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Melgosa Ramos FJ, Díaz Corpas T, Martín Jiménez S, Mateu Puchades A. Mid-Term Efficacy of Dupilumab in Children Aged≥36 Months to <12 Years With Atopic Dermatitis: A Case Series. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:625-627. [PMID: 38373609 DOI: 10.1016/j.ad.2023.04.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/21/2023] [Accepted: 04/01/2023] [Indexed: 02/21/2024] Open
Affiliation(s)
- F J Melgosa Ramos
- Department of Dermatology, University Hospital Doctor Peset of Valencia, Valencia (Valencia), Spain.
| | - T Díaz Corpas
- Department of Dermatology, University Hospital Doctor Peset of Valencia, Valencia (Valencia), Spain
| | - S Martín Jiménez
- Department of Dermatology, University Hospital Doctor Peset of Valencia, Valencia (Valencia), Spain
| | - A Mateu Puchades
- Department of Dermatology, University Hospital Doctor Peset of Valencia, Valencia (Valencia), Spain
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Melgosa Ramos FJ, Díaz Corpas T, Martín Jiménez S, Mateu Puchades A. Mid-Term Efficacy of Dupilumab in Children Aged≥36 Months to <12 Years With Atopic Dermatitis: A Case Series. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T625-T627. [PMID: 38570087 DOI: 10.1016/j.ad.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/21/2023] [Accepted: 04/01/2023] [Indexed: 04/05/2024] Open
Affiliation(s)
- F J Melgosa Ramos
- Department of Dermatology, University Hospital Doctor Peset of Valencia, Valencia (Valencia), España.
| | - T Díaz Corpas
- Department of Dermatology, University Hospital Doctor Peset of Valencia, Valencia (Valencia), España
| | - S Martín Jiménez
- Department of Dermatology, University Hospital Doctor Peset of Valencia, Valencia (Valencia), España
| | - A Mateu Puchades
- Department of Dermatology, University Hospital Doctor Peset of Valencia, Valencia (Valencia), España
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Chang CH, Stein SL. Malassezia-associated skin diseases in the pediatric population. Pediatr Dermatol 2024. [PMID: 38776177 DOI: 10.1111/pde.15603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/01/2024] [Indexed: 05/24/2024]
Abstract
Malassezia are yeast species that commonly colonize healthy skin. However, they have been associated with or implicated in the pathogenesis of numerous skin disorders, particularly in the setting of pediatric populations. In this review, we will focus on several Malassezia-associated skin conditions manifesting in infants, children, and adolescents: pityriasis versicolor, Malassezia folliculitis, infantile and adolescent seborrheic dermatitis, head and neck dermatitis, and neonatal cephalic pustulosis. We examine the literature and provide an overview of these conditions, including clinical presentation in diverse skin colors, diagnosis, risk factors, and treatment and management. Additionally, we summarize and highlight some of the proposed theories on the role of Malassezia spp. in the pathogenesis of these skin conditions.
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Affiliation(s)
- Christy H Chang
- College of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Sarah L Stein
- Section of Dermatology, Department of Medicine and Pediatrics, University of Chicago, Chicago, Illinois, USA
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Martínez-Doménech A, Zaragoza-Ninet V, Esteve-Martínez A, García-Rabasco A, Sánchez-Carazo JL, Pérez-Ferriols A. Efficacy and Safety of Dupilumab for the Treatment of Severe Atopic Dermatitis in Clinical Practice: A Single Center Experience. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:150-158. [PMID: 37858860 DOI: 10.1016/j.ad.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/09/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Dupilumab is a new targeted therapy for severe atopic dermatitis (AD) with limited real-world evidence. OBJECTIVE Explore our experience with dupilumab for AD in clinical practice at a tertiary care center. MATERIAL AND METHOD Unicentric observational retrospective study including adult and pediatric patients with severe AD receiving dupilumab between December 2017 and December 2021. The Eczema Area and Severity Index (EASI) score, Pruritus Numerical Rating Scale (P-NRS) and Sleep disturbance Numerical Rating Scale (S-NRS) were recovered to assess severity and response. RESULTS Fifty-nine patients received dupilumab: 52, 48, 26 and 13 patients reached 6, 12, 24 and 36 months of treatment, respectively. The EASI-75 response rates were 94.2%, 95.8%, 92.3% and 100% at months 6, 12, 24 and 36. The EASI-90 response rates were 63.5%, 72.9%, 84.6% and 92.3% at months 6, 12, 24 and 36. The EASI <7 response rates were 92.3%, 91.7%, 88.5% and 100% at months 6, 12, 24 and 36. The P-NRS ≥4 reduction rates were 86%, 87.5%, 92.3% and 100% at months 6, 12, 24 and 36. The S-NRS ≥4 reduction rates were 82.7%, 85.4%, 100% and 100% at months 6, 12, 24 and 36. Adverse events were mild and occurred in 20.3% of patients, all of them adults. CONCLUSION Our findings support dupilumab's favorable efficacy and tolerability profile in clinical practice. Dupilumab offers a rapid and sustained response, regardless of combined therapy. Longer follow-ups are still required to adequately assess its performance.
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Affiliation(s)
- A Martínez-Doménech
- Department of Dermatology, Hospital General Universitario de Valencia, Valencia, Spain
| | - V Zaragoza-Ninet
- Department of Dermatology, Hospital General Universitario de Valencia, Valencia, Spain.
| | - A Esteve-Martínez
- Department of Dermatology, Hospital General Universitario de Valencia, Valencia, Spain
| | - A García-Rabasco
- Department of Dermatology, Hospital General Universitario de Valencia, Valencia, Spain
| | - J L Sánchez-Carazo
- Department of Dermatology, Hospital General Universitario de Valencia, Valencia, Spain
| | - A Pérez-Ferriols
- Department of Dermatology, Hospital General Universitario de Valencia, Valencia, Spain
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5
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Martínez-Doménech A, Zaragoza-Ninet V, Esteve-Martínez A, García-Rabasco A, Sánchez-Carazo JL, Pérez-Ferriols A. Efficacy and Safety of Dupilumab for the Treatment of Severe Atopic Dermatitis in Clinical Practice: A Single Center Experience. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T150-T158. [PMID: 38048951 DOI: 10.1016/j.ad.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 10/09/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Dupilumab is a new targeted therapy for severe atopic dermatitis (AD) with limited real-world evidence. OBJECTIVE Explore our experience with dupilumab for AD in clinical practice at a tertiary care center. MATERIAL AND METHOD Unicentric observational retrospective study including adult and pediatric patients with severe AD receiving dupilumab between December 2017 and December 2021. The Eczema Area and Severity Index (EASI) score, Pruritus Numerical Rating Scale (P-NRS) and Sleep disturbance Numerical Rating Scale (S-NRS) were recovered to assess severity and response. RESULTS Fifty-nine patients received dupilumab: 52, 48, 26 and 13 patients reached 6, 12, 24 and 36 months of treatment, respectively. The EASI-75 response rates were 94.2%, 95.8%, 92.3% and 100% at months 6, 12, 24 and 36. The EASI-90 response rates were 63.5%, 72.9%, 84.6% and 92.3% at months 6, 12, 24 and 36. The EASI <7 response rates were 92.3%, 91.7%, 88.5% and 100% at months 6, 12, 24 and 36. The P-NRS ≥4 reduction rates were 86%, 87.5%, 92.3% and 100% at months 6, 12, 24 and 36. The S-NRS ≥4 reduction rates were 82.7%, 85.4%, 100% and 100% at months 6, 12, 24 and 36. Adverse events were mild and occurred in 20.3% of patients, all of them adults. CONCLUSION Our findings support dupilumab's favorable efficacy and tolerability profile in clinical practice. Dupilumab offers a rapid and sustained response, regardless of combined therapy. Longer follow-ups are still required to adequately assess its performance.
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Affiliation(s)
- A Martínez-Doménech
- Department of Dermatology, Hospital General Universitario de Valencia, Valencia, Spain
| | - V Zaragoza-Ninet
- Department of Dermatology, Hospital General Universitario de Valencia, Valencia, Spain.
| | - A Esteve-Martínez
- Department of Dermatology, Hospital General Universitario de Valencia, Valencia, Spain
| | - A García-Rabasco
- Department of Dermatology, Hospital General Universitario de Valencia, Valencia, Spain
| | - J L Sánchez-Carazo
- Department of Dermatology, Hospital General Universitario de Valencia, Valencia, Spain
| | - A Pérez-Ferriols
- Department of Dermatology, Hospital General Universitario de Valencia, Valencia, Spain
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Caminiti L, Galletta F, Foti Randazzese S, Barraco P, Passanisi S, Gambadauro A, Crisafulli G, Valenzise M, Manti S. Early Assessment of Efficacy and Safety of Biologics in Pediatric Allergic Diseases: Preliminary Results from a Prospective Real-World Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:170. [PMID: 38397282 PMCID: PMC10887585 DOI: 10.3390/children11020170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/13/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Despite the increasing interest in biologics for the management of allergic diseases, sparse real-world data are still available in the pediatric population. This study aimed to evaluate the early real-life efficacy and safety of omalizumab for patients with moderate-to-severe asthma and chronic spontaneous urticaria (CSU), and Dupilumab for patients with moderate-to-severe atopic dermatitis (AD). METHODS A prospective study enrolling children aged 6-18 years was designed to assess the efficacy and safety of biologic drugs at 16 weeks of treatment (T1). The effectiveness was measured using validated questionnaires (ACQ-5 for asthma, UAS7 for CSU, and EASI score for AD). Secondary outcome measures included reductions in inhaled corticosteroid (ICS) dosages, asthma-related hospitalizations/exacerbations, and quality of life (QoL) indicators (iNRS, sNRS, DLQI/cDLQI) for CSU and AD. Safety was expressed according to the descriptions of adverse events provided by EMA and FDA. RESULTS The study cohort consisted of eighteen children (mean age 12.9 ± 3.4 years). The omalizumab treatment significantly reduced ACQ-5 and UAS7 scores (p = 0.002 and p < 0.001, respectively). In patients with asthma, decreased ICS dosage and hospitalization/exacerbation rates were observed. QoL parameters significantly improved in CSU and AD patients. No severe adverse events were reported for either treatment. CONCLUSIONS Our findings validate omalizumab and dupilumab as effective and safe therapeutic options for managing moderate-to-severe allergic diseases in children and adolescents.
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Affiliation(s)
| | | | | | | | - Stefano Passanisi
- Pediatric Unit, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Street Consolare Valeria 1, 98124 Messina, Italy; (L.C.); (F.G.); (S.F.R.); (P.B.); (A.G.); (G.C.); (M.V.); (S.M.)
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Martinez-Cabriales S, Marcoux D, Liy-Wong C, Prajapati VH, Sibbald C, Cunningham N, Lansang P, Tonkin R, Joseph M, Wong L, Spring S, Gavigan G, Ramien M. Multicenter Canadian case series of pediatric patients less than 12 years of age with moderate-to-severe atopic dermatitis treated with dupilumab. Pediatr Dermatol 2024; 41:5-11. [PMID: 37906120 DOI: 10.1111/pde.15418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/05/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Dupilumab is approved for moderate-severe atopic dermatitis (AD) in patients aged ≥6 months by the US Food and Drug Administration and Health Canada; however, there are little real-world data because providers have limited practical experience with this recently approved therapy. OBJECTIVES To describe the real-world effectiveness and safety in patients aged <12 years with moderate-severe AD currently receiving or previously having received dupilumab. METHODS A multicenter retrospective study was conducted at six Canadian sites. Cases were divided into Group 1 ≤2 years old, Group 2 >2 to <6 years old, and Group 3 ≥6 to <12 years old. Medical history and details of dupilumab treatment were collected. The primary outcome was to measure the improvement in eczema area and severity index. Secondary outcomes examined included the children's dermatology life quality index/infant's dermatitis quality of life, peak pruritus numerical rating scale, and delay to dupilumab access for patients who were considered off-label for dupilumab due to their age. RESULTS Sixty three pediatric patients (37 males) with moderate-to-severe AD were included; the mean age was 6.4 years old (range: 2-11) when dupilumab treatment was started. Overall, 75% (36/48) achieved EASI-75% and 71% (34/48) achieved EASI-90. EASI-75 and EASI-90 were achieved in 90% (17/19) and 73% (12/19) in patients <6 years old, and 76% (22/29) and 59% (17/29) in patients >6 years old, respectively. No serious adverse events were reported. CONCLUSIONS Dupilumab is safe and effective for patients under the age of 12. However, even for experienced providers, access to the medication was challenging.
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Affiliation(s)
- Sylvia Martinez-Cabriales
- Alberta Children's Hospital, Department of Pediatrics, University of Calgary, Calgary, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Danielle Marcoux
- Division of Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Canada
| | - Carmen Liy-Wong
- Department of Pediatrics, Division of Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Vimal H Prajapati
- Dermatology Research Institute, Calgary, Canada
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Canada
- Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, Canada
- Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Canada
- Skin Health & Wellness Centre, Calgary, Canada
- Probity Medical Research, Calgary, Canada
| | - Cathryn Sibbald
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
- The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Natalie Cunningham
- Division of Dermatology, Department of Medicine, IWK Health Centre, Dalhousie University, Halifax, Canada
| | - Perla Lansang
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
- The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Rochelle Tonkin
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Canada
| | - Marissa Joseph
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
- The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Lauren Wong
- Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - Shanna Spring
- Department of Pediatrics, Division of Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Genevieve Gavigan
- Department of Pediatrics, Division of Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Michele Ramien
- Alberta Children's Hospital, Department of Pediatrics, University of Calgary, Calgary, Canada
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Canada
- Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, Canada
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Sams L, Wijetilleka S, Ponsford M, Gennery A, Jolles S. Atopic manifestations of inborn errors of immunity. Curr Opin Allergy Clin Immunol 2023; 23:478-490. [PMID: 37755421 PMCID: PMC10621644 DOI: 10.1097/aci.0000000000000943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
PURPOSE OF REVIEW Allergy and atopic features are now well recognized manifestations of many inborn errors of immunity (IEI), and indeed may be the hallmark in some, such as DOCK8 deficiency. In this review, we describe the current IEI associated with atopy, using a comprehensive literature search and updates from the IUIS highlighting clinical clues for underlying IEI such as very early onset of atopic disease or treatment resistance to enable early and accurate genetic diagnosis. RECENT FINDINGS We focus on recently described genes, their categories of pathogenic mechanisms and the expanding range of potential therapies. SUMMARY We highlight in this review that patients with very early onset or treatment resistant atopic disorders should be investigated for an IEI, as targeted and effective therapies exist. Early and accurate genetic diagnosis is crucial in this cohort to reduce the burden of disease and mortality.
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Affiliation(s)
- Laura Sams
- Paediatric Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital (GNCH), Royal Victoria Infirmary, Queen Victoria Road
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne
| | - Sonali Wijetilleka
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Mark Ponsford
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Andrew Gennery
- Paediatric Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital (GNCH), Royal Victoria Infirmary, Queen Victoria Road
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne
| | - Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
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Moreno A, Renert-Yuval Y, Guttman-Yassky E. Shedding light on key pharmacological knowledge and strategies for pediatric atopic dermatitis. Expert Rev Clin Pharmacol 2023; 16:119-131. [PMID: 36705936 PMCID: PMC9947941 DOI: 10.1080/17512433.2023.2173172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/23/2023] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Atopic dermatitis (AD) is an inflammatory disease affecting over 20% of the pediatric population, with 85% of cases presenting before the age of five. Recently, therapeutic options in pediatric patients have evolved rapidly, following extensive development in adult treatments. AREAS COVERED This review will encompass relevant molecular drivers, along with an overlook on treatment modalities in pediatric AD, as well as a summary of pipeline treatments in clinical trials for pediatric patients from PubMed, Google Scholar, and Clinicaltrials.gov up to July 2022. Topical corticosteroids are the mainstay for AD flares in adults and children. Topical approved agents in pediatric AD are calcineurin inhibitors, crisaborolecrisaborole, and ruxolitinib. Dupilumab is the only FDA approved biologic for patients with AD from six months of age. A Janus kinase inhibitor, upadacitinib, is a systemic treatment approved for pediatric AD patients (age >12 years). Systemic immunosuppressants used in pediatric AD include methotrexate, azathioprine, cyclosporinecyclosporine, and mycophenolate mofetil. EXPERT OPINION Data regarding disease prevention are conflicting, however, an abundance of research has transpired regarding amelioration of symptoms and induction of disease clearance by targeting numerous pathological mechanisms. Understanding the pediatric AD phenotype will further advance the field and the development of improved therapeutics.
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Affiliation(s)
- Ariana Moreno
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - Yael Renert-Yuval
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emma Guttman-Yassky
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Kamphuis E, Boesjes CM, Loman L, Bakker DS, Poelhekken M, Zuithoff NPA, Kamsteeg M, Romeijn GLE, van Wijk F, de Bruin-Weller MS, de Graaf M, Schuttelaar MLA. Dupilumab in daily practice for the treatment of pediatric atopic dermatitis: 28-week clinical and biomarker results from the BioDay registry. Pediatr Allergy Immunol 2022; 33:e13887. [PMID: 36564878 PMCID: PMC10107870 DOI: 10.1111/pai.13887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/07/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Dupilumab has proven to be an effective and safe treatment for atopic dermatitis (AD) in pediatric patients in clinical trials. However, few daily practice studies are available. The aim of this study is to evaluate the effect of 28 weeks dupilumab treatment on effectiveness, safety, and serum biomarkers in pediatric patients with moderate-to-severe AD in daily practice. METHODS Patients visited the outpatient clinic at baseline, 4, 16, and 28 weeks of treatment. Disease severity was assessed by the Eczema Area and Severity Index (EASI), Investigator Global Assessment (IGA), Numeric Rating Scale (NRS)-pruritus and -pain, and the Patient-Oriented Eczema Measure (POEM). Side effects were evaluated. Nineteen severity-associated serum biomarkers were measured. Predicted-EASI (p-EASI) was calculated. RESULTS Sixty-one patients were included. Respectively 75.4%, 49.2%, and 24.6% reached EASI-50, EASI-75, and EASI-90 and 36.1% achieved an IGA-score (almost) clear. Improvement of ≥4 points on POEM, NRS-pruritus, and NRS-pain was reached by 84.7%, 45.3%, and 77.4%, respectively. Most reported side effects were conjunctivitis (n = 10) and headache (n = 4). Biomarkers TARC, PARC, periostin, sIL-2Ra, and eotaxin-3 significantly decreased during treatment. The p-EASI showed a significant correlation with disease severity. CONCLUSION Dupilumab treatment significantly improved disease severity and disease-associated symptoms and decreased severity-associated serum biomarkers in pediatric AD patients in daily practice.
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Affiliation(s)
- Esmé Kamphuis
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Celeste M Boesjes
- Department of Dermatology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Laura Loman
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Daphne S Bakker
- Department of Dermatology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Mila Poelhekken
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marijke Kamsteeg
- Department of Dermatology, Radboud University Medical Center, Radboud University, Nijmegen, the Netherlands
| | - Geertruida L E Romeijn
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Femke van Wijk
- Center for Translational Immunology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Marjolein S de Bruin-Weller
- Department of Dermatology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Marlies de Graaf
- Department of Dermatology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Marie L A Schuttelaar
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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11
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Nihal A, Comstock JR, Holland KE, Singh AM, Seroogy CM, Arkin LM. Clearance of atypical cutaneous manifestations of hyper-IgE syndrome with dupilumab. Pediatr Dermatol 2022; 39:940-942. [PMID: 35734823 PMCID: PMC10084161 DOI: 10.1111/pde.15072] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022]
Abstract
Hyper-IgE syndromes (HIES) are a heterogeneous group of rare primary immunodeficiency diseases classically characterized by the triad of atopic dermatitis, and recurrent cutaneous and pulmonary infections. Autosomal dominant, loss-of-function STAT3 pathogenic variants are the most common genetic cause, which lead to deficiency of Th17 lymphocytes, impaired interferon gamma production, and IL-10 signal transduction, and an unbalanced IL-4 state. Dupilumab, a monoclonal antibody to the IL-4a receptor, inhibits both IL-4 and IL-13, and has been shown to improve atopic dermatitis and other manifestations of HIES including asthma and allergic bronchopulmonary aspergillosis. We present a pediatric patient with HIES who presented predominantly with eosinophilic folliculitis, recurrent cutaneous infections, and other non-eczematous findings and achieved sustained clearance with dupilumab.
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Affiliation(s)
- Aman Nihal
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jeanette R Comstock
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Kristen E Holland
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anne Marie Singh
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Division of Allergy, Immunology & Rheumatology, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Christine M Seroogy
- Division of Allergy, Immunology & Rheumatology, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Lisa M Arkin
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
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12
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Shi JQ, Dong XS, Zhang LL, Liu ZH. Herpes simplex virus encephalitis in atopic dermatitis patients and responses to dupilumab: A real association or a chance occurrence? Pediatr Dermatol 2022; 39:848-849. [PMID: 36206220 DOI: 10.1111/pde.15063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/17/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Jun-Qi Shi
- Section of Pediatric Dermatology, Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao-Shuang Dong
- Section of Pediatric Dermatology, Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lan-Lan Zhang
- Section of Pediatric Dermatology, Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ze-Hu Liu
- Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
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13
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Pagan AD, David E, Ungar B, Ghalili S, He H, Guttman-Yassky E. Dupilumab Improves Clinical Scores in Children and Adolescents With Moderate to Severe Atopic Dermatitis: A Real-World, Single-Center Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2378-2385. [PMID: 35753667 DOI: 10.1016/j.jaip.2022.06.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Dupilumab has proven safe and effective in children and adolescents with atopic dermatitis (AD) in clinical trials. However, comprehensive real-world studies in the pediatric AD population are still needed. OBJECTIVE To characterize the long-term treatment responses and adverse events of dupilumab-treated children and adolescents with AD during dermatology follow-up assessments. METHODS We reviewed electronic medical records from March 2017 to September 2021 of moderate to severe AD patients starting dupilumab at less than age 18 years. Demographics, AD scores (body surface area [BSA], Eczema Area and Severity Index [EASI], and Investigator's Global Assessment [IGA]) as well as safety data were collected. RESULTS A total of 89 patients, 50 females (56.2%) and 39 males (43.8%), were included. Mean ± SD treatment duration was 1.3 ± 0.9 years. Of these, 73 had score assessments at baseline and weeks 12 to 24. Mean ± SD improvements in BSA, EASI, and IGA were 63.1% ± 29.2%, 39.6% ± 29.9%, and 59.6% ± 30.7%, respectively. All patients (n = 23) who received dupilumab for 1 year or more achieved 75% improvement in EASI and IGA 0/1, and 60.8% achieved 90% improvement in EASI. Positive history of atopy was associated with greater percent improvement in BSA at weeks 12 to 24 (P < .05). Twelve patients had adverse events (13.5%), of which conjunctivitis (5.6%) and joint pain (2.2%) were most common. There were no serious adverse events. CONCLUSIONS Dupilumab was well-tolerated and effective in treating pediatric and adolescent AD regardless of age, sex, race, or ethnicity.
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Affiliation(s)
- Angel D Pagan
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Eden David
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Benjamin Ungar
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sabrina Ghalili
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Helen He
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY.
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14
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Zhou B, Dong J, Liang S, Shang S, Li L. The changes of IgE levels in type 2 inflammatory diseases after treatment of dupilumab: a systematic review and meta-analysis. Expert Rev Clin Pharmacol 2022; 15:1233-1242. [PMID: 36045562 DOI: 10.1080/17512433.2022.2120469] [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: 11/04/2022]
Abstract
BACKGROUND Dupilumab is approved for multiple type 2 inflammatory diseases. In the treatment procedure, the changes of IgE levels need further analysis. We evaluated the changes of IgE levels through a meta-analysis, aiming to provide a more comprehensive result. RESEARCH DESIGN AND METHODS Databases were searched to select eligible publications. After being included, study quality was assessed. The standardized mean difference (SMD) was used as an evaluation. RESULTS Seven studies were included. At week 4, the level of IgE did not decrease significantly, with SMD=-0.12 (95%CI: -0.31, 0.07) (P>0.05). At week 8, 12, 16, 24 and 52, the level of IgE decreased significantly, which was SMD=-0.26 (95%CI: -0.48, -0.03); -0.25 (95%CI: -0.32, -0.18); -0.49 (95%CI: -0.65, -0.33); -0.30 (95%CI: -0.38, -0.22); -0.40 (95%CI: -0.48, -0.32) (P<0.05). In AD studies, with the increase of IgE levels, due to the decrease in the total dose of dupilumab, the efficacy index showed a decreasing trend. CONCLUSIONS Levels of IgE can be significantly decreased in patients with dupilumab treatment. In AD patients, the efficacy was related to total dose; for patients with high IgE levels, efficacy may be better with the dose increased.
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Affiliation(s)
- Boyang Zhou
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jialin Dong
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Surong Liang
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shuai Shang
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Linfeng Li
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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15
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Samia AM, Cuervo-Pardo L, Montanez-Wiscovich ME, Cavero-Chavez VY. Dupilumab-Associated Head and Neck Dermatitis With Ocular Involvement in a Ten-Year-Old With Atopic Dermatitis: A Case Report and Review of the Literature. Cureus 2022; 14:e27170. [PMID: 36017279 PMCID: PMC9393337 DOI: 10.7759/cureus.27170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2022] [Indexed: 11/23/2022] Open
Abstract
Facial and neck erythema secondary to dupilumab use is a side effect not reported in clinical trials; however, it has been reported aftermarket initially in adults and most recently in adolescents. We report the youngest known case of head and neck dermatitis (HND) secondary to Malassezia furfur accompanied by ocular involvement. Treatment with oral fluconazole 150 mg weekly was initiated with subsequent cutaneous improvement. Additionally, his conjunctivitis improved with fluorometholone 0.1% eye drops. As dupilumab becomes more accessible to children, understanding the pathophysiology of HND, characterizing the clinical course, and developing diagnostic and treatment guidelines for this age group will be imperative.
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16
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Su W, Zhang J, Yang S, Tang M, Shen Y, Liu C, Ji J, Maurer M, Jiao Q. Galectin-9 contributes to the pathogenesis of atopic dermatitis via T cell immunoglobulin mucin-3. Front Immunol 2022; 13:952338. [PMID: 35967337 PMCID: PMC9364826 DOI: 10.3389/fimmu.2022.952338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/27/2022] [Indexed: 11/26/2022] Open
Abstract
Background Atopic dermatitis (AD), a common type 2 inflammatory disease, is driven by T helper (TH) 2/TH22polarization and cytokines.Galectin-9 (Gal-9), via its receptor T cell immunoglobulin- and mucin-domain-containing molecule-3 (TIM-3), can promote TH2/TH22 immunity. The relevance of this in AD is largely unclear. Objectives To characterize the role of TIM-3 and Gal-9 in the pathogenesis of AD and underlying mechanisms. Methods We assessed the expression of Gal-9 and TIM-3 in 30 AD patients, to compare them with those of 30 healthy controls (HC) and to explore possible links with disease features including AD activity (SCORAD), IgE levels, and circulating eosinophils and B cells. We also determined the effects of Gal-9 on T cells from the AD patients. Results Our AD patients had markedly higher levels of serum Gal-9 and circulating TIM-3-expressing TH1 and TH17 cells than HC. Gal-9 and TIM-3 were linked to high disease activity, IgE levels, and circulating eosinophils and/or B cells. The rates of circulating TIM-3-positive CD4+ cells were positively correlated with rates of TH2/TH22 cells and negatively correlated with rates of TH1/TH17 cells. Gal-9 inhibited the proliferation and induced the apoptosis of T cells in patients with AD, especially in those with severe AD. Conclusion Our findings suggest thatGal-9, via TIM-3, contributes to the pathogenesis of AD by augmenting TH2/TH22 polarization through the downregulation of TH1/TH17immunity. This makes Gal-9 and TIM-3 interesting to explore further, as possible drivers of disease and targets of novel AD treatment.
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Affiliation(s)
- Wenxing Su
- Department of Dermatology, The Second Affiliated Hospital of Soochow University, Su Zhou, China
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Plastic and Burn Surgery, The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu, China
| | - Ji Zhang
- Department of Dermatology, The Second Affiliated Hospital of Soochow University, Su Zhou, China
| | - Shun Yang
- Department of Dermatology, The Second Affiliated Hospital of Soochow University, Su Zhou, China
| | - Minhui Tang
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yu Shen
- Jiangsu Institute of Clinical Immunology and Jiangsu Key Laboratory of Clinical Immunology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Cuiping Liu
- Jiangsu Institute of Clinical Immunology and Jiangsu Key Laboratory of Clinical Immunology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiang Ji
- Department of Dermatology, The Second Affiliated Hospital of Soochow University, Su Zhou, China
- *Correspondence: Jiang Ji, ; Marcus Maurer, ; Qingqing Jiao,
| | - Marcus Maurer
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
- *Correspondence: Jiang Ji, ; Marcus Maurer, ; Qingqing Jiao,
| | - Qingqing Jiao
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Jiang Ji, ; Marcus Maurer, ; Qingqing Jiao,
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17
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Lasek A, Bellon N, Mallet S, Puzenat E, Bursztejn AC, Abasq C, Mazereeuw-Hautier J, Chiaverini C, Hubiche T, Raison Peyron N, Du Thanh A, Barbarot S, Aubert H, Reguiai Z, Droitcourt C, Fievet C, Bellissen A, Bachelerie M, Nosbaum A, Leymarie A, Armingaud P, Masson Regnault M, Mahé E. Effectiveness and safety of dupilumab in the treatment of atopic dermatitis in children (6-11 years): data from a French multicenter retrospective cohort in daily practice. J Eur Acad Dermatol Venereol 2022; 36:2423-2429. [PMID: 35854650 DOI: 10.1111/jdv.18450] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 06/24/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dupilumab is the first biotherapy available for the treatment of moderate-to-severe childhood atopic dermatitis (AD). OBJECTIVE The aim of this study was to evaluate the effectiveness and safety of dupilumab in daily practice. METHODS Patients aged 6 to 11, who had received a first dose of dupilumab were included in this multicenter retrospective cohort study. The primary endpoint was change in SCORAD after 3 months of treatment. Secondary endpoints were change in IGA score at 3 months, proportion of patients with SCORAD50 and SCORAD75, description of adverse events and proportion of children in our cohort who would be excluded from pivotal phase 3 clinical trial. RESULTS 80 patients were included. After 3 months of treatment, there was a significant decrease in SCORAD (mean: 21.8 ± 13.8 vs 53.9 ± 18.5; p<0.0001) and IGA (1.3 ± 0.8 vs 3.5 ± 0.7; p<0.0001). Conjunctivitis was observed in 11.3%(n=9/80); 3 patients experienced dupilumab facial redness (DFR); 17.5% (n=14/80) reported injection site reactions; 6.3% (n=5/80) discontinued treatment. 61.2 % (n=49/80) children were ineligible in the phase 3 trial. LIMITATIONS There is no control group. Because it was a real life study based on information from patient medical records in a French multicenter cohort, we cannot rule out the presence of reporting bias generated by the use of patient reported characteristics and missing information. CONCLUSION These real-life data confirm the efficacy and safety of dupilumab in children with moderate to severe AD extended to dyshidrosis and atopic prurigo but it also revealed a lower frequency of DFR and conjunctivitis. However, administration in injectable form may be a barrier in this age group.
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Affiliation(s)
- A Lasek
- Department of dermatology, Hôpital Saint Vincent de Paul, GHICL, Lille, France
| | - N Bellon
- Department of dermatology, Centre Hospitalier Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - S Mallet
- Department of dermatology, venereology, and cancerology, Hôpital de la Timone, Assistance-publique-Hôpitaux de Marseille, Marseille, France
| | - E Puzenat
- Department of dermatology, Centre Hospitalier Universitaire deBesançon, Besançon, France
| | - A C Bursztejn
- Department of dermatology, Hôpitaux de Brabois, CHRU Nancy, Vandœuvre-Lès-, Nancy, France
| | - C Abasq
- Department of dermatology, Centre Hospitalier Universitaire de Brest, Brest, France
| | - J Mazereeuw-Hautier
- Department of dermatology, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier Toulouse, France
| | - C Chiaverini
- Department of dermatology, hospital Archet 2, ESPIC CHU-Lenval, Nice, France
| | - T Hubiche
- Department of dermatology, hospital Archet 2, ESPIC CHU-Lenval, Nice, France
| | - N Raison Peyron
- Department of dermatology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - A Du Thanh
- Department of dermatology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - S Barbarot
- Department of dermatology, Hôtel-Dieu, Nantes, France
| | - H Aubert
- Department of dermatology, Hôtel-Dieu, Nantes, France
| | - Z Reguiai
- Department of dermatology, Polyclinique de Courlancy, Reims, France
| | - C Droitcourt
- Department of dermatology, Centre Hospitalier Universitaire Pontchaillou, Université de Rennes, Rennes, France
| | - C Fievet
- Department of dermatology, Centre Hospitalier Régional Universitaire Lille, Lille, France
| | - A Bellissen
- Department of dermatology, Centre Hospitalier d'Aubagne, Aubagne, France
| | - M Bachelerie
- Department of dermatology, Centre Hospitalier Universitaire de Clermond Ferrand, Clermont-Ferrand, France
| | - A Nosbaum
- Department of Clinical Immunology and Allergy, Lyon-Sud University Hospital, Pierre Bénite, Lyon, Lyon, France
| | - A Leymarie
- Department of dermatology, Centre Hospitalier Universitaire de Caen, Caen, France
| | - P Armingaud
- Department of dermatology, Centre Hospitalier d'Orléans, Orléans, France
| | | | - E Mahé
- Department of dermatology, Centre Hospitalier Victor Dupouy, Argenteuil, France
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18
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Mazzoni D, Lobo Y, Levitt D, Wheller L. Severe atopic dermatitis in a 21-month-old boy successfully treated with dupilumab. Pediatr Dermatol 2022; 39:606-608. [PMID: 35575257 DOI: 10.1111/pde.14996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/04/2022] [Accepted: 03/23/2022] [Indexed: 01/01/2023]
Abstract
While dupilumab has emerged as a novel targeted systemic treatment for severe AD, efficacy and safety-based data in young children are limited. We discuss the case of a 21-month-old child with severe recalcitrant atopic dermatitis successfully treated with dupilumab.
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Affiliation(s)
- Daniel Mazzoni
- Department of Dermatology, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Yolanka Lobo
- Department of Dermatology, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - David Levitt
- Department of General Paediatrics, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Laura Wheller
- Department of General Paediatrics, Queensland Children's Hospital, Brisbane, Queensland, Australia
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19
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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: 4] [Impact Index Per Article: 2.0] [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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20
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Lockhart MK, Siegfried EC. Evolving Landscape of Systemic Therapy for Pediatric Atopic Dermatitis. Dermatol Clin 2022; 40:137-143. [DOI: 10.1016/j.det.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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21
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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: 2.0] [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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22
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Rao M, Grove D, Haggstrom A. A rare presentation of herpes simplex virus encephalitis occurring in a pediatric patient on dupilumab for atopic dermatitis. Pediatr Dermatol 2022; 39:288-290. [PMID: 35243667 PMCID: PMC9310620 DOI: 10.1111/pde.14970] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/14/2022] [Accepted: 02/20/2022] [Indexed: 11/29/2022]
Abstract
A 4-year-old female with a history of atopic dermatitis developed herpes simplex virus (HSV) encephalitis while being treated with dupilumab and concomitant topical steroids. There was no prior history of HSV infections or immunodeficiency. To our knowledge, this is the first case of HSV encephalitis in a patient receiving dupilumab.
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Affiliation(s)
- Megana Rao
- Indiana University School of Medicine in Indianapolis, Indianapolis, Indiana, USA
| | - Daniel Grove
- Department of Pediatric Dermatology, Akron Children's Hospital in Akron, Akron, Ohio, USA
| | - Anita Haggstrom
- Department of Dermatology, Indiana University School of Medicine in Indianapolis, Indianapolis, Indiana, USA
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23
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Havele SA, Khurana MC, McMahon P, Murthy AS, Perman MJ, Treat JR. Safety of dupilumab in a 5-month-old infant with severe atopic dermatitis. Pediatr Dermatol 2022; 39:291-294. [PMID: 35434859 DOI: 10.1111/pde.14980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/26/2022] [Indexed: 11/29/2022]
Abstract
Dupilumab is a fully humanized monoclonal antibody that suppresses Th2-mediated inflammation by inhibiting signaling of interleukin-4 and interleukin-13 through the interleukin-4 alpha receptor subunit, and is approved by the FDA for the treatment of moderate to severe atopic dermatitis (AD) in children 6 years of age and older. While initial data from phase 2 trials in children less than 6 years are promising, dupilumab use in children less than 6 months of age is not well studied. Here we present a case of a 5-month-old boy with severe primary AD, eosinophilia, hypogammaglobulinemia, and poor weight gain, who was successfully treated with dupilumab and experienced no serious adverse effects. To our knowledge, this is the youngest patient to receive dupilumab to date.
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Affiliation(s)
- Sonia A Havele
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michele C Khurana
- Section of Dermatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Patrick McMahon
- Section of Dermatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aditi S Murthy
- Section of Dermatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marissa J Perman
- Section of Dermatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James R Treat
- Section of Dermatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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24
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Plachouri KM, Georgiou S. Dupilumab in pediatric dermatology. J DERMATOL TREAT 2022; 33:682-684. [DOI: 10.1080/09546634.2020.1789049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Kerasia-Maria Plachouri
- Dermatology Department, University of Patras, Greece, University General Hospital of Patras, Rio, Greece
| | - Sophia Georgiou
- Dermatology Department, University of Patras, Greece, University General Hospital of Patras, Rio, Greece
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25
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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: 20] [Impact Index Per Article: 10.0] [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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Napolitano M, Fabbrocini G, Neri I, Stingeni L, Boccaletti V, Piccolo V, Amoruso GF, Malara G, De Pasquale R, Di Brizzi EV, Diluvio L, Bianchi L, Chiricozzi A, Di Guida A, Del Duca E, Moschese V, Di Lernia V, Dragoni F, Gruber M, Hansel K, Licari A, Manti S, Leonardi S, Mastorino L, Ortoncelli M, Provenzano E, Palermo A, Patella V, Peduto T, Pezzolo E, Piras V, Potestio L, Battista T, Satta R, Termine S, Palma P, Zangari P, Patruno C. Dupilumab Treatment in Children Aged 6-11 Years With Atopic Dermatitis: A Multicentre, Real-Life Study. Paediatr Drugs 2022; 24:671-678. [PMID: 36028611 PMCID: PMC9417930 DOI: 10.1007/s40272-022-00531-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND The management of paediatric atopic dermatitis (AD) is challenging, mostly relying on emollients and topical corticosteroids. Dupilumab, a fully human monoclonal antibody, has been recently approved for the treatment of children aged 6-11 years with moderate-to-severe AD not adequately controlled with topical therapies or when those therapies are not advisable. OBJECTIVES The aim of this study was to evaluate in real life the effectiveness and safety of dupilumab in the treatment of children aged from 6 to 11 years. METHODS Demographic and clinical data of children aged 6-11 years, affected by moderate-to-severe AD and treated with dupilumab, were retrospectively collected from 24 dermatological and paediatric referral centres. Dupilumab was administered subcutaneously at an induction dose of 300 mg on day (D) 1, followed by 300 mg on D15 and 300 mg every 4 weeks. Disease severity was assessed at baseline and after week 2 (W2), W4 and W16 of dupilumab therapy using Eczema Area Severity Index (EASI), Pruritus Numerical Rating Scale (P-NRS) and Sleep NRS (S-NRS) and Children's Dermatology Life Quality Index (c-DLQI) score. RESULTS A total of 55 AD children (24 males [43.64%], 31 females [56.36%]; mean age 9.35 ± 1.75 years) were included. A significant improvement in EASI score, P-NRS, S-NRS and c-DLQI was observed from baseline to W16 of treatment with dupilumab. In particular, at W16 the proportion of patients achieving EASI75 was 74.54%. Moreover, at the same timepoint a significant mean percentage reduction for P-NRS, S-NRS and c-DLQI was also observed (68.39%, 70.22% and 79.03%, respectively). CONCLUSIONS Our real-life data seem to confirm the effectiveness of dupilumab in paediatric patients on all disease aspects, including extent and severity of signs, intensity of symptoms, sleep and QoL, with a good safety profile.
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Affiliation(s)
- Maddalena Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy.
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Iria Neri
- Division of Dermatology, IRCCS di Policlinico S Orsola, University of Bologna, Bologna, Italy
| | - Luca Stingeni
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Valeria Boccaletti
- Section of Dermatology, Department of Medicine, University of Brescia, Brescia, Italy
| | - Vincenzo Piccolo
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Giovanna Malara
- Struttura Complessa di Dermatologia, Grande Ospedale Metropolitano “Bianchi Melacrino Morelli”, Reggio Calabria, Italy
| | | | | | - Laura Diluvio
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy
| | - Luca Bianchi
- Dermatology Unit, Policlinico Tor Vergata, System Medicine Department, University of Tor Vergata, Rome, Italy
| | - Andrea Chiricozzi
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy ,Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Adriana Di Guida
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Elisabetta Del Duca
- Pediatric Immunopathology and Allergology Unit, Policlinico Tor Vergata, University of Rome Tor Vergata, Viale Oxford 81, Rome, Italy
| | - Viviana Moschese
- Pediatric Immunopathology and Allergology Unit, Policlinico Tor Vergata, University of Rome Tor Vergata, Viale Oxford 81, Rome, Italy
| | - Vito Di Lernia
- Dermatology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy
| | | | - Michaela Gruber
- Department of Pediatrics, Central Hospital of Bolzano, Bolzano, Italy
| | - Katharina Hansel
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Amelia Licari
- Pediatric Unit, Fondazione IRCCS Policlinico San Matteo, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Sara Manti
- Pediatric Respiratory Unit, Department of Clinical and Experimental Medicine, San Marco Hospital, University of Catania, Catania, Italy
| | - Salvatore Leonardi
- Pediatric Respiratory Unit, Department of Clinical and Experimental Medicine, San Marco Hospital, University of Catania, Catania, Italy
| | - Luca Mastorino
- Dermatology Clinic, Department of Clinical, Sciences, University of Turin, Turin, Italy
| | - Michela Ortoncelli
- Dermatology Clinic, Department of Clinical, Sciences, University of Turin, Turin, Italy
| | | | | | - Vincenzo Patella
- Division of Allergy and Clinical Immunology, Department of Medicine, “Santa Maria della Speranza” Hospital, 84091 Battipaglia, Italy
| | - Tiziana Peduto
- Division of Allergy and Clinical Immunology, Department of Medicine, “Santa Maria della Speranza” Hospital, 84091 Battipaglia, Italy
| | - Elena Pezzolo
- Dermatology Unit, Ospedale San Bortolo, Vicenza, Italy
| | - Viviana Piras
- Dermatological Clinic, Department of Medical Science and Public Health, AOU Cagliari, Cagliari, Italy
| | - Luca Potestio
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Teresa Battista
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Rosanna Satta
- Dipartimento Scienze Mediche, Chirurgiche e Sperimentali, Università di Sassari, Sassari, Italy
| | | | - Paolo Palma
- Research Unit of Clinical Immunology and Vaccinology, Academic Department of Pediatrics (DPUO), Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Paola Zangari
- Research Unit of Clinical Immunology and Vaccinology, Academic Department of Pediatrics (DPUO), Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Wang HJ, Yang TT, Lan CCE. Dupilumab treatment of eczema in a child with STAT3 hyper-immunoglobulin E syndrome. J Eur Acad Dermatol Venereol 2021; 36:e367-e369. [PMID: 34927771 DOI: 10.1111/jdv.17889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/28/2021] [Accepted: 12/15/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Huei-Jing Wang
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ting-Ting Yang
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Che Eric Lan
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Kang SY, Um JY, Chung BY, Kim JC, Park CW, Kim HO. Differential Diagnosis and Treatment of Itching in Children and Adolescents. Biomedicines 2021; 9:biomedicines9080919. [PMID: 34440123 PMCID: PMC8389554 DOI: 10.3390/biomedicines9080919] [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: 06/29/2021] [Revised: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 12/13/2022] Open
Abstract
Itching is prevalent in children with skin disorders and associated with effects on their mood, quality of life, and social functioning. Surprisingly, there are no data on childhood prevalence of pruritus in the general population. The aim of this article is to explore the epidemiology, clinical manifestation, and treatment for itch (pruritus) in the pediatric population (from infancy to adolescence), and to be helpful to primary care physicians who assess and diagnose pediatric patients with itching. In this study, we searched for specific keywords using PubMed and MEDLINE (Ovid) and, then, refined the retrieved searches for each cause and treatment. As a result of reviewing the literature, atopic dermatitis was shown to be the most common cause of itching, especially during infancy and through preschool. Not only skin disorders but also systemic diseases, drugs, and postburn states can predispose an individual to itching in childhood. There are traditional and newly developed treatment modalities for itching in pediatric patients. However, because the pharmacokinetics and pharmacodynamics of childhood are different from those of adults, the medications for itching have to be applied carefully for these age groups. There are many areas to be elucidated regarding the prevalence and objective assessment of pruritus in pediatric patients. Moreover, the safety profiles of medications in the pediatric population need to be better understood. Further studies to investigate itching in childhood are warranted.
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29
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Martinez-Cabriales SA, Kirchhof MG, Constantinescu CM, Murguia-Favela L, Ramien ML. Recommendations for Vaccination in Children with Atopic Dermatitis Treated with Dupilumab: A Consensus Meeting, 2020. Am J Clin Dermatol 2021; 22:443-455. [PMID: 34076879 PMCID: PMC8169786 DOI: 10.1007/s40257-021-00607-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/29/2022]
Abstract
Dupilumab is the only biologic therapy currently approved in Europe and the United States for severe atopic dermatitis in patients 6 years of age or older. Off-label use is rationalized in younger children with severe atopic dermatitis. Decisions about vaccination for children on dupilumab are complex and depend on both the child’s current treatment and the type of vaccination required. To achieve consensus on recommendations for vaccination of pediatric patients with atopic dermatitis treated with or planning to start dupilumab, a review of the literature and a modified-Delphi process was conducted by a working group of 5 panelists with expertise in dermatology, immunology, infectious diseases and vaccination. Here, we provide seven recommendations for vaccination of pediatric patients with atopic dermatitis treated with or planning to start dupilumab. These recommendations serve to guide physicians’ decisions about vaccination in children with atopic dermatitis treated with dupilumab. Furthermore, we highlight an unmet need for research to determine how significantly dupilumab affects cellular and humoral immune responses to vaccination with live attenuated and inactivated vaccines.
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Affiliation(s)
- Sylvia A Martinez-Cabriales
- Section of Community Pediatrics, Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, AB, Canada
| | - Mark G Kirchhof
- Division of Dermatology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Cora M Constantinescu
- Section of Infectious Diseases, Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, AB, Canada
| | - Luis Murguia-Favela
- Section of Hematology and Immunology, Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, AB, Canada
| | - Michele L Ramien
- Section of Community Pediatrics, Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, AB, Canada.
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
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30
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Agnihotri G, Lio PA, Lee KC. Differences in pediatric versus adult clinical trial characteristics for atopic dermatitis. Pediatr Dermatol 2021; 38:775-779. [PMID: 34173679 DOI: 10.1111/pde.14658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a growing burden in all ages. The aim of this study was to compare trial characteristics between pediatric and adult AD trials. METHODS Data were collected from ClinicalTrials.gov on AD therapeutic trials completed between 2003 and 2019. The trials were classified as pediatrics (mean or median age <18 years of the experimental group participants) or adults. The trials with and without results on ClinicalTrials.gov were searched on PubMed for further data collection. RESULTS Of 210 trials, 50 (24%) were pediatric trials [mean age: 8.2 ± 4.3 years (SD)] and 160 (76%) were adult trials [mean age 35.2 ± 5.7 years (SD)]. Pediatric and adult trials were equally likely to be randomized controlled trials; however, pediatric trials were more likely to be open-label trials (P < .001) and have no comparator (P < .001). Adult trials were more likely to be industry-funded (95% vs. 80%, P = .001). Any evaluation of drug safety was more likely present in adult trials (83% vs. 60%, P = .001). In trials examining AD severity as an outcome, the Eczema Area and Severity Index (EASI) predominated in adult trials (51% vs. 29%, P < .05) and Scoring Atopic Dermatitis (SCORAD) in pediatric trials (25% vs. 10%, P < .05). CONCLUSION The results highlight differences in trial design between pediatric and adult AD trials and show a lack of standardization in trial design.
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Affiliation(s)
- Gaurav Agnihotri
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Peter A Lio
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Medical Dermatology Associates of Chicago, Chicago, IL, USA
| | - Kachiu C Lee
- Department of Dermatology, Temple University, Philadelphia, PA, USA
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Ollech A, Mashiah J, Lev A, Simon AJ, Somech R, Adam E, Barzilai A, Hagin D, Greenberger S. Treatment options for DOCK8 deficiency-related severe dermatitis. J Dermatol 2021; 48:1386-1393. [PMID: 34043252 DOI: 10.1111/1346-8138.15955] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cutaneous manifestations of dedicator of cytokinesis 8 gene (DOCK8) deficiency, a combined type of T and B cell immunodeficiency, previously designated as autosomal recessive hyper IgE syndrome, includes dermatitis and skin infections. There are limited treatment options for dermatitis related to the syndrome. OBJECTIVE To describe a cohort of patients with DOCK8 deficiency with a focus on the treatment of their cutaneous manifestations. METHODS A retrospective study on all children with the genetic diagnosis of DOCK8 deficiency treated at the Sheba Medical Center between 1/1/2003 and 1/1/2021 was preformed. Collected data included: demographic features, family history, laboratory, genetic testing, skin manifestations, treatment, and disease course. Description of two cases of severe recalcitrant dermatitis treated with dupilumab is detailed. RESULTS Nine children with a genetic diagnosis of DOCK8 deficiency were included, of whom six were girls (66%) with a median age of 8.5 (±2.2 SD) years. The median age at diagnosis was 2.8 (±2.6 SD) years. Six patients were born to consanguineous parents. Five out of six patients who received hematopoietic stem cell transplantation (HSCT) had a complete response, and one was recently transplanted. Of note, two patients, while awaiting HSCT, were treated with dupilumab for their severe dermatitis resulting in a marked improvement of the cutaneous manifestations and pruritus. CONCLUSIONS Hematopoietic stem cell transplantation is the gold standard and most effective therapy for patients with DOCK8 deficiency. Dupilumab, a biological therapy indicated for atopic dermatitis and other Th2 derived dermatoses, is an excellent option for dermatitis in patients with DOCK8 deficiency and can be used as a bridge before HSCT. Larger studies are needed to confirm this observation.
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Affiliation(s)
- Ayelet Ollech
- Department of Dermatology, Pediatric Dermatology Service, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Mashiah
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Dermatology and Venereology, Pediatric Dermatology Unit, Dana Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Atar Lev
- Department of Pediatrics, Immunodeficiency Unit, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Amos J Simon
- Department of Pediatrics, Immunodeficiency Unit, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Raz Somech
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatrics, Immunodeficiency Unit, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Etai Adam
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Pediatric Hematology and Oncology, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Aviv Barzilai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Dermatology and Venereology, Pediatric Dermatology Unit, Dana Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - David Hagin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Dermatology and Venereology, Pediatric Dermatology Unit, Dana Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Allergy and Clinical Immunology Unit, Department of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shoshana Greenberger
- Department of Dermatology, Pediatric Dermatology Service, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Bax CE, Khurana MC, Treat JR, Castelo-Soccio L, Rubin AI, McMahon PJ. New-onset head and neck dermatitis in adolescent patients after dupilumab therapy for atopic dermatitis. Pediatr Dermatol 2021; 38:390-394. [PMID: 33426747 DOI: 10.1111/pde.14499] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND/OBJECTIVES Head and neck dermatitis after dupilumab therapy for atopic dermatitis has been frequently reported in adults and only rarely in adolescents. No cases detailing disease course and treatment response have previously been described in adolescents. METHODS/RESULTS This case series presents five adolescent patients who developed new-onset or worsening head and neck dermatitis after dupilumab therapy for atopic dermatitis. All five patients improved after oral antifungal therapy. CONCLUSIONS The clinical features, treatment response, and potential disease pathogenesis in pediatric patients are described. Adolescents with new-onset head and neck dermatitis after dupilumab therapy may clinically improve with antifungal therapy, suggesting that Malassezia species may be a contributing factor or antifungal therapy may be an effective antiinflammatory agent.
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Affiliation(s)
- Christina E Bax
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Michele C Khurana
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Section of Dermatology, Department of Pediatrics Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - James R Treat
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Section of Dermatology, Department of Pediatrics Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Leslie Castelo-Soccio
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Section of Dermatology, Department of Pediatrics Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Adam I Rubin
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Section of Dermatology, Department of Pediatrics Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Patrick J McMahon
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Section of Dermatology, Department of Pediatrics Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Bidirectional association between atopic dermatitis, conjunctivitis, and other ocular surface diseases: A systematic review and meta-analysis. J Am Acad Dermatol 2020; 85:453-461. [PMID: 33253849 DOI: 10.1016/j.jaad.2020.11.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/31/2020] [Accepted: 11/13/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Conjunctivitis and several other ocular surface diseases (OSDs) have been linked to atopic dermatitis (AD) and its treatment. OBJECTIVES To examine the association between AD, conjunctivitis, and other OSDs. METHODS A systematic review and meta-analysis was performed. Two authors independently searched EMBASE, PubMed, SCOPUS, and Web of Science and performed title/abstract and full-text review and data abstraction. Pooled random-effects prevalence and odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. RESULTS The search yielded 5719 nonduplicate articles; 134 were included in the quantitative analysis. AD was associated with conjunctivitis compared to reference individuals (OR, 2.78; 95% CI, 2.33-3.32); the prevalences of conjunctivitis in patients with AD and reference individuals were 31.7% (95% CI, 27.7-35.9) and 13.3% (95% CI, 11.0-15.7), respectively. Keratoconus (OR, 3.71; 95% CI, 1.99-6.94) and ocular herpes simplex (OR, 3.65; 95% CI 2.04-6.51) were also associated with AD. LIMITATIONS Disease definitions differed and often relied on self-reports. Few studies provided data concerning AD phenotype or OSDs other than conjunctivitis. CONCLUSIONS Conjunctivitis is the most common ocular comorbidity in AD. Signs and symptoms of conjunctivitis and other OSDs in AD may be underreported, making proactive inquiry and examination by physicians treating patients with AD important.
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Dakin H, Haas C. Successful and rapid clearance of severe, treatment-resistant atopic dermatitis with dupilumab in a 3-year-old. Dermatol Ther 2020; 33:e14282. [PMID: 32888373 DOI: 10.1111/dth.14282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/26/2020] [Accepted: 08/30/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Hannah Dakin
- Department of Dermatology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Christopher Haas
- Department of Dermatology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
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El Hachem M, Naldi L, Neri I, Pedone MP, Fanelli F, Galeone C. Atopic dermatitis in schoolchildren and adolescents: a critical review of Italian epidemiological data and systemic treatments. Ital J Dermatol Venerol 2020; 156:650-658. [PMID: 33070573 DOI: 10.23736/s2784-8671.20.06669-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The epidemiology of atopic dermatitis (AD) is largely different in pre-school and schoolchildren. We summarized the available epidemiological data on schoolchildren (6-11 years) and adolescents (12-17 years) in Italy and reviewed information on systemic treatments for moderate-to-severe AD in adolescents. EVIDENCE ACQUISITION In January 2019, we searched for data on prevalence and/or incidence of AD and on the efficacy, effectiveness and safety of systemic AD therapies. Papers were evaluated and selected, and relevant information was extracted. Twenty papers from 17 studies reported original epidemiological information on AD in Italy. EVIDENCE SYNTHESIS Most studies were conducted before 2005. Though variations emerged between studies, the lifetime prevalence of AD was estimated between 15-17% in schoolchildren and between 8-13% in adolescents. The (12-months) period prevalence of AD was estimated between 8-10% in children and between 8-11% in adolescents. Up-to-date information on the prevalence of severe AD is not available. Cyclosporine A may be used in pediatric age patients (children and adolescents) with persistent or severe AD refractory to topical treatments, but its use has several limitations, and is not recommended in patients younger than 16 years. The treatment paradigm of AD is still far from being satisfactory. CONCLUSIONS We provided a quantitative synthesis of AD epidemiology in Italian schoolchildren and adolescents. Recent data are needed, as most information dates back to the 1990s or early 2000s, and data on the incidence of AD, the proportion of severe cases, and treatment of severe cases in the real-world setting are scanty.
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Affiliation(s)
- May El Hachem
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Luigi Naldi
- Department of Dermatology, San Bortolo Hospital, Vicenza, Italy
| | - Iria Neri
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | | | - Carlotta Galeone
- Outcome Research Unit, Statinfo, Renate, Monza e Brianza, Italy -
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Halling AS, Loft N, Silverberg JI, Guttman-Yassky E, Thyssen JP. Real-world evidence of dupilumab efficacy and risk of adverse events: A systematic review and meta-analysis. J Am Acad Dermatol 2020; 84:139-147. [PMID: 32822798 DOI: 10.1016/j.jaad.2020.08.051] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/07/2020] [Accepted: 08/09/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Dupilumab, the first biological drug to be approved for the treatment of moderate to severe atopic dermatitis in adolescents and adults, has shown good efficacy and safety in clinical trials. OBJECTIVE To evaluate real-world data on the efficacy and safety of dupilumab in atopic dermatitis. METHODS PubMed and EMBASE were searched for observational studies with data on efficacy, drug survival, and safety of dupilumab for the treatment of atopic dermatitis. Primary outcomes were mean percentage change in Eczema Area and Severity Index (EASI) score and proportion of atopic dermatitis patients achieving 50%, 75%, and 90% improvement in EASI score after dupilumab therapy. RESULTS Twenty-two unique studies encompassing 3303 atopic dermatitis patients were included. After 16 weeks of dupilumab therapy, the pooled proportion of patients achieving 50%, 75%, and 90% EASI score improvement was 85.1%, 59.8%, and 26.8%, respectively, and the weighted mean reduction in EASI score was 69.6%. Conjunctivitis was the most common adverse event, reported in a pooled proportion of 26.1%. LIMITATIONS Limited data in terms of size and follow-up time were available. CONCLUSION Real-world data show that dupilumab is a successful and well-tolerated therapy for atopic dermatitis, but ocular adverse events commonly occur. Registries are needed to monitor for adverse events.
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Affiliation(s)
- Anne-Sofie Halling
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, Hellerup, Denmark.
| | - Nikolai Loft
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Emma Guttman-Yassky
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York
| | - Jacob P Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, Hellerup, Denmark
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Castagnoli R, De Filippo M, Votto M, Marseglia A, Montagna L, Marseglia GL, Licari A. An update on biological therapies for pediatric allergic diseases. Minerva Pediatr 2020; 72:364-371. [PMID: 32686927 DOI: 10.23736/s0026-4946.20.05993-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Allergic diseases represent a global health burden. Patients with allergic diseases may experience disability, reduced quality of life and productivity, emotional distress, and social restrictions, especially in the most severe cases. Current advances in unveiling the pathogenesis of allergic disorders have paved the way for the development of novel therapeutic strategies. Biological drugs have been widely studied in pediatric allergic asthma, with strong evidence of efficacy and safety. Moreover, promising results derive from studies on other conditions such as atopic dermatitis, chronic spontaneous urticaria, and food allergy. This review analyzes recent evidence on the role of biologic therapies for allergic diseases, focusing on the pediatric age.
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Affiliation(s)
- Riccardo Castagnoli
- Department of Pediatrics, Pediatric Clinic, IRCCS San Matteo Polyclinic Foundation, University of Pavia, Pavia, Italy
| | - Maria De Filippo
- Department of Pediatrics, Pediatric Clinic, IRCCS San Matteo Polyclinic Foundation, University of Pavia, Pavia, Italy
| | - Martina Votto
- Department of Pediatrics, Pediatric Clinic, IRCCS San Matteo Polyclinic Foundation, University of Pavia, Pavia, Italy
| | - Alessia Marseglia
- Department of Pediatrics, Pediatric Clinic, IRCCS San Matteo Polyclinic Foundation, University of Pavia, Pavia, Italy
| | - Lorenza Montagna
- Department of Pediatrics, Pediatric Clinic, IRCCS San Matteo Polyclinic Foundation, University of Pavia, Pavia, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Pediatric Clinic, IRCCS San Matteo Polyclinic Foundation, University of Pavia, Pavia, Italy -
| | - Amelia Licari
- Department of Pediatrics, Pediatric Clinic, IRCCS San Matteo Polyclinic Foundation, University of Pavia, Pavia, Italy
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Jamgochian M, Milgraum D, Milgraum S, Pappert A. Dupilumab as treatment for atopic dermatitis in a pediatric heart transplant patient: A case report. Dermatol Ther 2020; 33:e14018. [PMID: 32672892 DOI: 10.1111/dth.14018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/11/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Marielle Jamgochian
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - David Milgraum
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Sandy Milgraum
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Amy Pappert
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Abstract
PURPOSE OF REVIEW Atopic dermatitis (AD), chronic spontaneous urticaria (CSU), and allergic contact dermatitis (ACD) represent three important allergic dermatoses with many unmet therapeutic needs. The development of biologic agents has opened the door to both new treatment options and improved understanding of the underlying pathophysiology, both shared and unique for these entities. With several FDA-approved medications available and many more in development, the biologic revolution has begun for allergic dermatoses. RECENT FINDINGS This is a narrative review on the current state of pathomechanisms and appropriately targeted biologic agents for these three common allergic skin conditions. The importance of Th2 inflammation and the effect of inflammatory cytokines on the skin barrier may help explain the impressive efficacy of biologic agents, while maintaining relative safety. While some of the biologic agents show efficacy across multiple allergic dermatoses, more often it seems these more targeted pathways show accordingly precise efficacy. However, in each disease, multiple agents hold promise, and may be differentiated by safety and adverse effect profile rather than simply by efficacy. New understanding of the pathogenesis of the allergic dermatoses has ushered in a new era of biologic therapies. Competing mechanisms and molecules will continue to be developed and vetted in trials with hopes of continuously refined precision therapies with optimized safety and efficacy profiles.
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Affiliation(s)
- Sara N Bilimoria
- Northwestern University Feinberg School of Medicine, 363 W. Erie Street, Suite 350, Chicago, IL, 60616, USA
| | - Peter A Lio
- Northwestern University Feinberg School of Medicine, 363 W. Erie Street, Suite 350, Chicago, IL, 60616, USA.
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Licari A, Castagnoli R, Marseglia A, Olivero F, Votto M, Ciprandi G, Marseglia GL. Dupilumab to Treat Type 2 Inflammatory Diseases in Children and Adolescents. Paediatr Drugs 2020; 22:295-310. [PMID: 32157553 DOI: 10.1007/s40272-020-00387-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
During the past decade, significant therapeutic progress has been made in the field of allergic diseases, mainly concerning the pathogenic role of type 2 inflammation. Biologics targeting specific key cytokines, such as interleukin (IL)-4, IL-5, and IL-13, as well as IgE, have emerged as promising innovative therapies for allergic disorders. In this context, dupilumab has emerged as one of the most successful therapies targeting the IL-4R axis. Dupilumab is a human IgG4 antibody anti-IL-4 receptor (IL-4R) α-subunit that blocks IL-4R signaling induced by both IL-4 and IL-13, downregulating the molecular pathways that drive type 2 inflammatory diseases, including atopic dermatitis, allergic rhinitis, allergic asthma, chronic rhinosinusitis with nasal polyps, and eosinophilic esophagitis. This review presents the most recent evidence on dupilumab for the treatment of type 2 inflammatory diseases and discusses the future perspective, focusing on the pediatric age group and adolescents.
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Affiliation(s)
- Amelia Licari
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, viale Golgi 19, 27100, Pavia, Italy.
| | - Riccardo Castagnoli
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, viale Golgi 19, 27100, Pavia, Italy
| | - Alessia Marseglia
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, viale Golgi 19, 27100, Pavia, Italy
| | - Francesca Olivero
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, viale Golgi 19, 27100, Pavia, Italy
| | - Martina Votto
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, viale Golgi 19, 27100, Pavia, Italy
| | | | - Gian Luigi Marseglia
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, viale Golgi 19, 27100, Pavia, Italy
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Ahn K, Kim BE, Kim J, Leung DY. Recent advances in atopic dermatitis. Curr Opin Immunol 2020; 66:14-21. [PMID: 32299014 DOI: 10.1016/j.coi.2020.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/28/2020] [Indexed: 01/22/2023]
Abstract
The prevalence and disease burden of atopic dermatitis (AD) is substantial. AD causes significant impairment in quality of life. It is also associated with mental disorders as well as cardiovascular diseases. Many factors including race, environment, skin barrier dysfunction, immune regulatory abnormalities, and microbiome have been reported to affect the pathophysiology of AD. A variety of cell types including Th2, Th17, Th22, and type 2 innate lymphoid cells contribute to AD. Cytokines from these immune cells cause abnormal epidermal differentiation and skin barrier dysfunction. Moreover, microbial dysbiosis and deficiency of antimicrobial peptides result in Staphylococcus aureus infection. Recently, new drugs have been successfully launched to target polarized immune pathways that lead to moderate-to-severe AD.
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Affiliation(s)
- Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea; Environmental Health Center for Atopic Diseases, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Byung Eui Kim
- Department of Pediatrics, National Jewish Health, 1400 Jackson St, Denver, CO, 80206, USA
| | - Jihyun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea; Environmental Health Center for Atopic Diseases, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Donald Ym Leung
- Department of Pediatrics, National Jewish Health, 1400 Jackson St, Denver, CO, 80206, USA.
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