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Piraccini BM, Pampaloni F, Cedirian S, Quadrelli F, Bruni F, Rapparini L, Caro G, Acri MC, Ala L, Rossi A, Pellacani G, Lacarrubba F, Micali G, Dall'Oglio F, Vastarella M, Cantelli M, Nappa P, Diluvio L, Bianchi L, Gnesotto L, Sechi A, Naldi L, Tassone F, Peris K, Caldarola G, Pinto LM, Girolomoni G, Marangoni F, Bellinato F, Gisondi P, Scandagli I, Prignano F, Pimpinelli N, Tomasini C, Barruscotti S, De Simoni E, Simonetti O, Ambrogio F, Foti C, Boccaletti V, Fraghì A, Marzano AV, Mattioli MA, Rocca L, Barbareschi M, Ferrucci SM, Gallo G, Ribero S, Quaglino P, Balestri R, Ioris T, Caposiena Caro RD, Zalaudek I, Vagnozzi E, Fargnoli MC, Caponio C, Rubegni P, Cinotti E, Trovato E, Romanelli M, Dini V, Manzo Margiotta F, Feliciani C, de Felici Del Giudice MB, Atzori L, Sanna S, Lembo S, Raimondo A, Magnano M, Starace M. Real-life effectiveness and safety of baricitinib in patients with severe alopecia areata: A 24-week Italian study. J Eur Acad Dermatol Venereol 2024. [PMID: 39247945 DOI: 10.1111/jdv.20312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 08/05/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Alopecia areata is an autoimmune condition characterized by rapid hair loss in the scalp, eyebrows and eyelashes, for which treatments are limited. Baricitinib, an oral inhibitor of Janus kinases 1 and 2, has been recently approved to treat alopecia areata. MATERIALS AND METHODS We conducted a retrospective study involving 23 medical centres across Italy, enrolling patients affected by severe alopecia areata (SALT >50), for more than 6 months. Clinical and trichoscopic assessment was performed at each visit and impact on quality of life, anxiety and depression were evaluated using the Skindex-16 and the Hospital Anxiety and Depression Scale (HADS), respectively. RESULTS A total of 118 patients were enrolled, with a mean age of 39 years and a mean SALT >95. The mean value of the SALT score decreased from an average of 96.6 (±8.23 sd) to 48 (±35.2 sd) after 24 weeks of treatment and 42.3% of patients achieved a SALT 30, 31.3% a SALT 20 and 20.3% a SALT 10 by Week 24. Trichoscopic signs showed fewer yellow dots and black dots significantly earlier than hair regrowth. Adverse events during the treatment period (mild laboratory test abnormalities) were reported in 12.7% patients. No drop-out were registered. CONCLUSION Data on the effectiveness and safety of baricitinib are promising and support the use of this drug in severe forms of AA, also in the early stages. We also suggest performing trichoscopy in order to reveal early response to therapy.
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Affiliation(s)
- B M Piraccini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - F Pampaloni
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - S Cedirian
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - F Quadrelli
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - F Bruni
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - L Rapparini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - G Caro
- Unit of Dermatology, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - M C Acri
- Unit of Dermatology, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - L Ala
- Unit of Dermatology, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - A Rossi
- Unit of Dermatology, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - G Pellacani
- Unit of Dermatology, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - F Lacarrubba
- Dermatology Clinic, University of Catania, Catania, Italy
| | - G Micali
- Dermatology Clinic, University of Catania, Catania, Italy
| | - F Dall'Oglio
- Dermatology Clinic, University of Catania, Catania, Italy
| | - M Vastarella
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - M Cantelli
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - P Nappa
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - L Diluvio
- Dermatology Unit, Fondazione Policlinico di Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - L Bianchi
- Dermatology Unit, Fondazione Policlinico di Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - L Gnesotto
- Dermatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - A Sechi
- Dermatology Unit, San Bortolo Hospital, Vicenza, Italy
| | - L Naldi
- Dermatology Unit, San Bortolo Hospital, Vicenza, Italy
| | - F Tassone
- 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
| | - K Peris
- 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
| | - G Caldarola
- 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
| | - L M Pinto
- 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
| | - G Girolomoni
- Dipartimento di Medicina, Sezione di Dermatologia, Università di Verona, Verona, Italy
| | - F Marangoni
- Dipartimento di Medicina, Sezione di Dermatologia, Università di Verona, Verona, Italy
| | - F Bellinato
- Dipartimento di Medicina, Sezione di Dermatologia, Università di Verona, Verona, Italy
| | - P Gisondi
- Dipartimento di Medicina, Sezione di Dermatologia, Università di Verona, Verona, Italy
| | - I Scandagli
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - F Prignano
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - N Pimpinelli
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - C Tomasini
- Dermatology Clinic, Fondazione IRCCS Policlinico san Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - S Barruscotti
- Dermatology Clinic, Fondazione IRCCS Policlinico san Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - E De Simoni
- Dermatology Clinic-Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - O Simonetti
- Dermatology Clinic-Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - F Ambrogio
- Section of Dermatology and Venereology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - C Foti
- Section of Dermatology and Venereology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - V Boccaletti
- Clinica Dermatologica, Università degli Studi di Brescia, Brescia, Italy
| | - A Fraghì
- Clinica Dermatologica, Università degli Studi di Brescia, Brescia, Italy
| | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - M A Mattioli
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - L Rocca
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - M Barbareschi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - S M Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - G Gallo
- Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, Italy
| | - S Ribero
- Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, Italy
| | - P Quaglino
- Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, Italy
| | - R Balestri
- Division of Dermatology, "U.O. Multizonale APSS", Trento, Italy
| | - T Ioris
- Division of Dermatology, "U.O. Multizonale APSS", Trento, Italy
| | - R D Caposiena Caro
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - I Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - E Vagnozzi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Dermatology Unit, San Salvatore Hospital, ASL 1, Abruzzo, Italy
| | - M C Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Dermatology Unit, San Salvatore Hospital, ASL 1, Abruzzo, Italy
| | - C Caponio
- Dermatology Unit, San Salvatore Hospital, ASL 1, Abruzzo, Italy
| | - P Rubegni
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria Alle Scotte Hospital, Siena, Italy
| | - E Cinotti
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria Alle Scotte Hospital, Siena, Italy
| | - E Trovato
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria Alle Scotte Hospital, Siena, Italy
| | - M Romanelli
- Dermatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - V Dini
- Dermatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - F Manzo Margiotta
- Dermatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - C Feliciani
- Unit of Dermatology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - L Atzori
- Dermatology Unit, Department Medical Sciences and Public Health, University of Cagliari, Catania, Italy
| | - S Sanna
- Dermatology Unit, Department Medical Sciences and Public Health, University of Cagliari, Catania, Italy
| | - S Lembo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - A Raimondo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - M Magnano
- Unit of Dermatology, Versilia Hospital, Lido di Camaiore, Lucca, Italy
| | - M Starace
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Ferrucci SM, Tavecchio S, Ceresa A, Angileri L, Berti E, Marzano AV, Buoli M. Which Factors Are Associated with Persistence of Depressive and Anxiety Symptoms in Patients Affected by Atopic Dermatitis despite 2-Year Treatment with Dupilumab? J Clin Med 2024; 13:1980. [PMID: 38610745 PMCID: PMC11012912 DOI: 10.3390/jcm13071980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Atopic Dermatitis (AD) is a prevalent inflammatory skin disease whose course is often complicated by the presence of concomitant anxiety and depressive disorders. Dupilumab has been demonstrated to be largely effective in AD. The aims of the present study were to (1) to verify the effectiveness of 2-year dupilumab treatment on the depressive and anxiety symptoms of patients affected by AD and (2) to identify predictors of the persistence of psychiatric symptoms despite maintenance treatment with dupilumab. Methods: A total of 331 patients with severe AD were assessed at baseline and at different times over 2 years by a large set of rating scales, including the Eczema Area and Severity Index (EASI), the Hospital Anxiety and Depression Scale (HADS), and the Dermatology Life Quality Index (DLQI). Paired sample t-tests were performed to verify the effectiveness of dupilumab on the severity of AD and mental health items. Two binary logistic regression models were then used to identify the predictors of the persistence of clinically significant depression and anxiety, defined by a score ≥ 8 on each sub-scale of the HADS. Results: After 2 years of treatment with dupilumab, the patients benefited, showing a significant improvement in both the dermatological disease and comorbid depression/anxiety (p < 0.001 for all scales). Overall, 17.5% and 13% of patients, respectively, reported residual depressive and anxiety symptoms after the 2-year treatment with dupilumab. The baseline predictors of the persistence of clinically significant depressive symptoms after the 2-year treatment with dupilumab were found to be a higher body mass index (BMI) (p = 0.012), a lower impact of dermatological disease on quality of life (p = 0.015), and more severe depressive symptoms (p < 0.01), while for anxiety, the only predictor was found to be female gender (p = 0.03). Conclusions: Using a multidisciplinary approach, at baseline, dermatologists should more closely monitor patients who are at a greater risk of maintaining residual psychiatric symptoms despite therapy, such as those with more severe depressive symptoms and those who are overweight.
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Affiliation(s)
- Silvia Mariel Ferrucci
- Dermatology Section, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.M.F.)
| | - Simona Tavecchio
- Dermatology Section, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.M.F.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
| | - Alessandro Ceresa
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Luisa Angileri
- Dermatology Section, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.M.F.)
| | - Emilio Berti
- Dermatology Section, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.M.F.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
| | - Angelo Valerio Marzano
- Dermatology Section, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.M.F.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
| | - Massimiliano Buoli
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
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