brazil; Department of Dermatology, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | | | - Renan Bonamigo
- Department of Dermatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Roberto Takaoka
- Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rosana Lazzarini
- Dermatology Clinic, Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Silmara Cestari
- Department of Dermatology, Teaching and Research Institute of Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | | | - Tania Cestari
- Department of Dermatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Phyllis I Spuls
- Department of Dermatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, The Netherlands
| | - Louise A A Gerbens
- Department of Dermatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, The Netherlands
| | - Valeria Aoki
- Department of Dermatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Butala S, Castelo-Soccio L, Seshadri R, Simpson EL, O'Shea JJ, Bieber T, Paller AS. Biologic Versus Small Molecule Therapy for Treating Moderate to Severe Atopic Dermatitis: Clinical Considerations. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1361-1373. [PMID: 36948491 PMCID: PMC10164714 DOI: 10.1016/j.jaip.2023.03.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 03/24/2023]
Abstract
The U.S. Food and Drug Administration approval of dupilumab for moderate-to-severe atopic dermatitis shifted the paradigm from use of broad, systemic immunosuppressants to a safer, targeted treatment and led to the emergence of newer interleukin (IL)-4/IL-13 directed biologics and small molecule therapies, namely Janus kinase (JAK) inhibitors (JAKi). Tralokinumab and emerging (not yet approved) lebrikizumab, which both target IL-13, are alternative biologics to dupilumab. The emerging anti-IL-31 receptor nemolizumab is likely to be used second-line to other biologics, primarily for pruritus. Three JAKi are currently in use for treating atopic dermatitis, 2 of which, abrocitinib and upadacitinib, are U.S. Food and Drug Administration-approved. This review provides an in-depth, practical discussion on use of these biologics and JAKi that are approved or have completed phase 3 clinical trials in pediatric patients and adults, comparing the groups of medications based on available efficacy and safety data.
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Affiliation(s)
- Sneha Butala
- Departments of Dermatology and Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Leslie Castelo-Soccio
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Md
| | - Rishi Seshadri
- Department of Dermatology, Oregon Health and Science University, Portland, Ore
| | - Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, Ore
| | - John J O'Shea
- Molecular Immunology and Inflammation Branch, National Institute of Arthritis, Molecular Immunology and Inflammation Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Md
| | - Thomas Bieber
- Department of Dermatology and Allergy, University of Bonn, Bonn, Germany
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Ill.
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Londoño J, Perez L, Moreno S, Chapman E, Garcia MB, Celis AM, Muñoz MA, Castillo D, Sánchez J, Arevalo Y, Lozano A, Alvis-Zakzuk NJ, Muñoz C, Botero L, Beltran C, García E. Effectiveness and safety of dupilumab in adults with moderate and severe atopic dermatitis in Colombia: Real-life experience. World Allergy Organ J 2023; 16:100763. [PMID: 37091550 PMCID: PMC10113899 DOI: 10.1016/j.waojou.2023.100763] [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: 10/05/2022] [Revised: 02/20/2023] [Accepted: 03/12/2023] [Indexed: 04/25/2023] Open
Abstract
Background Dupilumab is a treatment approved for uncontrolled moderate-to-severe atopic dermatitis (AD). Tropical and developing countries such as Colombia have characteristics that may impact the natural history of AD and access to medical treatments. In that sense, we aimed to describe the effectiveness and safety of dupilumab in adults with moderate to severe AD in a Colombian multicenter cohort. Methods Multicenter descriptive study that included patients who started treatment between March 2018 and May 2020 in 6 centers. Disease severity was assessed using the following: Scoring Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI), Patient Oriented Eczema Measure (POEM), and Dermatology Life Quality Index (DLQI). These measurements were collected according to availability at baseline, 3-5 months, 6-12 months, and more than 12 months. Days of sick leave, hospitalizations, and AD flares before and after dupilumab treatment were reported. Adverse events (AEs) were recorded during follow-up. Results Ninety-three patients were included, with a median age of 32 years (IQR: 24.0; 40.0) and a disease evolution time of 21 years (IQR: 16.0; 29.5). 88.2% had at least 1 allergic disease other than AD. An improvement greater than or equal to 75% EASI was observed in 41.7% of patients at 3-5 months, in 73.7% of patients at 6-12 months, and in 75.0% of patients after 12 months. For those reporting SCORAD and POEM, the median percent change ([IQR], n) from baseline in SCORAD was -67.1 ([-79.2; -54.2], n = 16), -70.5 ([-85.8; -47.9], n = 36) and -66.7 ([-77.3; -51.0], n = 13); and POEM, -58.6 ([-66.4; -55.5], n = 4), -73.0 ([-86.5; -66.7], n = 16) and -87.3 ([-93.4; -69.6], n = 8), respectively. Before initiation of dupilumab treatment, 82 (88.2%) patients reported at least 1 flare of AD in the past 12 months. During the follow-up period, 30 (32.3%) patients reported at least 1 exacerbation or flare. Twelve patients (12.9%) presented an AE and 3 (3.2%) patients discontinued dupilumab for this cause. Conclusions Dupilumab was effective and safe for the treatment of moderate to severe AD in point-of-care settings, with results similar to randomized controlled and other real-life studies. These positive results are still maintained even though a high number of patients had short interruptions in the use of dupilumab due to administrative problems.
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Affiliation(s)
| | - Lucia Perez
- Allergy Research Group, UNIMEQ-ORL, Bogotá, Colombia
| | - Sergio Moreno
- Allergy Research Group, UNIMEQ-ORL, Bogotá, Colombia
- School of Medicine, Universidad de Los Andes Bogotá, Colombia
| | - Edgardo Chapman
- Allergy Research Group, UNIMEQ-ORL, Bogotá, Colombia
- Allergy Section, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - María Beatriz Garcia
- Allergy Research Group, UNIMEQ-ORL, Bogotá, Colombia
- Allergy Section, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | | | | | | | - Jorge Sánchez
- Group of Clinical and Experimental Allergy - Hospital "Alma Mater de Antioquia", University of Antioquia, Medellín, Colombia
- Medellín Allergology Unit, Medellín, Colombia
- Clinical and Experimental Allergology Group, Universidad de Antioquia Medellín, Colombia
| | | | | | | | - Cesar Muñoz
- Clínica Respiratoria y de Alergias SAS Cartagena, Colombia
| | | | | | - Elizabeth García
- Allergy Research Group, UNIMEQ-ORL, Bogotá, Colombia
- Allergy Section, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- School of Medicine, Universidad de Los Andes Bogotá, Colombia
- Corresponding author.
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Impact of a Decade of Research Into Atopic Dermatitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:63-71. [PMID: 36162801 DOI: 10.1016/j.jaip.2022.09.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/06/2022] [Accepted: 09/13/2022] [Indexed: 01/11/2023]
Abstract
The last decade has seen an unprecedented pace of change, particularly of clinical research in atopic dermatitis (AD). This review summarizes some key discoveries. Over the last 10 years, nearly half of all studies investigated the efficacy and safety of novel therapeutic agents, particularly biologics and small molecules. Clear demonstration of benefit in clinical trials with no significant safety concerns provided strong evidence leading to subsequent Food and Drug Administration approval and routine use of the anti-IL-4 receptor alpha antagonist dupilumab in patients 6 months and older, the selective Janus kinase 1 (JAK1) inhibitors upadacitinib for patients 12 years and older and abrocitinib, the IL-13 antagonist tralokinumab, and the JAK1/2 inhibitor baricitinib for adults 18 years and older. Several other drugs are in the pipeline. Other areas under the spotlight have been trials of skin moisturizers and probiotics in the prevention of AD, investigating the role of filaggrin and skin barrier function and the role of skin and gut microbiome, with Staphylococcus aureus second immunoglobulin-binding protein having been found to uniquely trigger allergic skin responses in AD. Skin microbiome, epidermal metabolites/structural components, and local inflammatory biomarkers are now commonly assessed using genomic and proteomic analysis of tape strips rather than more invasive biopsy to identify factors such as C-C motif chemokine ligand-17 that correlate with disease severity and response to therapy. Overall, the last decade has ushered in a new and exciting era in our understanding, diagnosis, and treatment of this common allergic skin disease.
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Gu Y, Wang X, Liu F, Zhang J, Zhang X, Liu J, Li S, Wang D, Guan H, Hou D. Total flavonoids of sea buckthorn (Hippophae rhamnoides L.) improve MC903-induced atopic dermatitis-like lesions. JOURNAL OF ETHNOPHARMACOLOGY 2022; 292:115195. [PMID: 35306042 DOI: 10.1016/j.jep.2022.115195] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 06/14/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Sea buckthorn (Hippophae rhamnoides L.) is popularly used as a herbal medicine and food additive in the world. Total flavonoids of Hippophae rhamnoides (TFH) are reported to have anti-inflammatory and immunomodulatory activities. AIM The effects of TFH on atopic dermatitis (AD)-like lesions induced by MC903 in mice was elucidated in the study. METHODS To induce AD-like lesions, MC903 was adopted to apply repeatedly on the left ear in C57BL/6 mice. After induction of AD-like lesions, 0.5% and 1% TFH cream was applied topically on ears of mice once a day for 8 days. The degree of skin lesions was evaluated by macroscopical and histological methods. Expressions of filaggrin (FLG) was evaluated by Western blotting. Real-time polymerase chain reaction (qPCR) was adopted to detect the mRNA expression of thymic stromal lymphopoietin (TSLP), interferon (IFN)-γ, interleukin (IL-4), tumor necrosis factor (TNF)-α in skin lesions. In vitro, Cytokine Antibody Arrays were performed to measure production of cytokines in IFN-γ/TNF-α-treated HaCaT cells, Western blotting was employed to detect the expressions of p-NF-κB, p-ERK and p-P38. RESULTS Topical application of TFH significantly improved the severity of dermatitis by inhibiting the infiltration of mast cell, increasing expression of FLG, decreasing the expressions of TNF-α, IL-4, IFN-γ and TSLP in skin lesions. TFH decreased the levels of IL-1α, IL-1β, IL-6, monocyte chemoattractant protein (MCP)-1, MCP-3, macrophage-derived chemokine (MDC), platelet-derived growth factor (PDGF)-BB, thymus and activation regulated chemokine (TARC) in the supernatants of the HaCaT cells treated by IFN-γ/TNF-α. Furthermore, expressions of p-NF-κB, p-ERK and p-P38 were also decreased by TFH administration with dose dependent manner in HaCaT cells treated by IFN-γ/TNF-α. CONCLUSIONS Topical application of TFH improved AD-like lesions in mice induced by MC903. Which exerted the effects of anti-inflammation and repairing skin barrier by regulating Th1/Th2 balance. This finding indicates that TFH is a novel potential agent for the external treatment of AD.
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Affiliation(s)
- Yajing Gu
- Key Laboratory of Vector Biology and Pathogen Control of Zhejiang Province, Huzhou University, Huzhou, 313000, PR China.
| | - Xinxin Wang
- Basic Medical and Forensic Medicine, Baotou Medical College, Baotou, Inner Mongolia, 014060, PR China; Liaoning University of Traditional Chinese Medicine, Shenyang, 110847, PR China.
| | - Fang Liu
- Changzhi Medical College, Changzhi, Shanxi, 046000, PR China.
| | - Jin Zhang
- Key Laboratory of Vector Biology and Pathogen Control of Zhejiang Province, Huzhou University, Huzhou, 313000, PR China.
| | - Xiufang Zhang
- Xiang'an Hospital of Xiamen University, Xiamen, Fujian, 361100, PR China.
| | - Jiping Liu
- Neurosurgery Department, Northern Hospital of Sinopharm, Baotou, Inner Mongolia, 014030, PR China.
| | - Sijia Li
- Liaoning University of Traditional Chinese Medicine, Shenyang, 110847, PR China.
| | - Decheng Wang
- The Second Clinical Medical Institute, Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning, 110847, PR China.
| | - Hongquan Guan
- Liaoning University of Traditional Chinese Medicine, Shenyang, 110847, PR China.
| | - Diandong Hou
- Key Laboratory of Vector Biology and Pathogen Control of Zhejiang Province, Huzhou University, Huzhou, 313000, PR China; Liaoning University of Traditional Chinese Medicine, Shenyang, 110847, PR China.
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9
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Ahn J, Lee DH, Na CH, Shim DH, Choi YS, Jung HJ, Simpson EL. Facial Erythema in Patients with Atopic Dermatitis Treated with Dupilumab- A Descriptive Study of Morphology and Etiology. J Eur Acad Dermatol Venereol 2022; 36:2140-2152. [PMID: 35695074 DOI: 10.1111/jdv.18327] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/03/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The development of dermatitis on face and neck, which was not described in phase 3 clinical trials, has been reported in the literature in patients treated with dupilumab. Little is known regarding the causes or defining features of the facial dermatitis. OBJECTIVES We conducted surveys of consecutive patients with AD on dupilumab to describe its clinical features, morphology, and etiology. METHODS A multicenter prospective cohort study was conducted from January 1, 2020, to December 31, 2020. A total of 162 patients under dupilumab treatment were asked to complete a questionnaire and patients were evaluated by dermatologists. RESULTS Out of all 162 patients, 137 (84.6%) patients reported pre-existing facial dermatitis prior to dupilumab therapy. 121 (88.3%) patients with pre-existing facial dermatitis reported improvement of their facial dermatitis with dupilumab therapy, 9 (6.6%) patients reported no change after the treatment, and 7 (4.3%) patients of them got worse after the treatment (exacerbation group). Out of 25 patients who reported no pre-existing active facial dermatitis, 6 (24%) patients reported new-onset facial erythema after the starting dupilumab therapy (new-onset group). A large proportion of the patients in both the exacerbation (86%) and new-onset groups (67%) had a history of facial TCS use. Both groups showed similar clinical manifestations and distribution with few differences. CONCLUSIONS The vast majority of patients treated with dupilumab in academic institutions from Korea and U.S. experienced improvement in their facial dermatitis with dupilumab therapy. A small proportion of patients had new onset and exacerbation. Although the mechanisms of this adverse event remains unclear, steroid withdrawal should be considered as a diagnosis of the erythema in some patients.
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Affiliation(s)
- Jiyoung Ahn
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Dong Heon Lee
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Chan Ho Na
- Department of Dermatology, Chosun University College of Medicine, Gwangju, Korea
| | - Dong Hyun Shim
- Department of Dermatology, Chosun University College of Medicine, Gwangju, Korea
| | - Yu Sung Choi
- Department of Dermatology, Ulsan University College of Medicine, Ulsan, Korea
| | - Hye Jung Jung
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
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10
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Eichenfield LF, Armstrong A, Guttman-Yassky E, Lio PA, Chen CC, Hines DM, McGuiness CB, Ganguli S, Delevry D, Sierka D, Mallya UG. Real-World Effectiveness of Dupilumab in Atopic Dermatitis Patients: Analysis of an Electronic Medical Records Dataset. Dermatol Ther (Heidelb) 2022; 12:1337-1350. [PMID: 35543920 PMCID: PMC9209584 DOI: 10.1007/s13555-022-00731-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/12/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction While the efficacy of dupilumab for the treatment of adults with moderate-to-severe atopic dermatitis (AD) has been demonstrated in several clinical trials, patients in such trials may not necessarily reflect the real-world clinical practice setting. This study evaluated the real-world effectiveness of dupilumab in adults with moderate-to-severe AD based on physician global assessment, percent body surface area affected, and patient-reported itch. Methods From Modernizing Medicine’s Electronic Medical Assistant dermatology-specific electronic medical records, adults (≥ 18 years) were identified with a diagnosis of AD and ≥ 1 dupilumab prescription (index event) between 1 April 2017 and 31 January 2019. Three cohorts were identified based on 3-month pre-index (1) Investigator Global Assessment (IGA) score ≥ 3, (2) an itch severity numerical rating scale (NRS) score ≥ 3, and (3) body surface area (BSA) affected ≥ 10%. Changes from pre-index on the outcome within each cohort were evaluated at 4 months post-index. Patients were also stratified for evaluation of outcomes by baseline demographic (sex, age) and prior AD treatments (topical therapy only or no treatment, any systemic therapy). Results More than 70% of the 435 AD patients with baseline IGA score ≥ 3 improved to an IGA score of ≤ 2 at month 4 post-dupilumab initiation, including 42.8% who achieved IGA 0/1 (clear/minimal). Among 112 patients with a pre-index itch severity NRS ≥ 3, scores were reduced from mean (SD) 7.0 (2.4) pre-index to 2.8 (2.8) at month 4 (p < 0.0001); 70.5% of patients had a reduction ≥ 3 points. In the BSA cohort (n = 387), affected BSA was significantly reduced from a pre-index mean (SD) of 39.3% (26.1%) to 16.3% (21.2%) at month 4 (p < 0.0001). Significant improvements in IGA, itch NRS, and BSA were observed regardless of demographic (age and sex) or clinical characteristics such as treatment history (all p < 0.0001 compared with pre-index). Conclusions Consistent with outcomes observed in clinical trials, patients treated with dupilumab in real-world clinical settings achieved clinically meaningful improvements in severity and extent of AD and severity of itch comparable to those reported in clinical trials at a similar time point.
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Affiliation(s)
- Lawrence F Eichenfield
- Departments of Dermatology and Pediatrics, University of California, San Diego School of Medicine, 3020 Children's Way, Mail Code 5092, San Diego, CA, 92123, USA.
| | - April Armstrong
- Department of Dermatology, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
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11
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Zhou B, Peng C, Li L, Liu R, Zhu L, Chen X, Li J. Efficacy and Safety of Dupilumab in Chinese Patients With Atopic Dermatitis: A Real-World Study. Front Med (Lausanne) 2022; 9:838030. [PMID: 35402441 PMCID: PMC8984471 DOI: 10.3389/fmed.2022.838030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/22/2022] [Indexed: 11/25/2022] Open
Abstract
Background Atopic dermatitis (AD) is a common skin disease, but treatment of this disease has been challenging. Dupilumab is a new biological agent for AD that has been proven to be safe and effective in clinical trials. Although dupilumab was approved for listing in China in June 2020, real-world data about the application of dupilumab in China are lacking. This study aimed to collect and analyze real-world data on dupilumab among Chinese AD patients. Methods Demographic and clinical data for 116 AD patients receiving dupilumab treatment were reviewed. The Eczema Area and Severity Index (EASI), SCORing Atopic Dermatitis (SCORAD), Numerical Rating Scale (NRS), Patient Oriented Eczema Measure (POEM), and Dermatology Quality of Life Index (DLQI) of patients were evaluated every 2 weeks from baseline to 16 weeks of treatment. Any adverse events during treatment were recorded. Results Among the 116 patients in this study, baseline levels of IgE, eosinophils, and LDH were elevated in 62.79% (n = 86), 45.30% (n = 86), and 54.20% of patients (n = 48), respectively. The SCORAD index and POEM, DLQI, and NRS scores were significantly improved in all patients at 2 weeks (p < 0.0001), 4 weeks (p < 0.01), and 16 weeks (p < 0.001). EASI scores also improved significantly in all patients at 2 weeks (p < 0.01), 4 weeks (> 0.05), and 16 weeks (p < 0.01). However, 11 patients (9.48%) had no response. IgE and LDH levels (p > 0.05), Eosinophil counts (p < 0.01) in blood increased temporarily in the first 4 weeks and then decreased and stabilized during dupilumab treatment. Conjunctivitis was the most common adverse event (2.59%) among the patients. We found that the curative efficacy of dupilumab at 4th weeks was related to the patient’s age and course of disease. Nevertheless, there is no relationship between levels of eosinophils, IgE, LDH and the therapeutic efficacy of dupilumab. Conclusion The real-world data in China showed that dupilumab can effectively treat AD and is well tolerated with a low incidence of adverse events.
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Affiliation(s)
- Bingjing Zhou
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Cong Peng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Liqiao Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Runqiu Liu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Lei Zhu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jie Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Jie Li,
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12
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Kojanova M, Tanczosova M, Strosova D, Cetkovska P, Fialova J, Dolezal T, Machovcova A, Gkalpakiotis S. Dupilumab for the treatment of atopic dermatitis: Real-world data from the Czech Republic BIOREP registry. J DERMATOL TREAT 2022; 33:2578-2586. [PMID: 35170381 DOI: 10.1080/09546634.2022.2043545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Dupilumab has been approved to treat moderate-to-severe atopic dermatitis; however, the data in a real-world setting are still limited. OBJECTIVE To analyze the effectiveness and safety of dupilumab. METHODS This was a real-life Czech multicenter retrospective study from patients treated with dupilumab for severe AD. RESULTS A total of 360 patients were included. At 16 weeks, 66.6%, 34.1%, and 5.5% of patients achieved EASI75/90 and EASI100, respectively. Improvement continued with the time, and the proportion of patients with EASI75/90 and EASI100 increased to 89.5%, 55.6%, and 12.9% after one year of treatment and reached 95.8%, 60.4%, and 27.1% in the second year of therapy, respectively. A significant reduction was observed in the DLQI scores. The most common adverse events were infections in 5.8% of patients, followed by ocular complications in 2.5% of patients. Persistence rates were 98.2% at four months to 93.1% at month 24, and lack of effectiveness was the most common reason for discontinuation. CONCLUSION This real-life study confirmed the effectiveness and safety of dupilumab in a real-life setting during the COVID-19 pandemic. Our study revealed a higher frequency of infections and a lower conjunctivitis frequency than other real-life studies and clinical trials.
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Affiliation(s)
- M Kojanova
- Department of Dermatovenereology, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - M Tanczosova
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, Prague, Czech Republic
| | | | - P Cetkovska
- Department of Dermatovenereology, Faculty of Medicine in Pilsen, Charles University, Czech Republic
| | - J Fialova
- Department of Dermatovenereology, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - T Dolezal
- Value Outcomes, Prague, Czech Republic
| | - A Machovcova
- Motol University Hospital, Prague, Czech Republic
| | - S Gkalpakiotis
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, Prague, Czech Republic
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13
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Neagu N, Dianzani C, Avallone G, Dell'Aquila C, Morariu SH, Zalaudek I, Conforti C. Dupilumab ocular side effects in patients with atopic dermatitis: a systematic review. J Eur Acad Dermatol Venereol 2022; 36:820-835. [PMID: 35122335 DOI: 10.1111/jdv.17981] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 01/05/2022] [Indexed: 11/29/2022]
Abstract
Atopic dermatitis (AD) is a chronic, inflammatory skin disorder that most frequently occurs in children, but it can also affect adults. Even though most AD cases can be managed with topical treatments, moderate-to-severe forms require systemic therapies. Dupilumab is the first human monoclonal antibody approved for the treatment of AD. Its action is through IL-4 receptor alpha subunit inhibition, thus blocking IL-4 and IL-13 signaling pathways. It has been shown to be an effective, well tolerated therapy for AD, as well as for asthma, chronic rhinosinusitis with nasal polyposis (CRSwNP) and eosinophilic esophagitis (EoE). However, an increasing incidence of Dupilumab-induced ocular surface disease (DIOSD) has been reported in patients treated with Dupilumab, as compared to placebo. The aim of this study was to summarize scientific data regarding DIOSD in AD patients treated with Dupilumab. A search of PubMed and clinicaltrials.gov databases was performed. There was no limit to study design. All AD cases were moderate-to-severe. DIOSD was either dermatologist-, allergist-, or ophtalmologist-assessed. Evidence shows that DIOSD occurs most frequently in patients with atopic dermatitis and not in other skin conditions, neither in patients with asthma, CRSwNP, nor EoE who are on Dupilumab treatment. Further studies are warranted in order to establish a causal relationship between Dupilumab and ocular surface disease. Nevertheless, ophtalmological evaluations prior to Dupilumab initiation can benefit AD patients with previous ocular pathology or current ocular symptomatology. Also, patch testing for ocular allergic contact dermatitis might be advantageous in patients with a history of allergic conjunctivitis. Furthermore, TARC, IgE and circulating eosinophils levels might be important biomarkers for a baseline assessment of future candidates to Dupilumab treatment. However, TARC measurements should be resumed for research purposes only.
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Affiliation(s)
- N Neagu
- State Clinic of Dermatology, Mureș County Hospital, Tîrgu Mureș, Romania
| | - C Dianzani
- Plastic and Reconstructive Surgery Unit, Medico University of Rome, Campus Bio, Rome, Italy
| | - G Avallone
- Medical Sciences Department, Section of Dermatology, University of Turin, Turin, Italy
| | - C Dell'Aquila
- Department of Medical, Surgical Sciences and Health, Eye Clinic, University of Trieste, Trieste, Italy
| | - S-H Morariu
- State Clinic of Dermatology, Mureș County Hospital, Tîrgu Mureș, Romania
| | - I Zalaudek
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
| | - C Conforti
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
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14
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Erbağcı E, Demirel Öğüt N, Yıldırım SK, Hapa FA. Is Dupilumab Effective in Adult-Onset Atopic Dermatitis: Real-life Experience of 16 Patients. J Cosmet Dermatol 2022; 21:4852-4857. [PMID: 35100490 DOI: 10.1111/jocd.14821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Dupilumab is approved for the treatment of atopic dermatitis (AD). However, there are few studies demonstrating its efficacy and safety, particularly in the treatment of adult-onset AD. OBJECTIVE The aim of this study is to evaluate the real-life experience regarding the efficacy and safety of dupilumab in the treatment of adult-onset AD. METHODS This study is a case series in retrospective design. Patients with the diagnosis of adult-onset AD, using dupilumab at standard dose for at least 3 months were included in the study. Demographic and laboratory data of the cases, data regarding to dupilumab treatment were recorded. The eczema area severity index (EASI) and the visual analog scale (VAS) for itch were used to evaluate treatment efficacy. RESULTS A total of 16 patients, 6 female and 10 male, were included. The median age was 41 years, the median age of the disease onset was 37.5 years, the median duration of the disease was 90 months. The median duration of the dupilumab treatment was 10.5 months. The mean percent reduction from baseline in EASI score was 85.8 ± 12.2 at 3 months, 90.7 ± 9.3 at 6 months, and 93.1 ± 5 at 12 months. The mean percent reduction from baseline in VAS itch score was 82.2 ± 8.6 at 3 months. Acute vestibular neuritis developed in one patient during the dupilumab therapy and resolved with anti-inflammatory therapy. CONCLUSION Dupilumab seems to be highly effective and safe in the treatment of adult-onset AD. Present study is important as it is the first study to evaluate this patient group specifically.
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Affiliation(s)
- Ece Erbağcı
- Uşak University Training and Research Hospital, Department of Dermatology and Venereology, Uşak, Turkey
| | - Neslihan Demirel Öğüt
- Uşak University Training and Research Hospital, Department of Dermatology and Venereology, Uşak, Turkey
| | - Sema Koç Yıldırım
- Uşak University Training and Research Hospital, Department of Dermatology and Venereology, Uşak, Turkey
| | - Fatma Aslı Hapa
- İzmir Demokrasi University Buca Seyfi Demirsoy Training and Research Hospital, Department of Dermatology and Venereology, İzmir, Turkey
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15
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Torres T, Paiva-Lopes MJ, Gonçalo M, Claro C, Oliveira M, Gomes J, Vieira AP, Amoedo P, Alpalhão M, Nogueira M, Santiago F, Henrique M, Amaro C, Esteves T, Alves J, Cerejeira D, Mendes-Bastos P, Pestana M, Ramos L, Rocha J, Carvalho R, Teixeira L, Selores M, Mota A, Filipe P. Dupilumab for atopic dermatitis: a real-world portuguese multicenter retrospective study. J DERMATOL TREAT 2022; 33:2554-2559. [PMID: 35083945 DOI: 10.1080/09546634.2022.2035309] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction: Atopic dermatitis (AD) is a difficult-to-treat inflammatory skin disease with a high impact on patients' quality of life. Dupilumab, an IL-4 and IL-13 inhibitor, was the first monoclonal antibody approved for the treatment of moderate-to-severe AD and is currently approved in patients aged 6 or older.Methods: This is a nationwide, multicenter, retrospective, 48-week study designed by the Portuguese Group of AD to assess real-world efficacy and safety of dupilumab for the treatment of AD.Results: A total of 169 patients were enrolled, with a mean disease duration of 22.75 (±11.98) years. The percentage of patients achieving an improvement of at least 75% in Eczema Area and Severity Index (EASI) compared to baseline (EASI75 response) at weeks 12 and 48 was 67.6% and 74.1%, respectively. In the same timepoints, 25.0% and 44.1% achieved an EASI90 response. Patient-reported outcome measures also improved throughout the study period. Regarding safety, 32.0% of the patients developed adverse events, with conjunctivitis (26.6%), persistent facial erythema (4.7%), and arthritis/arthralgia (3.6%) as the more frequently reported.Conclusion: Data from real-world populations are crucial to guide clinicians in their daily decisions. This study provides data demonstrating that dupilumab is an effective and safe therapeutic option for AD.
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Affiliation(s)
- T Torres
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - M J Paiva-Lopes
- Department of Dermatology, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal.,CEDOC, Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - M Gonçalo
- Department of Dermatology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal.,Clinic of Dermatology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - C Claro
- Department of Dermatology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - M Oliveira
- Department of Dermatology, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - J Gomes
- Department of Dermatology, Hospital de Braga, Braga, Portugal
| | - A P Vieira
- Department of Dermatology, Hospital de Braga, Braga, Portugal
| | - P Amoedo
- Department of Dermatology, Centro Hospitalar Universitário de São João EPE, Porto, Portugal
| | - M Alpalhão
- Department of Dermatology, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal.,Dermatology University Clinic, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,Dermatology Research Unit, IMM João Lobo Antunes, University of Lisbon, Lisbon, Portugal
| | - M Nogueira
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - F Santiago
- Department of Dermatology, Centro Hospitalar Leiria-Pombal, Leiria, Portugal
| | - M Henrique
- Department of Dermatology, Centro Hospitalar Leiria-Pombal, Leiria, Portugal
| | - C Amaro
- Department of Dermatology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - T Esteves
- Department of Dermatology, Hospital Central do Funchal, Madeira, Portugal
| | - J Alves
- Department of Dermatology, Hospital Garcia de Orta, Almada, Portugal
| | - D Cerejeira
- Department of Dermatology, Hospital Garcia de Orta, Almada, Portugal
| | - P Mendes-Bastos
- Dermatology Center, Hospital CUF Descobertas, Lisboa, Portugal
| | - M Pestana
- Department of Dermatology, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - L Ramos
- Department of Dermatology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - J Rocha
- Department of Dermatology, Hospital de Pedro Hispano, Matosinhos, Portugal
| | - R Carvalho
- Department of Dermatology, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal.,Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - L Teixeira
- Center for Health Technology and Services Research (CINTESIS), Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS.UP), Porto, Portugal
| | - M Selores
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - A Mota
- Department of Dermatology, Centro Hospitalar Universitário de São João EPE, Porto, Portugal.,Faculty of Medicine, University of Porto, CINTESIS, Porto, Portugal
| | - P Filipe
- Department of Dermatology, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal.,Dermatology University Clinic, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,Dermatology Research Unit, IMM João Lobo Antunes, University of Lisbon, Lisbon, Portugal
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Kamata M, Tada Y. A Literature Review of Real-World Effectiveness and Safety of Dupilumab for Atopic Dermatitis. JID INNOVATIONS 2021; 1:100042. [PMID: 34909737 PMCID: PMC8659403 DOI: 10.1016/j.xjidi.2021.100042] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/01/2021] [Accepted: 07/14/2021] [Indexed: 02/08/2023] Open
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease with pruritus, characterized by recurrent eczema with exacerbations and remissions. AD impairs patients’ QOL and places a heavy burden on patients. Recently, dupilumab, an anti–IL-4Rα antibody, was approved for the treatment of patients with moderate-to-severe AD who are refractory to topical agents and/or conventional systemic therapy. Clinical trials of dupilumab for AD demonstrated high efficacy and tolerable safety profiles. Furthermore, real-world evidence of dupilumab for AD is accumulating. Most of these data show favorable effectiveness and safety profile; however, they also clarified issues, including conjunctivitis and facial redness. There are still a certain number of patients with significant failure. In this article, we review real-world evidence of dupilumab for AD, identify concerns specific to dupilumab, and discuss unmet needs and issues to be addressed in the future.
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Key Words
- AA, alopecia areata
- AD, atopic dermatitis
- CsA, cyclosporin A
- EASI, Eczema Area and Severity Index
- HSV, herpes simplex virus
- IGA, Investigator’s Global Assessment
- LDH, lactate dehydrogenase
- TCS, topical corticosteroid
- Th, T helper type
- q2w, every other week
- qw, weekly
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Affiliation(s)
- Masahiro Kamata
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Yayoi Tada
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
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Efficacy and Safety of Dupilumab in Clinical Practice: One Year of Experience on 165 Adult Patients from a Tertiary Referral Centre. Dermatol Ther (Heidelb) 2021; 11:355-361. [PMID: 33712985 PMCID: PMC8018995 DOI: 10.1007/s13555-021-00505-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Indexed: 11/24/2022] Open
Abstract
We have read with great interest the article by Kreeshan et al., which reported data on effectiveness and laboratory safety of dupilumab. We performed a retrospective study including 165 adult patients affected by moderate-to-severe atopic dermatitis (AD) and treated with dupilumab for at least 52 weeks. A significant improvement in eczema area severity index (EASI) score after 16 and 52 weeks of treatment with dupilumab was observed. The mean EASI score at baseline was 28.84 ± 6.4 and significantly reduced to 10.05 ± 8.00 at 16 weeks (p < 0.001), and to 3.04 ± 4.73 at 52 weeks (p < 0.001), with a mean percentage reduction of 65.15% and 89.45%, respectively. Efficacy of dupilumab was demonstrated by a significant reduction of all the scores (P-NRS, S-NRS and DLQI). Furthermore, no patient discontinued the drug because of inefficacy. Fifty-seven out of 165 (34.54%) patients reported at least one adverse event (AE) during the 52-week treatment. Our study confirms that dupilumab can represent a long-term treatment for moderate-to-severe adult AD, beyond 16 weeks. In our experience, dupilumab demonstrated a favourable safety profile at 52 weeks and only a few patients had to discontinue the treatment because of AEs.
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