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Magnolo N, Cameron MC, Shahriari M, Geng B, Calimlim BM, Teixeira H, Hu X, Yang Y, Liu Y, Zhang S, Sancho Sanchez C, Altman K, Langley RG. Rapid and sustained improvements in itch and quality of life with upadacitinib plus topical corticosteroids in adults and adolescents with atopic dermatitis: 52-week outcomes from the phase 3 AD Up study. J DERMATOL TREAT 2024; 35:2344589. [PMID: 38697950 DOI: 10.1080/09546634.2024.2344589] [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: 02/26/2024] [Accepted: 04/10/2024] [Indexed: 05/05/2024]
Abstract
Purpose: Atopic dermatitis (AD) adversely impacts quality of life (QoL). We evaluated the effect of upadacitinib, an oral selective Janus kinase inhibitor approved for moderate-to-severe AD, plus topical corticosteroids (+TCS) on patient-reported outcomes (PROs) over 52 weeks. Materials and methods: In the phase 3 AD Up study (NCT03568318), adults and adolescents with moderate-to-severe AD were randomized 1:1:1 to once-daily upadacitinib 15 mg, 30 mg, or placebo + TCS. Itch, skin pain/symptoms, sleep, QoL, daily activities, emotional state, mental health, and patient impressions of disease severity/improvement/treatment satisfaction were assessed. Results: This analysis included 901 patients. Within 1-2 weeks, PRO improvements were greater with both upadacitinib doses than with placebo (p <.05). Improvements increased through weeks 4-8; rates were generally maintained through week 52. At week 52, the proportion of patients with clinically meaningful improvements in itch (Worst Pruritus Numerical Rating Scale improvement ≥4), skin pain (AD Symptom Scale Skin Pain improvement ≥4), sleep (AD Impact Scale [ADerm-IS] Sleep improvement ≥12), daily activities (ADerm-IS Daily Activities improvement ≥14), and emotional state (ADerm-IS Emotional State improvement ≥11) ranged from 62.1%-77.7% with upadacitinib 15 mg + TCS and 71.3%-83.6% with upadacitinib 30 mg + TCS. Conclusions: Upadacitinib + TCS results in rapid, sustained improvements in burdensome AD symptoms and QoL.
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Affiliation(s)
- Nina Magnolo
- Department of Dermatology and Venereology, University Hospital of Münster, Münster, Germany
| | | | - Mona Shahriari
- Department of Dermatology, Yale University, New Haven, CT, USA
| | - Bob Geng
- Division of Allergy and Immunology, University of California San Diego, and Rady Children's Hospital, San Diego, CA, USA
| | | | | | | | | | | | | | | | | | - Richard G Langley
- Division of Clinical Dermatology and Cutaneous Science, Dalhousie University, Halifax, Canada
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Wollenberg A, Gooderham M, Katoh N, Aoki V, Pink AE, Binamer Y, Silverberg JI. Patient-reported burden in adults with atopic dermatitis: an international qualitative study. Arch Dermatol Res 2024; 316:380. [PMID: 38850461 PMCID: PMC11162389 DOI: 10.1007/s00403-024-03130-w] [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: 02/09/2024] [Revised: 04/29/2024] [Accepted: 05/02/2024] [Indexed: 06/10/2024]
Abstract
The objective was to study a large, international, ethnically diverse population of patients with atopic dermatitis (AD) to support the creation of patient-centric recommendations for AD management. Qualitative data were generated from 45-min, 1:1 telephone interviews conducted across 15 countries in each patient's native language. Interviews explored the impact of AD on patients' lives, patients' most important symptoms, treatment expectations, and treatment decision-making. Participants were also questioned on their current knowledge of AD scoring systems and what was most important to include in these tools. In total, 88 adult patients (≥ 18 years old) receiving treatment for AD were recruited through a market research database, clinician referrals, and local advertising. All patients were screened to ensure a balanced and diverse sample in terms of age, gender, educational level, employment status, geographic location, and AD severity. Patients involved in market research or activities supporting advocacy groups within the previous 6 months or affiliated with or employed by pharmaceutical companies were excluded. AD had a substantial impact on patients' lives. Itch, skin redness, and dry/flaky skin were the most frequently reported symptoms, with > 75% of patients experiencing these symptoms every 1-3 days. Mental health issues were common and resulted in the greatest negative impact on patients' daily lives. Patients perceived clinicians to underestimate the burden of their AD. Patients had little awareness of AD scoring systems and indicated a preference for these to be more clearly incorporated in clinical practice. For an ideal scoring system, patients favored using a combination of patient-reported and clinician-reported outcomes to reflect disease burden and ensure consistency across all settings. This global study generated diverse patient perspectives on the disease burden of AD, their expectations of treatment, and their views on AD scoring methods. These data provide evidence to support the development of patient-centric recommendations for AD management.
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Affiliation(s)
- Andreas Wollenberg
- Department of Dermatology and Allergy, Ludwig-Maximilian University of Munich, Munich, Germany.
- Department of Dermatology, Augsburg University Hospital, Augsburg, Germany.
| | - Melinda Gooderham
- Department of Dermatology, Queen's University, Ontario, Canada
- Department of Dermatology, SKiN Centre for Dermatology, Ontario, Canada
| | - Norito Katoh
- Department of Dermatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Valeria Aoki
- Department of Dermatology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Andrew E Pink
- St. John's Institute of Dermatology, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Yousef Binamer
- Department of Dermatology, Alfaisal University, Riyadh, Saudi Arabia
- Department of Dermatology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Jonathan I Silverberg
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
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Müller S, Maintz L, Bieber T. Treatment of atopic dermatitis: Recently approved drugs and advanced clinical development programs. Allergy 2024; 79:1501-1515. [PMID: 38186219 DOI: 10.1111/all.16009] [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: 02/05/2023] [Revised: 11/28/2023] [Accepted: 12/19/2023] [Indexed: 01/09/2024]
Abstract
Atopic dermatitis (AD) represents the most common skin disease characterized by heterogeneous endophenotypes and a high disease burden. In Europe, six new systemic therapies for AD have been approved: the biologics dupilumab (anti-interleukin-4 receptor (IL-4R) α in 2017), tralokinumab (anti-IL-13 in 2021), lebrikizumab (anti-IL-13 in 2023), and the oral janus kinase (JAK) inhibitors (JAKi) targeting JAK1/2 (baricitinib in 2020 in the EU) or JAK1 (upadacitinib in 2021 and abrocitinib in 2022). Herein, we give an update on new approvals, long-term safety, and efficacy. Upadacitinib and abrocitinib have the highest short-term efficacy among the approved systemic therapies. In responders, dupilumab and tralokinumab catch up regarding long-term efficacy and incremental clinical benefit within continuous use. Recently, the European Medicines Agency has released recommendations for the use of JAKi in patients at risk (cardiovascular and thromboembolic diseases, malignancies, (former) smoking, and age ≥65 years). Furthermore, we give an overview on emerging therapies currently in Phase III trials. Among the topical therapies, tapinarof (aryl hydrocarbon receptor), ruxolitinib (JAK1/2i), delgocitinib (pan-JAKi), asivatrep (anti-transient receptor potential vanilloid), and phosphodiesterase-4-inhibitors (roflumilast, difamilast) are discussed. Among systemic therapies, current data on cord-blood-derived mesenchymal stem cells, CM310 (anti IL-4Rα), nemolizumab (anti-IL-31RA), anti-OX40/OX40L-antibodies, neurokinin-receptor-1-antagonists, and difelikefalin (κ-opioid-R) are reported.
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Affiliation(s)
- Svenja Müller
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
- Christine Kühne Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland
| | - Laura Maintz
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
- Christine Kühne Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland
| | - Thomas Bieber
- Christine Kühne Center for Allergy Research and Education Davos (CK-CARE), Davos, Switzerland
- Davos BioSciences, Davos, Switzerland
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Kwatra SG, De Bruin-Weller M, Silverberg JI, Lio P, Deleuran M, Aydin H, Calimlim BM, Lane MC, Liu Y, Ofori S, Weidinger S. Targeted Combined Endpoint Improvement in Patient and Disease Domains in Atopic Dermatitis: A Treat-to-Target Analysis of Adults with Moderate-to-Severe Atopic Dermatitis Treated with Upadacitinib. Acta Derm Venereol 2024; 104:adv18452. [PMID: 38708991 DOI: 10.2340/actadv.v104.18452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 04/09/2024] [Indexed: 05/07/2024] Open
Abstract
A treat-to-target approach was recently developed to guide systemic treatment for adults with atopic dermatitis (AD). Recommendations outlined criteria for a 3-month initial acceptable treatment target and a 6-month optimal target, evaluated using global assessment of patient-reported disease severity, as well as Eczema Area and Severity Index, itch assessed on an 11-point numerical rating scale, Dermatology Life Quality Index, or Patient-Oriented Eczema Measure. Achievement of these targets with once-daily upadacitinib (15 mg and 30 mg) monotherapy was evaluated using integrated adult data from the Measure Up 1 and 2 phase 3 studies. Among the 852 patients treated with upadacitinib 15 mg or 30 mg, the 3-month initial acceptable target was achieved by >80%, >78%, and ≥87% of patients, and the 6-month optimal target was achieved by ≥53%, >61%, and >73% of patients at weeks 2, 16, and 52, respectively. Achievement of all 6 individual criteria for each of the target goals also increased over time. These findings suggest that upadacitinib 15 mg and 30 mg may help improve standards of care in patients with moderate-to-severe AD by achieving 6-month target goals at 16 weeks and as early as 2 weeks for most patients.
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Affiliation(s)
- Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | | | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Peter Lio
- Department of Dermatology & Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mette Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | | | | | - Stephan Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
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Simpson EL, Prajapati VH, Leshem YA, Chovatiya R, de Bruin-Weller MS, Ständer S, Pink AE, Calimlim BM, Lee WJ, Teixeira H, Ladizinski B, Hu X, Yang Y, Liu Y, Liu M, Grada A, Platt AM, Silverberg JI. Upadacitinib Rapidly Improves Patient-Reported Outcomes in Atopic Dermatitis: 16-Week Results from Phase 3 Clinical Trials (Measure Up 1 and 2). Dermatol Ther (Heidelb) 2024; 14:1127-1144. [PMID: 38696027 PMCID: PMC11116320 DOI: 10.1007/s13555-024-01157-5] [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: 02/08/2024] [Accepted: 04/03/2024] [Indexed: 05/24/2024] Open
Abstract
INTRODUCTION Atopic dermatitis (AD) is characterized by intense itch and other symptoms that negatively impact quality of life (QoL). This study evaluates the effect of upadacitinib (an oral selective Janus kinase inhibitor) monotherapy on patient-reported outcomes (PROs) among adults and adolescents with moderate-to-severe AD over 16 weeks. METHODS This integrated analysis of the double-blind, placebo-controlled periods of phase 3 monotherapy clinical trials Measure Up 1 (NCT03569293) and Measure Up 2 (NCT03607422) assessed itch (Worst Pruritus Numerical Rating Scale [WP-NRS] and SCORing Atopic Dermatitis [SCORAD]), skin pain and symptom severity (AD Symptom Scale), symptom frequency (Patient-Oriented Eczema Measure), sleep (AD Impact Scale [ADerm-IS] and SCORAD), daily activities and emotional state (ADerm-IS), QoL (Dermatology Life Quality Index [DLQI] and Children's DLQI), mental health (Hospital Anxiety and Depression Scale), and patient impressions (Patient Global Impression of Severity, Patient Global Impression of Change, and Patient Global Impression of Treatment). RESULTS Data from 1683 patients (upadacitinib 15 mg, n = 557; upadacitinib 30 mg, n = 567; placebo, n = 559) were analyzed. A greater proportion of patients receiving upadacitinib versus placebo experienced improvements in itch (≥ 4-point improvement on WP-NRS) by week 1 (upadacitinib 15 mg, 11.2%; upadacitinib 30 mg, 17.7%; placebo, 0.5%; P < 0.001), with response rates sustained through week 16 (upadacitinib 15 mg, 47.1%; upadacitinib 30 mg, 59.8%; placebo, 10.4%; P < 0.001). Improvements were similar for PROs assessing skin pain/symptoms, sleep, daily activities, QoL, emotional state, mental health, and patient impressions of disease severity and treatment. Responses generally improved rapidly (within 1-2 weeks), increased through weeks 4-6, and were maintained through week 16. CONCLUSIONS Once-daily oral upadacitinib monotherapy improved response rates across PROs compared with placebo. Upadacitinib therapy resulted in rapid, sustained improvements in PROs measuring symptom burden and QoL in adults and adolescents with moderate-to-severe AD. TRIAL REGISTRATION ClinicalTrials.gov identifiers, NCT03569293 and NCT03607422.
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Affiliation(s)
- Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, 3303 S. Bond Avenue, Portland, OR, 97239, USA.
| | - Vimal H Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Sections of Community Pediatrics and Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Skin Health & Wellness Centre, Calgary, AB, Canada
- Dermatology Research Institute, Calgary, AB, Canada
- Probity Medical Research, Calgary, AB, Canada
| | - Yael A Leshem
- Division of Dermatology, Rabin Medical Center, Petah Tikva, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raj Chovatiya
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
- Center for Medical Dermatology and Immunology Research, Chicago, IL, USA
| | - Marjolein S de Bruin-Weller
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sonja Ständer
- Center for Chronic Pruritus, Münster University Hospital, Münster, Germany
| | - Andrew E Pink
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | | | | | | | | | | | - Meng Liu
- AbbVie Inc, North Chicago, IL, USA
| | | | | | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Kamphuis E, Boesjes CM, Loman L, Kamsteeg M, Haeck I, Van Lynden-van Nes AMT, Politiek K, Van der Gang LF, De Graaf M, De Bruin-Weller MS, Schuttelaar MLA. Real-world Experience of Abrocitinib Treatment in Patients with Atopic Dermatitis and Hand Eczema: Up to 28-week Results from the BioDay Registry. Acta Derm Venereol 2024; 104:adv19454. [PMID: 38323500 PMCID: PMC10863496 DOI: 10.2340/actadv.v104.19454] [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: 09/15/2023] [Accepted: 12/13/2023] [Indexed: 02/08/2024] Open
Abstract
Limited daily practice data on the effect of abrocitinib in patients with atopic dermatitis are available. The aim of this multicentre prospective study is to evaluate the effectiveness and safety of abrocitinib in patients with atopic dermatitis treated in daily practice. In a subgroup, the effectiveness of abrocitinib on hand eczema was evaluated. A total of 103 patients from the BioDay registry were included in the study: week 4 (n = 95), week 16 (n = 61) and week 28 (n = 39). At week 28, the Eczema Area and Severity Index (EASI)-50/75/90 was achieved by 81.8%, 57.6%, and 18.2%, respectively, and the weekly average pruritus numerical rating scale ≤ 4 by 62.9%. The effectiveness of abrocitinib was not significantly different between dupilumab non-responders and dupilumab-naïve patients/responders, and between upadacitinib non-responders and upadacitinib-naïve patients/responders. Mean ± standard deviation Hand Eczema Severity Index decreased from 27.4 ± 27.7 at baseline to 7.7 ± 12.1 at week 28 (n = 31). Thirty-two patients (31.1%) discontinued treatment due to ineffectiveness (n = 17), adverse events (n = 9) or both (n = 3). The most frequently reported adverse event was nausea (n = 28). In conclusion, abrocitinib is an effective treatment for atopic dermatitis and can be effective for patients with previous inadequate response to dupilumab or upadacitinib. Furthermore, hand eczema can improve in patients treated with abrocitinib for atopic dermatitis.
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Affiliation(s)
- Esmé Kamphuis
- Department of Dermatology, University Medical Center Groningen, Groningen, The Netherlands
| | - Celeste M Boesjes
- Department of Dermatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Laura Loman
- Department of Dermatology, University Medical Center Groningen, Groningen, The Netherlands
| | - Marijke Kamsteeg
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Inge Haeck
- Department of Dermatology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | | | - Klaziena Politiek
- Department of Dermatology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Liana F Van der Gang
- Department of Dermatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marlies De Graaf
- Department of Dermatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Marie L A Schuttelaar
- Department of Dermatology, University Medical Center Groningen, Groningen, The Netherlands.
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Saeki H, Kataoka Y, Etoh T, Katoh N, Teramukai S, Tajima Y, Fujita H, Ardeleanu M, Arima K. Correlation Analysis of Clinician- and Patient-Reported Outcomes Among Japanese Adults with Atopic Dermatitis. Dermatol Ther (Heidelb) 2024; 14:533-543. [PMID: 38326699 PMCID: PMC10890985 DOI: 10.1007/s13555-023-01094-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/21/2023] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION Atopic dermatitis (AD) is a chronic relapsing condition with high disease burden and impact on health-related quality of life (HRQoL). Correlations between clinician- and patient-reported outcomes tend to be poor, and limited data in Asian patients are available. METHODS ADDRESS-J was a prospective, non-interventional, longitudinal study that evaluated the real-world effectiveness and safety of AD treatment in Japanese adults (aged 20-59 years) with moderate-to-severe AD. Three clinician-reported AD severity outcomes (Investigator's Global Assessment, Eczema Area and Severity Index, and body surface area affected), three dermatological patient-reported outcomes (Patient-Oriented Eczema Measure, Dermatology Life Quality Index, and Worst Itch Numerical Rating Scale), and two general HRQoL patient-reported outcomes (5-dimension EuroQoL questionnaire and EuroQol Visual Analog Scale) were collected at baseline and every 3 months throughout the 24-month observation period. Four biomarkers were also analyzed when available (thymus and activation-regulated chemokine [TARC], lactate dehydrogenase [LDH], total immunoglobulin E [IgE], and peripheral blood eosinophil counts [PB EOS]). Spearman's correlation coefficients were calculated using all available pooled data from baseline through 24 months. RESULTS Correlations between the three clinician-reported outcomes were high/very high (Spearman's correlation coefficients 0.76-0.92); those between the three dermatological patient-reported outcomes were moderate (0.53-0.64), and those between the clinician-reported and dermatological patient-reported outcomes were low/moderate (0.37-0.51). Correlations between the general HRQoL patient-reported outcomes and the clinician-reported and dermatological patient-reported outcomes were negligible-moderate (0.26-0.60). Biomarker correlations with the clinician-reported and dermatological patient-reported outcomes were low/moderate for TARC and LDH (0.44-0.63), but negligible/low for PB EOS and total IgE (0.01-0.41). CONCLUSIONS These results show that clinician- and patient-reported outcomes do not necessarily correlate well in Japanese adults with AD. This highlights the importance of including patient-reported outcomes when assessing disease severity/impact, planning treatment, and assessing response to treatment. TRIAL REGISTRATION UMIN Clinical Trials Registry (UMIN-CTR) Identifier UMIN000022623.
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Affiliation(s)
- Hidehisa Saeki
- Department of Dermatology, Nippon Medical School, Tokyo, 113-8602, Japan.
| | - Yoko Kataoka
- Department of Dermatology, Osaka Habikino Medical Center, Osaka, 583-8588, Japan
| | - Takafumi Etoh
- Atago Dermatology Clinic, Tokyo, 105-0012, Japan
- Department of Dermatology, Tokyo Teishin Hospital, Tokyo, 102-8798, Japan
| | - Norito Katoh
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
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Pezzolo E, Ortoncelli M, Ferrucci SM, Guanti MB, Schena D, Napolitano M, Rossi M, Foti C, D’Amico D, Amoruso GF, Morrone P, Ribero S, Barei F, Biagi M, Pascucci E, Patruno C, Calzavara Pinton P, Romita P, Gargiulo L, Narcisi A, Naldi L. Drug Survival of Upadacitinib and Predicting Factors of Discontinuation in Adult Patients Affected by Moderate-to-Severe Atopic Dermatitis: An Italian Multicenter Analysis. J Clin Med 2024; 13:553. [PMID: 38256686 PMCID: PMC10816142 DOI: 10.3390/jcm13020553] [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: 12/24/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Background: Limited real-world data are available on upadacitinib drug survival in patients with atopic dermatitis (AD). Objectives: To investigate upadacitinib drug survival, and the reasons and predictors of drug discontinuation in AD patients. Methods: All consecutive patients aged 18-75 years, affected by moderate-to-severe AD, and treated with upadacitinib for more than 1 month at dermatological clinics were included during November 2020-August 2023. Upadacitinib survival was investigated through Kaplan-Meier survival analysis and the predictors through multivariable logistic regression analysis. Results: Overall, 325 adult AD patients (mean (SD) age, 38.6(15.6) years) had a 1-year and 1.5-year upadacitinib drug survival of 91.5% and 80.2%, respectively. The main reasons for drug discontinuation (25/325, 7.7%) were adverse events (4.9%), including cutaneous or infectious diseases (1.5%), such as acne and herpes zoster; blood test changes (1.2%), including hypercholesterolemia, creatine phosphokinase or liver enzyme elevation, and lymphopenia; urinary or respiratory infections (0.9%); deep venous thrombosis (0.3%); malignancies (0.3%); loss of consciousness (0.3%); and arthralgias (0.3%); followed by ineffectiveness (0.6%). No specific characteristic was significantly associated with an increased risk of upadacitinib discontinuation. Conclusions: Our findings show that upadacitinib was effective in moderate-to-severe AD after more than 1 year of continuous treatment but point to the need for clinical and laboratory monitoring of patients.
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Affiliation(s)
- Elena Pezzolo
- Dermatology Unit, Ospedale San Bortolo, 36100 Vicenza, Italy
- Study Centre of the Italian Group for Epidemiologic Research in Dermatology (GISED), 24128 Bergamo, Italy
| | - Michela Ortoncelli
- Dermatology Clinic, Department of Medical Sciences, University of Turin, 10124 Turin, Italy
| | - Silvia Mariel Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Mario Bruno Guanti
- Department of Dermatology, University of Modena and Reggio Emilia, 41100 Modena, Italy
| | - Donatella Schena
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37100 Verona, Italy
| | - Maddalena Napolitano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | | | - Caterina Foti
- Unit of Dermatology, Department of Precision and Regenerative Medicine and Jonian Area, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Domenico D’Amico
- UOC Dermatologia, AOU “R. Dulbecco”, Ospedale ‘A. Pugliese’, 88100 Catanzaro, Italy
| | | | - Pietro Morrone
- UOC Dermatologia, Azienda Ospedaliera Cosenza, 87100 Cosenza, Italy
| | - Simone Ribero
- Dermatology Clinic, Department of Medical Sciences, University of Turin, 10124 Turin, Italy
| | - Francesca Barei
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Matteo Biagi
- Department of Dermatology, University of Modena and Reggio Emilia, 41100 Modena, Italy
| | - Enrico Pascucci
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37100 Verona, Italy
| | - Cataldo Patruno
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy;
| | | | - Paolo Romita
- Unit of Dermatology, Department of Precision and Regenerative Medicine and Jonian Area, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Luigi Gargiulo
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
- Dermatology Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy;
| | - Alessandra Narcisi
- Dermatology Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy;
| | - Luigi Naldi
- Dermatology Unit, Ospedale San Bortolo, 36100 Vicenza, Italy
- Study Centre of the Italian Group for Epidemiologic Research in Dermatology (GISED), 24128 Bergamo, Italy
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9
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Deleuran M, Dézfoulian B, Elberling J, Knutar I, Lapeere H, Lossius AH, Schuttelaar MLA, Stockman A, Wikström E, Bradley M, de Bruin-Weller M, Gutermuth J, Mandelin JM, Schmidt MC, Thyssen JP, Vestergaard C. Systemic anti-inflammatory treatment of atopic dermatitis during conception, pregnancy and breastfeeding: Interdisciplinary expert consensus in Northern Europe. J Eur Acad Dermatol Venereol 2024; 38:31-41. [PMID: 37818828 DOI: 10.1111/jdv.19512] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/09/2023] [Indexed: 10/13/2023]
Abstract
Treating atopic dermatitis (AD) in pregnant or breastfeeding women, and in women and men with AD aspiring to be parents is difficult and characterized by uncertainty, as evidence to inform decision-making on systemic anti-inflammatory treatment is limited. This project mapped consensus across dermatologists, obstetricians and patients in Northwestern Europe to build practical advice for managing AD with systemic anti-inflammatory treatment in men and women of reproductive age. Twenty-one individuals (sixteen dermatologists, two obstetricians and three patients) participated in a two-round Delphi process. Full consensus was reached on 32 statements, partial consensus on four statements and no consensus on four statements. Cyclosporine A was the first-choice long-term systemic AD treatment for women preconception, during pregnancy and when breastfeeding, with short-course prednisolone for flare management. No consensus was reached on second-choice systemics preconception or during pregnancy, although during breastfeeding dupilumab and azathioprine were deemed suitable. It may be appropriate to discuss continuing an existing systemic AD medication with a woman if it provides good disease control and its benefits in pregnancy outweigh its risks. Janus kinase (JAK) inhibitors, methotrexate and mycophenolate mofetil should be avoided by women during preconception, pregnancy and breastfeeding, with medication-specific washout periods advised. For men preconception: cyclosporine A, azathioprine, dupilumab and corticosteroids are appropriate; a 3-month washout prior to conception is desirable for methotrexate and mycophenolate mofetil; there was no consensus on JAK inhibitors. Patient and clinician education on appropriate (and inappropriate) AD treatments for use in pregnancy is vital. A shared-care framework for interdisciplinary management of AD patients is advocated and outlined. This consensus provides interdisciplinary clinical guidance to clinicians who care for patients with AD before, during and after pregnancy. While systemic AD medications are used uncommonly in this patient group, considerations in this article may help patients with severe refractory AD.
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Affiliation(s)
- M Deleuran
- Department of Dermatology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - B Dézfoulian
- Dermatology Department, Liège University Hospital, Liège, Belgium
| | - J Elberling
- Department of Dermatology and Allergy, Department of Clinical Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - I Knutar
- Department of Dermatology, Vaasa Central Hospital, Vaasa, Finland
| | - H Lapeere
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - A H Lossius
- Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - M L A Schuttelaar
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A Stockman
- Department of Dermatology, AZ Delta, Torhout, Belgium
| | - E Wikström
- Dermatology Health Clinic, Oulu, Finland
| | - M Bradley
- Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Solna, Sweden
| | - M de Bruin-Weller
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Gutermuth
- Vrije Universiteit Brussel (VUB), SKIN Research Group, Department of Dermatology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - J M Mandelin
- Department of Dermatology, Helsinki University Central Hospital, Helsinki, Finland
| | - M C Schmidt
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - J P Thyssen
- Department of Dermatology and Venereology, Bispebjerg Hospital, Copenhagen, Denmark
| | - C Vestergaard
- Department of Dermatology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
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10
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Renert-Yuval Y, Del Duca E, Arents B, Bissonnette R, Drucker AM, Flohr C, Guttman-Yassky E, Hijnen D, Kabashima K, Leshem YA, Paller AS, Silverberg JI, Simpson EL, Spuls P, Vestergaard C, Wollenberg A, Irvine AD, Thyssen JP. Treat-to-target in dermatology: A scoping review and International Eczema Council survey on the approach in atopic dermatitis. J Eur Acad Dermatol Venereol 2024; 38:42-51. [PMID: 37700595 DOI: 10.1111/jdv.19506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/04/2023] [Indexed: 09/14/2023]
Abstract
Treat-to-target (T2T) is a pragmatic therapeutic strategy being gradually introduced into dermatology after adoption in several other clinical areas. Atopic dermatitis (AD), one of the most common inflammatory skin diseases, may also benefit from this structured and practical therapeutic approach. We aimed to evaluate existing data regarding the T2T approach in dermatology, with a specific focus on AD, as well as the views of International Eczema Council (IEC) members on the potential application of a T2T approach to AD management. To do so, we systematically searched for peer-reviewed publications on the T2T approach for any skin disease in the PubMed and Scopus databases up to February 2022 and conducted a survey among IEC members regarding various components to potentially include in a T2T approach in AD. We identified 21 relevant T2T-related reports in dermatology, of which 14 were related to psoriasis, five to AD, one for juvenile dermatomyositis and one for urticaria. In the IEC member survey, respondents proposed treatable traits (with itch, disease severity and sleep problems getting the highest scores), relevant comorbidities (with asthma being selected most commonly, followed by anxiety and depression in adults), recommended specialists that should define the approach in AD (dermatologists, allergists and primary care physicians were most commonly selected in adults), and applicable assessment tools (both physician- and patient-reported), in both adult and paediatric patients, for potential future utilization of the T2T approach in AD. In conclusion, while the T2T approach may become a useful tool to simplify therapeutic goals and AD management, its foundation in AD is only starting to build. A multidisciplinary approach, including a wide range of stakeholders, including patients, is needed to further define the essential components needed to utilize T2T in AD.
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Affiliation(s)
- Yael Renert-Yuval
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA
- Pediatric Dermatology Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ester Del Duca
- Department of Dermatology, University Magna Graecia, Catanzaro, Italy
| | - Bernd Arents
- Dutch Association for People with Atopic Eczema, Nijkerk, The Netherlands
| | | | - Aaron M Drucker
- Division of Dermatology, Department of Medicine, University of Toronto and Women's College Hospital, Toronto, Ontario, Canada
| | - Carsten Flohr
- St John's Institute of Dermatology, King's College London and Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Emma Guttman-Yassky
- Department of Dermatology, and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dirkjan Hijnen
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Kenji Kabashima
- Department of Dermatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yael A Leshem
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Dermatology, Rabin Medical Center, Petach Tikva, Israel
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Eric L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Phyllis Spuls
- Department of Dermatology, Amsterdam Public Health/Infection and Immunology, Amsterdam University Medical Center, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Andreas Wollenberg
- Department of Dermatology and Allergy, Ludwig Maximilian University, Munich, Germany
- Department of Dermatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Alan D Irvine
- Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Jacob P Thyssen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
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11
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Simpson EL, Blauvelt A, Silverberg JI, Cork MJ, Katoh N, Mark T, Schneider SKR, Wollenberg A. Tralokinumab Provides Clinically Meaningful Responses at Week 16 in Adults with Moderate-to-Severe Atopic Dermatitis Who Do Not Achieve IGA 0/1. Am J Clin Dermatol 2024; 25:139-148. [PMID: 37804473 PMCID: PMC10796753 DOI: 10.1007/s40257-023-00817-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND AND OBJECTIVE Investigator's Global Assessment of clear/almost clear skin (IGA 0/1) is a difficult endpoint to achieve after short-term treatment of chronic moderate-to-severe atopic dermatitis, and does not fully reflect clinically meaningful changes in other parameters. We assessed the impact of tralokinumab versus placebo on other clinically meaningful parameters in patients not achieving IGA 0/1 at week 16 using pooled data from two monotherapy phase III trials, ECZTRA 1 and 2. METHODS This post hoc analysis included patients (n = 1328) from ECZTRA 1 and 2 who did not achieve the co-primary endpoint, IGA 0/1 at week 16 without rescue medication. Endpoints evaluating atopic dermatitis extent and severity included proportions of patients achieving IGA 0/1, 50%, 75%, and 90% improvement in Eczema Area and Severity Index (EASI-50/75/90); endpoints evaluating patient-reported outcomes included a ≥ 3-point improvement in worst daily pruritus Numerical Rating Scale (NRS), a ≥ 3-point improvement in eczema-related sleep interference (sleep) NRS, a ≥ 4-point improvement in Dermatology Life Quality Index (DLQI), and DLQI ≤ 5. Specifically, clinically meaningful responses were defined as EASI-50, a ≥ 3-point improvement in itch NRS, or a ≥ 4-point improvement in DLQI at week 16. RESULTS Among ECZTRA 1 and 2 patients who did not achieve IGA 0/1 at week 16 without rescue medication, a significantly greater proportion of patients receiving tralokinumab versus placebo achieved EASI-50 (33.0% vs 13.0%), a ≥ 3-point improvement in itch NRS (22.6% vs 9.4%), or a ≥ 4-point improvement in DLQI (41.2% vs 24.5%) at week 16. In addition, compared with placebo, a numerically greater proportion of tralokinumab-treated patients achieved all three measures of clinically meaningful response (30% vs 18%) or a clinically meaningful change in at least one outcome (48.8% vs 28.5%). Significantly greater proportions of patients receiving tralokinumab versus placebo achieved additional clinician-reported and patient-reported outcomes, such as EASI-75 (13.5% vs 4.1%), EASI-90 (3.5% vs 1.1%), DLQI ≤ 5 (22.5% vs 12.5%), and a ≥ 3-point improvement in sleep NRS (24.5% vs 11.5%). CONCLUSIONS Tralokinumab provided clinically meaningful responses in patients with moderate-to-severe atopic dermatitis who did not achieve IGA 0/1 at week 16 and/or used rescue medication. Using multiple validated outcome measures of both efficacy and quality of life, alongside IGA scores, can better characterize tralokinumab treatment responses in patients with moderate-to-severe atopic dermatitis. [Video abstract available] CLINICAL TRIAL REGISTRATION: NCT03131648 (ECZTRA 1); study start date: 30 May, 2017; primary completion date: 7 August, 2018; study completion date: 10 October, 2019. NCT03160885 (ECZTRA 2); study start date: 12 June, 2017; primary completion date: 4 September, 2019; study completion date: 14 August, 2019. Video abstract: Tralokinumab provides clinically meaningful responses at week 16 in adults with moderate-to-severe atopic dermatitis who do not achieve IGA 0/1 (MP4 362818 KB).
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Affiliation(s)
- Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | | | - Jonathan I Silverberg
- Department of Dermatology, George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - Michael J Cork
- Sheffield Dermatology Research, IICD, University of Sheffield, Sheffield, UK
| | - Norito Katoh
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | | | - Andreas Wollenberg
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Frauenlobstrasse 9-11, 80337, Munich, Germany.
- Department of Dermatology and Allergy, University Hospital Augsburg, Augsburg, Germany.
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12
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Vestergaard C, Skovsgaard C, Johansen C, Deleuran M, Thyssen JP. Treat-to-Target in Atopic Dermatitis. Am J Clin Dermatol 2024; 25:91-98. [PMID: 38079107 DOI: 10.1007/s40257-023-00827-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 01/23/2024]
Abstract
Atopic dermatitis is one of the most common inflammatory skin diseases among children and adults. Over the last 5 years, the armamentarium for the treatment of this disease, with both topical and systemic drugs, has increased. Treat-to-target is basically the concept where a treatment goal and a time frame for that goal is set at initiation of a new treatment, and if the goals are not achieved in time, treatment will be adjusted. In clinical trials, treatment targets are based on scoring systems for disease severity as recommended by the Harmonizing Outcome Measure for Eczema (HOME) initiative, with the primary endpoint being a reduction of at least 75% of the baseline Eczema Area and Severity Index (EASI) score (EASI-75). The question, however, is if these are useful targets in real-world settings and how this should be implemented in everyday clinical practice. In rheumatology, setting a measurable target and a time frame for an instigated therapy has been shown to lead to more efficient and successful treatment. For atopic dermatitis, the instruments recommended by HOME form the core outcome measures for the treat-to-target frameworks published to date, which are based on expert consensus and Delphi processes. Although atopic dermatitis patients have a high risk of co-morbidities, including physical, psychological and socioeconomic, instruments to measure the severity of co-morbidities have not been included in these existing frameworks. In order to apply a treat-to-target strategy that is meaningful for both the patient and the doctor, validated tools for the measurement of treatment effect on co-morbidities exist and should be included in a shared decision-making process with the individual patient when choosing which targets to aim for and what should be considered treatment success. An obvious limitation for the implementation of a treat-to-target strategy in the clinical setting with atopic dermatitis is that retrieving the data needed is very time consuming. This could to some degree be mitigated by the use of electronic applications in which patients could report their outcomes.
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Affiliation(s)
| | | | - Claus Johansen
- Department of Dermatology, Aarhus University hospital, Aarhus, Denmark
| | - Mette Deleuran
- Department of Dermatology, Aarhus University hospital, Aarhus, Denmark
| | - Jacob P Thyssen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
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13
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Parra Sánchez AR, van Vollenhoven RF, Morand EF, Bruce IN, Kandane-Rathnayake R, Weiss G, Tummala R, Al-Mossawi H, Sorrentino A. Targeting DORIS Remission and LLDAS in SLE: A Review. Rheumatol Ther 2023; 10:1459-1477. [PMID: 37798595 PMCID: PMC10654283 DOI: 10.1007/s40744-023-00601-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023] Open
Abstract
Remission is the established therapeutic goal for patients with systemic lupus erythematosus (SLE) and is currently defined by the widely adopted Definition Of Remission In SLE (DORIS) criteria. Attainment of remission is rare in the clinical setting, thus an alternative, pragmatic treatment target of low disease activity, as defined by the Lupus Low Disease Activity State (LLDAS), provides a less stringent and more attainable treatment goal for a wider proportion of patients compared with DORIS remission. Randomized controlled trials and real-world analyses have confirmed the positive clinical benefits of achieving either DORIS remission or LLDAS. The treat-to-target (T2T) approach utilizes practical clinical targets to proactively tailor individual treatment regimens. Studies in other chronic inflammatory diseases using the T2T approach demonstrated significantly improved clinical outcomes and quality-of-life measures compared with established standard of care. However, such trials have not yet been performed in patients with SLE. Here we review the evolution of DORIS remission and LLDAS definitions and the evidence supporting the positive clinical outcomes following DORIS remission or LLDAS attainment, before discussing considerations for implementation of these outcome measures as potential T2T objectives. Adoption of DORIS remission and LLDAS treatment goals may result in favorable patient outcomes compared with established standard of care for patients with SLE.
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Affiliation(s)
- Agner R Parra Sánchez
- Amsterdam Rheumatology Center ARC, Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Centre, Amsterdam, The Netherlands.
| | - Ronald F van Vollenhoven
- Amsterdam Rheumatology Center ARC, Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Eric F Morand
- Sub-Faculty of Clinical and Molecular Medicine, Monash University, Clayton, VIC, Australia
| | - Ian N Bruce
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Gudrun Weiss
- Global Medical Affairs, Respiratory and Immunology, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | - Raj Tummala
- Clinical Development, Late Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Hussein Al-Mossawi
- Clinical Development, Late Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Alessandro Sorrentino
- Global Medical Affairs, Respiratory and Immunology, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
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14
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Berna-Rico E, Fiz-Benito E, Busto-Leis JM, Servera-Negre G, de Lucas-Laguna R, Feito-Rodriguez M. Effectiveness and Safety of Dupilumab in Children Under 6 Years of Age with Moderate-to-Severe Atopic Dermatitis: A Retrospective Real-World Study. Dermatology 2023; 240:337-342. [PMID: 38035567 PMCID: PMC10997240 DOI: 10.1159/000535282] [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: 06/08/2023] [Accepted: 11/12/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Dupilumab has recently been shown to be effective in children under 6 years of age with atopic dermatitis (AD). Nevertheless, real-life and long-term follow-up data are scarce. We aimed to assess the effectiveness, safety, and long-term outcomes of dupilumab in a daily-practice setting in this age group. METHOD This was a retrospective observational cohort study. Only patients with 16 or more weeks of treatment were included in the analysis. The proportion of patients who achieved ≥75% or 90% reduction from baseline EASI (EASI75 and EASI90, respectively) and the percentage of patients who achieved vIGA 0-1 were analyzed at 4, 16, 48, 72, and 96 weeks (when available). Adverse events were recorded during follow-up. RESULTS A total of 19 patients <6 years old with moderate-to-severe AD were included in the cohort, with a median age of 4.7 years (range: 2.6-5.9). The median weeks on dupilumab were 51.3 (IQR: 24.6-79.3). EASI75 was achieved in 11/19 patients (57.9%) at w4, 16/19 (84.2%) at w16, 9/12 (75%) at w48, 6/6 (100%) at w72, and in 2/2 (100%) at week 96. The objective of vIGA 0-1 was reached by 10/19 patients (51.6%) at w4, by 14/19 (73.7%) at w16, by 9/12 (75%) at w48, by 5/6 (83.3%) at w72, and by 2/2 (100%) at w96. Dupilumab was discontinued in 3 patients (15.8%) due to loss of response. One patient developed a paradoxical palmo-plantar eruption. We found no cases of conjunctivitis, facial erythema, or injection-site reactions related to dupilumab. CONCLUSIONS Dupilumab was effective and safe in our cohort of patients with moderate-to-severe AD under 6 years of age. Response was maintained in the long term in most patients with longer follow-up. Its adverse effect profile was similar to that found in older children and adults.
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Affiliation(s)
- Emilio Berna-Rico
- Department of Dermatology, Hospital Universitario Ramon y Cajal, IRYCIS, Madrid, Spain
| | - Esther Fiz-Benito
- Department of Dermatology, Hospital Universitario La Paz, Madrid, Spain
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15
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Pereyra-Rodriguez JJ, Baldrich ES, Ruiz-Villaverde R, Torres EB, De la C Dobao P, Nart IF, Menéndez ÁF, Martin-Santiago A, Miquel JM, Silvestre JF, Armario-Hita JC. Clinical Approach to Patients with Moderate-to-Severe Atopic Dermatitis: A Spanish Delphi Consensus. Acta Derm Venereol 2023; 103:adv12314. [PMID: 37982727 PMCID: PMC10680463 DOI: 10.2340/actadv.v103.12314] [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: 04/12/2023] [Accepted: 09/12/2023] [Indexed: 11/21/2023] Open
Abstract
Despite emerging evidence and advances in the management of atopic dermatitis there a lack of consensus regarding the diagnostic criteria, therapeutic approach, method to assess severity, and patient follow-up for this condition. An expert consensus study was conducted to provide recommendations on the management of patients with moderate-to-severe atopic dermatitis. The study used Delphi-like methodology based on a literature review, a summary of the scientific evidence, and a 2-round survey. The agreement of 60 panellists on 21 statements was evaluated. Consensus was pre-defined as ≥ 80% agreement of all respondents. In the first round 6 statements reached consensus. Unanimous consensus was achieved regarding therapeutic goals and patient satisfaction (maintained in the long term and periodic goals reassessment recommended every 3-6 months). In the second round, half of the statements reached consensus, all related to patient follow-up, treatment goals, and atopic comorbidities. The statements that did not reach consensus were related to diagnosis (biomarkers, allergy, and food testing) and starting patients on conventional systemic treatment rather than advanced treatment. The study assessed expert opinion regarding a variety of topics related to the clinical approach to patients with moderate-to-severe atopic dermatitis, in order to provide guidance on the diagnosis and management of patients with atopic dermatitis.
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Affiliation(s)
| | - Esther S Baldrich
- Department of Dermatology, Santa Creu i Sant Pau Hospital, Barcelona, Spain.
| | | | - Eulalia B Torres
- Department of Dermatology, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Pablo De la C Dobao
- Department of Dermatology, Infanta Leonor University Hospital, Madrid, Spain
| | - Ignasi F Nart
- Department of Dermatology, Bellvitge University Hospital, Barcelona, Spain
| | - Ángeles F Menéndez
- Department of Dermatology, Pontevedra University Hospital, Pontevedra, Spain
| | - Ana Martin-Santiago
- Department of Dermatology, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Javier M Miquel
- Department of Dermatology, Arnau de Vilanova Hospital, Valencia, Spain
| | - Juan F Silvestre
- Department of Dermatology, Alicante University General Hospital, Alicante, Spain
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16
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Orfali RL, Lorenzini D, Bressan A, Tanaka AA, Cerqueira AMMD, Hirayama ADS, Ramos AMC, Proença CC, Silva CMDR, Laczynski CMM, Carneiro FR, Duarte G, Hans Filho G, Gonçalves HDS, Melo LPD, Azulay-Abulafia L, Weber MB, Rivitti-Machado MC, Zaniboni MC, Ogawa M, Pires MC, Ianhez M, Felix PAO, Bonamigo R, Takaoka R, Lazzarini R, Cestari S, Mayor SAS, Cestari T, Oliveira ZNPD, Spuls PI, Gerbens LAA, Aoki V. Consensus on the therapeutic management of atopic dermatitis ‒ Brazilian Society of Dermatology: an update on phototherapy and systemic therapy using e-Delphi technique. An Bras Dermatol 2023; 98:814-836. [PMID: 37302894 PMCID: PMC10589461 DOI: 10.1016/j.abd.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/04/2023] [Accepted: 04/09/2023] [Indexed: 06/13/2023] Open
Abstract
This publication is an update of the "Consensus on the therapeutic management of atopic dermatitis - Brazilian Society of Dermatology" published in 2019, considering the novel, targeted-oriented systemic therapies for atopic dermatitis. The initial recommendations of the current consensus for systemic treatment of patients with atopic dermatitis were based on a recent review of scientific published data and a consensus was reached after voting. The Brazilian Society of Dermatology invited 31 experts from all regions of Brazil and 2 international experts on atopic dermatitis who fully contributed to the process. The methods included an e-Delphi study to avoid bias, a literature search and a final consensus meeting. The authors added novel approved drugs in Brazil and the indication for phototherapy and systemic therapy for AD. The therapeutical response to systemic treatment is hereby reported in a suitable form for clinical practice and is also part of this updated manuscript.
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Affiliation(s)
- Raquel Leao Orfali
- Department of Dermatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Daniel Lorenzini
- Department of Dermatology, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Aline Bressan
- Department of Dermatology, Hospital Universitário Pedro Ernesto, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Anber Ancel Tanaka
- Department of Dermatology, Hospital Universitário Evangélico Mackenzie, Curitiba, PR, Brazil
| | | | - André da Silva Hirayama
- Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Andréa Machado Coelho Ramos
- Department of Dermatology, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Carolina Contin Proença
- Dermatology Clinic, Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Gleison Duarte
- Department of Dermatology, Instituto Bahiano de Imunoterapia, Salvador, BH, Brazil
| | - Gunter Hans Filho
- Department of Dermatology, Hospital Universitário Maria Aparecida Pedrossian, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Heitor de Sá Gonçalves
- Department of Health, National Reference Center in Sanitary Dermatology Dona Libânia, Fortaleza, CE, Brazil
| | - Ligia Pessoa de Melo
- Department of Dermatology, Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil; Health Department, Hospital Otávio de Freitas, Recife, PE, Brazil
| | - Luna Azulay-Abulafia
- Department of Dermatology, Hospital Universitário Pedro Ernesto, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Professor Rubem David Azulay Institute of Dermatology, Santa Casa de Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Maria Cecília Rivitti-Machado
- Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Department of Dermatology, Universidade Metropolitana de Santos, Santos, SP, Brazil
| | - Mariana Colombini Zaniboni
- Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marília Ogawa
- Department of Dermatology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Mario Cezar Pires
- Department of Dermatology, Complexo Hospitalar Padre Bento, Guarulhos, SP, Brazil; Department of Dermatology, State Public Servant Hospital, São Paulo, SP, Brazil
| | - Mayra Ianhez
- Department of Dermatology, Hospital for Tropical Diseases, Goiânia, GO, Brazil; Department of Dermatology, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | | | - Renan Bonamigo
- Department of Dermatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Roberto Takaoka
- Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rosana Lazzarini
- Dermatology Clinic, Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Silmara Cestari
- Department of Dermatology, Teaching and Research Institute of Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | | | - Tania Cestari
- Department of Dermatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Phyllis I Spuls
- Department of Dermatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, The Netherlands
| | - Louise A A Gerbens
- Department of Dermatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, The Netherlands
| | - Valeria Aoki
- Department of Dermatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Silverberg JI, Hong HCH, Calimlim BM, Lee WJ, Teixeira HD, Collins EB, Crowell MM, Johnson SJ, Armstrong AW. Comparative Efficacy of Targeted Systemic Therapies for Moderate-to-Severe Atopic Dermatitis without Topical Corticosteroids: An Updated Network Meta-analysis. Dermatol Ther (Heidelb) 2023; 13:2247-2264. [PMID: 37658223 PMCID: PMC10539231 DOI: 10.1007/s13555-023-01000-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/02/2023] [Indexed: 09/03/2023] Open
Abstract
INTRODUCTION The treatment landscape for moderate-to-severe atopic dermatitis (AD) continues to expand. This network meta-analysis (NMA) updates a previously conducted NMA to include data from the most recent phase 3 trials to assess the comparative efficacy of targeted systemic therapies without the addition of topical corticosteroids (TCS) and/or topical calcineurin inhibitors (TCI) in adults with moderate-to-severe AD. METHODS Data from recent phase 3 monotherapy trials of lebrikizumab, ADvocate1 (NCT04146363) and ADvocate2 (NCT04178967), were included in the analyses, along with other eligible phase 3/4 randomized placebo-controlled trials for abrocitinib, baricitinib, dupilumab, tralokinumab, and upadacitinib identified through a systemic literature review in Silverberg et al. (Dermatol Ther (Heidelb) 12(5):1181-1196, 2022). The proportion of patients achieving Eczema Area and Severity Index (EASI) improvement ≥ 90% from baseline (EASI-90), EASI improvement ≥ 75% from baseline (EASI-75), ≥ 4-point improvement on Pruritus Numerical Rating Scale from baseline (ΔNRS ≥ 4), and Investigator Global Assessment (IGA) score of 0 or 1 (clear or almost clear) and reduction of ≥ 2 points from baseline (IGA 0/1) were evaluated using a Bayesian network meta-analysis. RESULTS The updated NMA analyzed 13 unique placebo-controlled trials involving 7105 patients in 32 arms across 6 targeted therapies. Upadacitinib 30 mg was the most efficacious therapy across all endpoints at the primary timepoint (week 12 or 16) and at earlier timepoints, generally followed by abrocitinib 200 mg, upadacitinib 15 mg, dupilumab 300 mg, and lebrikizumab 250 mg or abrocitinib 100 mg. Baricitinib 2 mg and tralokinumab were generally ranked lower across outcomes. CONCLUSIONS Many factors need to be considered for treatment selection for AD, especially as new treatments continue to emerge. After incorporating recent placebo-controlled phase 3 data of lebrikizumab, upadacitinib 30 mg, upadacitinib 15 mg, and abrocitinib 200 mg remain the most efficacious targeted systemic therapies over 12-16 weeks of therapy in AD. These updated findings can help healthcare providers when creating a patient's personalized treatment plan.
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Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave NW, Ste 2B-425, Washington, DC, 20037, USA.
| | - H Chih-Ho Hong
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
- Probity Medical Research, Surrey, BC, Canada
| | | | | | | | | | | | | | - April W Armstrong
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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18
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Gooderham MJ, Pink AE, Simpson EL, Silverberg JI, Güler E, Watkins M. Abrocitinib 100 mg Once Daily for Moderate-to-Severe Atopic Dermatitis: A Review of Efficacy and Safety, and Expert Opinion on Use in Clinical Practice. Dermatol Ther (Heidelb) 2023; 13:1893-1907. [PMID: 37482564 PMCID: PMC10442301 DOI: 10.1007/s13555-023-00948-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/25/2023] [Indexed: 07/25/2023] Open
Abstract
Abrocitinib is a Janus kinase (JAK) 1-selective inhibitor approved for the treatment of moderate-to-severe atopic dermatitis (AD). Although specific dose recommendations for abrocitinib vary across regional product labels, abrocitinib 100 mg once daily is recommended as a starting and maintenance dose. This review summarizes the efficacy and safety of abrocitinib 100 mg once daily for patients with moderate-to-severe AD based on data from the pivotal phase 3 studies of the JAK1 Atopic Dermatitis Efficacy and Safety (JADE) clinical program, JADE MONO-1 (NCT03349060), JADE MONO-2 (NCT03575871), JADE COMPARE (NCT03720470), JADE TEEN (NCT03796676), and JADE REGIMEN (NCT03627767). Preliminary long-term efficacy and safety data are also summarized from the long-term extension study JADE EXTEND (NCT03422822). Expert opinion on use of abrocitinib 100 mg once daily in clinical practice is provided. In addition to efficacy, the decision to use abrocitinib for the treatment of AD should allow for individual patient factors such as age, comorbidities, previous therapy, quality of life, and treatment tolerability, and involve shared decision-making between the patient and clinician.
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Affiliation(s)
- Melinda J Gooderham
- SKiN Centre for Dermatology, Peterborough, and Queen's University, 775 Monaghan Road, Peterborough, Kingston, ON, K9J 5K2, Canada.
| | - Andrew E Pink
- St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Eric L Simpson
- Dermatology Department, Oregon Health & Science University, Portland, OR, USA
| | - Jonathan I Silverberg
- Dermatology Department, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Kolkhir P, Akdis CA, Akdis M, Bachert C, Bieber T, Canonica GW, Guttman-Yassky E, Metz M, Mullol J, Palomares O, Renz H, Ständer S, Zuberbier T, Maurer M. Type 2 chronic inflammatory diseases: targets, therapies and unmet needs. Nat Rev Drug Discov 2023; 22:743-767. [PMID: 37528191 DOI: 10.1038/s41573-023-00750-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 08/03/2023]
Abstract
Over the past two decades, significant progress in understanding of the pathogenesis of type 2 chronic inflammatory diseases has enabled the identification of compounds for more than 20 novel targets, which are approved or at various stages of development, finally facilitating a more targeted approach for the treatment of these disorders. Most of these newly identified pathogenic drivers of type 2 inflammation and their corresponding treatments are related to mast cells, eosinophils, T cells, B cells, epithelial cells and sensory nerves. Epithelial barrier defects and dysbiotic microbiomes represent exciting future drug targets for chronic type 2 inflammatory conditions. Here, we review common targets, current treatments and emerging therapies for the treatment of five major type 2 chronic inflammatory diseases - atopic dermatitis, chronic prurigo, chronic urticaria, asthma and chronic rhinosinusitis with nasal polyps - with a high need for targeted therapies. Unmet needs and future directions in the field are discussed.
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Affiliation(s)
- Pavel Kolkhir
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) Davos, University of Zürich, Davos, Switzerland
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) Davos, University of Zürich, Davos, Switzerland
| | - Claus Bachert
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Münster, Münster, Germany
- Department of Otolaryngology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Division of ENT diseases, Karolinska Hospital, Stockholm, Sweden
| | - Thomas Bieber
- Department of Dermatology and Allergy, University Hospital, Bonn, Germany
- Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
- Davos Biosciences, Davos, Switzerland
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Asthma & Allergy Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Martin Metz
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic Barcelona, FRCB-IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Spain
| | - Oscar Palomares
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University of Madrid, Madrid, Spain
| | - Harald Renz
- Institute of Laboratory Medicine, member of the German Center for Lung Research (DZL) and the Universities of Giessen and Marburg Lung Center (UGMLC), Philipps-University Marburg, Marburg, Germany
- Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - Sonja Ständer
- Section Pruritus Medicine, Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Torsten Zuberbier
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
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20
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Butron P, Galvan C, Ballona R, Castro-Vargas EG, Bravo-Puccio F, Gereda-Solari JE, Larco-Sousa JI, Matos E, Torres-Ibérico R. [Algoritmo de tratamiento de la dermatitis atópica en Perú. Consenso de expertos]. REVISTA ALERGIA MÉXICO 2023; 70:167-186. [PMID: 37933927 DOI: 10.29262/ram.v70i3.1228] [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: 02/08/2023] [Accepted: 03/08/2023] [Indexed: 11/08/2023] Open
Abstract
Objective Atopic dermatitis is a chronic, systemic, relapsing disease with dermatological manifestations, which imposes a high burden on patients, families and the health care system and has a high psychological, social, and economic impact and on the quality of life of patients. It mainly affects the pediatric population and, to a lesser extent, the adult population. The clinical presentation varies according to the age and evolution of the disease, and currently there are multiple pharmacological and non-pharmacological therapies available for the symptomatic management of patients. Methods To present an algorithm for the management of atopic dermatitis, proposed as a series of recommendations on the management, diagnosis, education, and follow-up of these patients. Results A consensus was reached using the nominal group technique. The methodology was developed in 7 phases, including: posing the research questions, literature search, an initial proposal of recommendations, elaboration of the final recommendations and the management algorithm with three voting cycles, consensus was established with 80% favorability. Conclusions The result of the consensus process is a management algorithm for patients with mild, moderate/severe atopic dermatitis derived from expert recommendations. The algorithm establishes diagnostic and treatment criteria and provides updated recommendations, including all therapeutic alternatives available in Peru for the management of patients with mild, moderate, and severe atopic dermatitis.
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21
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Gu C, Yao X, Li W. Burden of Disease; the Current Status of the Diagnosis and Management of Atopic Dermatitis in China. J Clin Med 2023; 12:5370. [PMID: 37629411 PMCID: PMC10456078 DOI: 10.3390/jcm12165370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/07/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Atopic dermatitis (AD) is now a global health problem and has been attracting extensive attention from both academic and public society in China. This review aimed to present the current status of the prevalence, disease burden, clinical features, diagnosis, and management of AD in China. The prevalence of AD has been increasing rapidly in China during the past decades, partially due to the increased recognition of the disease; there are still substantial amounts of over-diagnosed eczema and under-diagnosed AD. Chinese dermatologists see many AD patients with atypical manifestation, which poses a challenge to the diagnosis. The Chinese diagnostic criteria for adults and pediatric patients with AD have been proposed respectively and validated with high sensitivity and specificity. International and Chinese guidelines for management of AD have been popularized; however, there are still many practices that need verification through randomized case-control study. Dupilumab and JAK inhibitors have demonstrated favorable efficacy for AD patients in China, and a multidimensional approach is needed for selection of the patients and evaluation of the efficacy and safety. Patient education and long-term management for AD are just beginning in China, and need to be strengthened in the future.
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Affiliation(s)
- Chaoying Gu
- Department of Dermatology, Shanghai Institute of Dermatology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xu Yao
- Department of Allergy and Rheumatology, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210042, China
| | - Wei Li
- Department of Dermatology, Shanghai Institute of Dermatology, Huashan Hospital, Fudan University, Shanghai 200040, China
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22
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Chiricozzi A, Ferrucci SM, Di Nardo L, Gori N, Balato A, Ortoncelli M, Maurelli M, Galluzzo M, Munera Campos M, Seremet T, Caldarola G, De Simone C, Ippoliti E, Torres T, Gkalpakiotis S, Conrad C, Carrascosa JM, Bianchi L, Argenziano G, Ribero S, Girolomoni G, Marzano AV, Peris K. Current treatment goals are achieved by the majority of patients with atopic dermatitis treated with tralokinumab: results from a multicentric, multinational, retrospective, cohort study. Expert Opin Biol Ther 2023; 23:1307-1315. [PMID: 38108300 DOI: 10.1080/14712598.2023.2292627] [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: 09/25/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Tralokinumab is a human monoclonal antibody targeting interleukin-13 that is approved for the treatment of moderate-severe atopic dermatitis. Studies analyzing the efficacy and safety of tralokinumab in a real-world setting are scarce. RESEARCH DESIGN AND METHODS A European, multicentric, real-world, retrospective cohort study was defined to assess the effectiveness and safeness profile of tralokinumab, investigating the achievement of pre-specified treatment goals; and to detect potential differences in terms of effectiveness and safeness across some selected patient subcohorts. RESULTS A total of 194 adult patients were included in this study. A significant improvement in physician-assessed disease severity was detected at each follow-up visit as compared with baseline and similar trend was observed for patient-reported outcomes and quality of life. No meaningful difference in effectiveness was found when considering patient age (<65 versus ≥65 years), neither dissecting patient cohort in dupilumab-naive vs dupilumab-treated subjects. Among tralokinumab-treated patients, 88% achieved at least one currently identified real-world therapeutic goal at week 16. CONCLUSIONS This retrospective multicenter study confirmed the effectiveness and safeness of tralokinumab throughout 32 weeks of observation, showing the achievement of therapeutic goals identified in both trial and real-world settings in a large proportion of tralokinumab-treated patients.
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Affiliation(s)
- A Chiricozzi
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - S M Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - L Di Nardo
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - N Gori
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Balato
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - M Ortoncelli
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - M Maurelli
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - M Galluzzo
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Dermatology Unit, Fondazione Policlinico "Tor Vergata", Rome, Italy
| | - M Munera Campos
- Department of Dermatology, Germans Trias i Pujol University Hospital (HUGTP), Autonomous University of Barcelona (UAB), Badalona, Spain
| | - T Seremet
- Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, Switzerland
| | - G Caldarola
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - C De Simone
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - E Ippoliti
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - T Torres
- Department of Dermatology, Centro Hospitalar Universitário de Santo António, University of Porto, Porto, Portugal
| | - S Gkalpakiotis
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, Prague, Czech Republic
| | - C Conrad
- Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, Switzerland
| | - J M Carrascosa
- Department of Dermatology, Germans Trias i Pujol University Hospital (HUGTP), Autonomous University of Barcelona (UAB), Badalona, Spain
| | - L Bianchi
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Dermatology Unit, Fondazione Policlinico "Tor Vergata", Rome, Italy
| | - G Argenziano
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - S Ribero
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - G Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, 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
| | - K Peris
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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23
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Gao Q, Zhao Y, Zhang J. Efficacy and safety of abrocitinib and upadacitinib versus dupilumab in adults with moderate-to-severe atopic dermatitis: A systematic review and meta-analysis. Heliyon 2023; 9:e16704. [PMID: 37332971 PMCID: PMC10272339 DOI: 10.1016/j.heliyon.2023.e16704] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/20/2023] Open
Abstract
Background The sparsity of head-to-head trials for medications used as in atopic dermatitis (AD) treatment makes therapy options difficult. Objective To better compare the efficacy and safety of abrocitinib and upadacitinib with dupilumab in patients with moderate-to-severe AD. Methods We systematically searched MEDLINE, EMBASE, and the Cochrane Library database for head-to-head trials. Results Three studies with 2256 patients were included. The analysis revealed that improvement of EASI-75 was rapidly registered with abrocitinib/upadacitinib as compared to the dupilumab, even as early as week 2 of treatment. The proportions of patients who reached the endpoint of EASI-75 at week 12 and end of therapy were also higher in the abrocitinib/upadacitinib group. Significant improvement in EASI-90 scores was demonstrated with abrocitinib/upadacitinib at week 2 and at all subsequent time points. The administration of abrocitinib/upadacitinib provided a faster onset of IGA response at week 2. The differences in IGA response remained significant at week 12 and end of therapy. Compared with dupilumab, a larger proportion of patients treated with abrocitinib/upadacitinib achieved early itch relief at 2 weeks. Better results were found later during treatment, in between the 12 weeks to the end of study in abrocitinib/upadacitinib group. The only observed significant result of adverse events were severe adverse events between the abrocitinib/upadacitinib group (n = 40) and the dupilumab group (n = 24) (p = 0.043). TEAEs of any causality that led to treatment discontinuation and serious adverse events have not shown special risks in the patients treated with abrocitinib/upadacitinib. Conclusions This study demonstrated that anti-JAK therapy, particularly abrocitinib and upadacitinib, exhibited superiority over dupilumab in achieving fast relief of disease signs with an acceptable safety profile in patients with moderate-to-severe atopic dermatitis.
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Affiliation(s)
| | | | - Junling Zhang
- Corresponding author. Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital; No.354, Beima Road, Hongqiao District, Tianjin 300120, China
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24
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De Bruin-Weller M, Deleuran M, Biedermann T, Bissonnette R, Foley P, Girolomoni G, Hercogová J, Hong CH, Katoh N, Pink A, Richard MA, Shumack S, Silvestre JF, Thyssen JP, Weidinger S. The Treat-to-Target Project in Atopic Dermatitis: One Year On. Acta Derm Venereol 2023; 103:adv5382. [PMID: 37083095 PMCID: PMC10134065 DOI: 10.2340/actadv.v103.5382] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/28/2023] [Indexed: 04/22/2023] Open
Abstract
Atopic dermatitis is a chronic skin condition for which a range of systemic treatments have recently been approved. A treat-to-target strategy has been developed previously alongside an algorithm to guide the management of patients with atopic dermatitis. Here, we review the strategy and algorithm in the context of the evolving therapeutic landscape, and identify areas for further refinement and development.
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Affiliation(s)
- Marjolein De Bruin-Weller
- Department of Allergology and Dermatology, UMC Utrecht, National Expertise Center for Eczema, Utrecht, The Netherlands.
| | - Mette Deleuran
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - Tilo Biedermann
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | | | - Peter Foley
- The University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Australia; Probity Medical Research, Skin Health Institute, Melbourne, Victoria, Australia
| | - Giampiero Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Italy
| | - Jana Hercogová
- Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Chih-Ho Hong
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - Norito Katoh
- Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Andrew Pink
- St John's Institute of Dermatology, Guy's and St, Thomas' NHS Foundation Trust, London, UK; Department of Dermatology, Kings College, London, UK
| | - Marie-Aleth Richard
- CEReSSEA 3279, Research Center in Health Services and Quality of Life, Aix Marseille University, Marseille, France; Department of Dermatology, University Hospital of La Timone, Marseille, France; Dermatology Department, Assistance Publique Hôpitaux de Marseille, APHM, Marseille, France
| | - Stephen Shumack
- Department of Dermatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | | | - Jacob P Thyssen
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Stephan Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Paul C, Griffiths CEM, Costanzo A, Herranz P, Grond S, Mert C, Tietz N, Riedl E, Augustin M. Factors Predicting Quality of Life Impairment in Adult Patients with Atopic Dermatitis: Results from a Patient Survey and Machine Learning Analysis. Dermatol Ther (Heidelb) 2023; 13:981-995. [PMID: 36862306 DOI: 10.1007/s13555-023-00897-0] [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: 12/19/2022] [Accepted: 01/27/2023] [Indexed: 03/03/2023] Open
Abstract
INTRODUCTION Atopic dermatitis (AD) is a chronic, inflammatory skin disorder that impairs patients' quality of life (QoL). Physician assessment of AD disease severity is determined by clinical scales and assessment of affected body surface area (BSA), which might not mirror patients' perceived disease burden. METHODS Using data from an international cross-sectional web-based survey of patients with AD and a machine learning approach, we sought to identify disease attributes with the highest impact on QoL for patients with AD. Adults with dermatologist-confirmed AD participated in the survey between July-September 2019. Eight machine learning models were applied to the data with dichotomised Dermatology Life Quality Index (DLQI) as the response variable to identify factors most predictive of AD-related QoL burden. Variables tested were demographics, affected BSA and affected body areas, flare characteristics, activity impairment, hospitalisation and AD therapies. Three machine learning models, logistic regression model, random forest and neural network, were selected on the basis of predictive performance. Each variable's contribution was computed via importance values from 0 to 100. For relevant predictive factors, further descriptive analyses were conducted to characterise those findings. RESULTS In total, 2314 patients completed the survey with mean age 39.2 years (standard deviation 12.6) and average disease duration of 19 years. Measured by affected BSA, 13.3% of patients had moderate-to-severe disease. However, 44% of patients reported a DLQI > 10, indicative of a very large to extremely large impact on QoL. Activity impairment was the most important factor predicting high QoL burden (DLQI > 10) across models. Hospitalisation during the past year and flare type were also highly ranked. Current BSA involvement was not a strong predictor of AD-related QoL impairment. CONCLUSIONS Activity impairment was the single most important factor for AD-related QoL impairment while current extent of AD did not predict higher disease burden. These results support the importance of considering patients' perspectives when determining the severity of AD.
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Affiliation(s)
- Carle Paul
- Université Toulouse Paul Sabatier, Toulouse, France
| | - Christopher E M Griffiths
- Dermatology Centre, Salford Royal Hospital, University of Manchester, Manchester Biomedical Research Centre, Manchester, UK
| | | | | | | | - Can Mert
- HaaPACS GmbH, Schriesheim, Germany
| | | | - Elisabeth Riedl
- Eli Lilly and Company, Indianapolis, IN, USA.,Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Matthias Augustin
- University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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26
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BOESJES CM, VAN DER GANG LF, ZUITHOFF NPA, BAKKER DS, SPEKHORST LS, HAECK I, KAMSTEEG M, de GRAAF M, DE BRUIN-WELLER MS. Effectiveness of Upadacitinib in Patients with Atopic Dermatitis including those with Inadequate Response to Dupilumab and/or Baricitinib: Results from the BioDay Registry. Acta Derm Venereol 2023; 103:adv00872. [PMID: 36794894 PMCID: PMC9949218 DOI: 10.2340/actadv.v103.5243] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/12/2023] [Indexed: 02/17/2023] Open
Abstract
Clinical trials showed that upadacitinib, a selective Janus kinase-1 inhibitor, is effective for treatment of moderate-to-severe atopic dermatitis. However, daily practice studies are limited. This multicentre prospective study evaluated the effectiveness of 16 weeks of upadacitinib treatment for moderate-to-severe atopic dermatitis in adult patients, including those with previous inadequate response to dupilumab and/or baricitinib, in daily practice. A total of 47 patients from the Dutch BioDay registry treated with upadacitinib were included. Patients were evaluated at baseline, and after 4, 8 and 16 weeks of treatment. Effectiveness was assessed by clinician- and patient-reported outcome measurements. Safety was assessed by adverse events and laboratory assessments. Overall, the probabilities (95% confidence intervals) of achieving Eczema Area and Severity Index ≤ 7 and Numerical Rating Scale - pruritus ≤ 4 were 73.0% (53.7-86.3) and 69.4% (48.7-84.4), respectively. The effectiveness of upadacitinib was comparable in patients with inadequate response to dupilumab and/or baricitinib and in patients who were naïve for these treatments or who had stopped such treatments due to adverse events. Fourteen (29.8%) patients discontinued upadacitinib due to ineffectiveness, adverse events or both (8.5%, 14.9% and 6.4%, respectively). Most frequently reported adverse events were acneiform eruptions (n = 10, 21.3%), herpes simplex (n = 6, 12.8%), nausea and airway infections (both n = 4, 8.5%). In conclusion, upadacitinib is an effective treatment for patients with moderate-to-severe atopic dermatitis, including those with previous inadequate response to dupilumab and/or baricitinib treatment.
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Affiliation(s)
- Celeste M. BOESJES
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis
| | - Liana F. VAN DER GANG
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis
| | - Nicolaas P. A. ZUITHOFF
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht
| | - Daphne S. BAKKER
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis
| | - Lotte S. SPEKHORST
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis
| | - Inge HAECK
- Department of Dermatology, Reinier de Graaf Gasthuis, Delft
| | - Marijke KAMSTEEG
- Department of Dermatology, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands
| | - Marlies de GRAAF
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis
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27
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Augustin M, Bauer A, Ertner K, von Kiedrowski R, Schenck F, Ramaker-Brunke J, Möller S, Fait A, Bastian M, Thaçi D. Dupilumab Demonstrates Rapid Onset of Action in Improving Signs, Symptoms and Quality of Life in Adults with Atopic Dermatitis. Dermatol Ther (Heidelb) 2023; 13:803-816. [PMID: 36738405 PMCID: PMC9984619 DOI: 10.1007/s13555-023-00894-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Dupilumab has significantly improved the signs, symptoms and quality of life (QoL) of patients with moderate-to-severe atopic dermatitis (AD) in randomised, controlled clinical trials. However, there is a need to assess the effectiveness and safety of dupilumab in real-world clinical practice. The PROLEAD study was designed to examine the effectiveness and safety of dupilumab in moderate-to-severe AD in a real-world setting in Germany. Here, we present 12-week effectiveness and safety results with dupilumab from PROLEAD. METHODS PROLEAD is a multicentre, prospective, non-interventional study being conducted at 126 routine care sites across Germany. Adults with moderate-to-severe AD who require systemic therapy were treated with dupilumab as indicated by the Summary of Product Characteristics. Data collected included physician assessments (EASI, BSA, SCORAD, and IGA) and patient-reported outcomes (PROs [POEM, DLQI, EQ-5D-5L, Peak Pruritus NRS and MOS Sleep Scale]). RESULTS Of 839 patients assessed for eligibility, 828 were included. The full analysis and safety analysis sets comprised 775 and 818 patients, respectively. The number of patients receiving concomitant therapy decreased from baseline to Week 12. Mean (standard deviation [SD]) percentage change in EASI score from baseline to Week 12 was -67.5% (48.4%) and was comparable across the four body regions. The proportion of patients achieving EASI-75 was 59.4% at Week 12. Mean (SD) Peak Pruritus NRS decreased from 7.4 (2.3) at baseline to 3.4 (2.6) at Week 12. Improvements from baseline to Week 12 were reported in all PROs assessed. No new safety signals were observed. DISCUSSION Improvements in efficacy outcomes and adverse event rates in a real-world setting were more favourable than in phase 3 clinical trials. CONCLUSIONS The 12-week findings of PROLEAD demonstrate that treatment with dupilumab is effective and well tolerated, with rapid onset of action in signs, symptoms and QoL in patients with moderate-to-severe AD in the real world. TRIAL REGISTRATION NUMBER DUPILL08907; NIS-Nr. 433.
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Affiliation(s)
- Matthias Augustin
- Institute of Health Care Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea Bauer
- Department of Dermatology, University Allergy Centre, University Hospital Carl Gustav Carus, Technical University, Dresden, Germany
| | | | - Ralph von Kiedrowski
- Company for Medical Study and Service Selters, GmbH and Dermatology Practice Dr von Kiedrowski, Selters (Westerwald), Germany
| | | | | | | | | | | | - Diamant Thaçi
- Institute and Comprehensive Center Inflammation Medicine, University of Lübeck, Lübeck, Germany
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28
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Simpson EL, Gooderham M, Wollenberg A, Weidinger S, Armstrong A, Soung J, Ferrucci S, Lima RG, Witte MM, Xu W, ElMaraghy H, Natalie CR, Pierce E, Blauvelt A. Efficacy and Safety of Lebrikizumab in Combination With Topical Corticosteroids in Adolescents and Adults With Moderate-to-Severe Atopic Dermatitis: A Randomized Clinical Trial (ADhere). JAMA Dermatol 2023; 159:182-191. [PMID: 36630140 PMCID: PMC9857439 DOI: 10.1001/jamadermatol.2022.5534] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Importance Lebrikizumab (LEB), a high-affinity monoclonal antibody targeting interleukin (IL)-13, demonstrated efficacy and safety in patients with moderate-to-severe atopic dermatitis (AD) during 16 weeks of monotherapy in a phase 2b trial, and two 52-week phase 3 trials. Objective To evaluate efficacy and safety of LEB combined with low- to mid-potency topical corticosteroids (TCS) in patients with moderate-to-severe AD. Design, Setting, and Participants The ADhere trial was a 16-week randomized, double-blinded, placebo (PBO)-controlled, multicenter, phase 3 clinical trial conducted from February 3, 2020, to September 16, 2021. The study was conducted at 54 outpatient sites across Germany, Poland, Canada, and the US and included adolescent (aged ≥12 to <18 years weighing ≥40 kg) and adult patients with moderate-to-severe AD. The treatment allocation ratio was 2:1 (LEB:PBO). Interventions Overall, 211 patients were randomized to subcutaneous LEB (loading dose of 500 mg at baseline and week 2, followed by 250 mg every 2 weeks [Q2W] thereafter) or PBO Q2W in combination with TCS for 16 weeks. Main Outcomes and Measures Efficacy analyses at week 16 included proportions of patients achieving Investigator's Global Assessment score of 0 or 1 (IGA [0,1]) with 2 or more points improvement from baseline, and 75% improvement in the Eczema Area and Severity Index (EASI-75). Key secondary end points included evaluation of itch, itch interference on sleep, and quality of life. Safety assessments included monitoring adverse events (AEs). Results The mean (SD) age of patients was 37.2 (19.3) years, 103 (48.8%) patients were women, 31 (14.7%) patients were Asian, and 28 (13.3%) patients were Black/African American. At week 16, IGA (0,1) was achieved by 145 (41.2%) patients in the LEB+TCS group vs 66 (22.1%) receiving PBO+TCS (P = .01); corresponding proportions of patients achieving EASI-75 were 69.5% vs 42.2% (P < .001). The LEB+TCS group showed statistically significant improvements in all key secondary end points. Most treatment-emergent adverse events (TEAEs) were nonserious, mild or moderate in severity, and did not lead to study discontinuation. The TEAEs frequently reported in the LEB+TCS group included conjunctivitis (7 [4.8%]), headache (7 [4.8%]), hypertension (4 [2.8%]), injection site reactions (4 [2.8%]), and herpes infection (5 [3.4%]) vs 1.5% or less patient-reported frequencies in the PBO+TCS group. Similar frequencies of patient-reported serious AEs following LEB+TCS (n = 2, 1.4%) and PBO+TCS (n = 1, 1.5%). Conclusions and Relevance In this randomized phase 3 clinical trial, LEB+TCS was associated with improved outcomes in adolescents and adults with moderate-to-severe AD compared with TCS alone, and safety was consistent with previously reported AD trials. Trial Registration ClinicalTrials.gov Identifier: NCT04250337.
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Affiliation(s)
- Eric L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland
| | | | - Andreas Wollenberg
- LMU - Department of Dermatology and Allergology, Munich, Germany.,Department of Dermatology, Free University Brussels, University Hospital Brussels, Brussels, Belgium
| | - Stephan Weidinger
- Department of Dermatology, Christian Albrechts University of Kiel, Kiel, Germany
| | | | | | - Silvia Ferrucci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dermatology Unit, Milan, Italy
| | | | | | - Wen Xu
- Eli Lilly and Company, Indianapolis, Indiana
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29
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Kamphuis E, Loman L, Han HL, Romeijn GLE, Politiek K, Schuttelaar MLA. Experiences from daily practice of upadacitinib treatment on atopic dermatitis with a focus on hand eczema: Results from the BioDay registry. Contact Dermatitis 2023; 88:351-362. [PMID: 36621910 DOI: 10.1111/cod.14276] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/12/2022] [Accepted: 01/05/2023] [Indexed: 01/10/2023]
Abstract
BACKGROUND Real-world data on the effectiveness of upadacitinib on atopic dermatitis (AD), hand eczema (HE) and HE in the context of AD are limited. OBJECTIVES To evaluate the effectiveness and safety of upadacitinib on AD and on HE in patients with AD. METHODS This prospective observational cohort study includes clinical outcomes: Eczema Area and Severity Index (EASI), Investigator's Global Assessment (IGA), Hand Eczema Severity Index (HECSI), Photographic guide; and PROMs: average pruritus and pain Numeric Rating Scale (NRS) score of the past week, Patient-Oriented Eczema Measure (POEM), Patient-Oriented Eczema, Dermatology Life Quality Index (DLQI), Atopic Dermatitis Control Tool (ADCT), Patient Global Assessment of Disease (PGAD), Quality Of Life Hand Eczema Questionnaire (QOLHEQ) at baseline, Week 4, and Week 16 of upadacitinib-treated patients. Adverse events were monitored during each visit. RESULTS Thirty-eight patients were included, of which 32 patients had HE. At Week 16, EASI-75 was achieved by 50.0%. Absolute cutoff score NRS-pruritus ≤4 was reached by 62.5%, POEM ≤7 by 37.5%, DLQI ≤5 by 59.4%, ADCT <7 by 68.8%, and PGAD rating of at least 'good' by 53.1%. HECSI-75 was achieved by 59.3% and (almost) clear on the Photographic guide by 74.1%. The minimally important change in QOLHEQ was achieved by 57.9%. Sub-analysis in patients with concomitant irritant contact dermatitis showed no differences. Safety analysis showed no new findings compared to clinical trials. CONCLUSIONS Upadacitinib can be an effective treatment for patients with AD and concomitant HE in daily practice. Future studies should focus on the effectiveness of upadacitinib on chronic HE, especially on the different etiological subtypes of HE, including HE in non-atopic individuals.
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Affiliation(s)
- Esmé Kamphuis
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Laura Loman
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Henry L Han
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Geertruida L E Romeijn
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Klaziena Politiek
- Department of Dermatology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Marie L A Schuttelaar
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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30
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van der Schoot LS, Baerveldt EM, van Enst WA, Menting SP, Seyger MMB, Wanders SL, van Ee I, Pieterse AH, van den Reek JMPA, de Jong EMGJ. National consensus on biologic dose reduction in psoriasis: a modified eDelphi procedure. J DERMATOL TREAT 2022; 34:2154570. [PMID: 36472386 DOI: 10.1080/09546634.2022.2154570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Dose reduction of biologics for psoriasis is applied in daily practice, although guidelines are lacking. Striving for clear criteria is important, as it leads to a consistent application of dose reduction. OBJECTIVE To achieve consensus on criteria for biologic dose reduction in psoriasis patients with stable and low disease activity. METHODS An online Delphi procedure (eDelphi) was conducted. Dutch dermatologists were invited to participate in a maximum of 3 voting rounds. Proposed statements were selected based on literature review and included criteria for the application of dose reduction and dosing schedules. Biologic dose reduction was defined as 'application of injection interval prolongation'. Proposed statements were rated using a 9-point Likert scale; consensus was reached when ≥70% of all voters rated 'agree' (7-9) and <15% rated 'disagree' (1-3). RESULTS A total of 27 dermatologists participated and reached a consensus on 15 recommendations over 2 voting rounds. Agreed statements included criteria for dose reduction eligibility, criteria for dose reduction (dis)continuation, and dosing schedules for adalimumab, etanercept, and ustekinumab. Based on the eDelphi outcomes, an algorithm fit for implementation in current practice was developed. CONCLUSIONS Recommendations of this national consensus process can guide clinicians, and consequently their patients, toward consistent application of biologic dose reduction.
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Affiliation(s)
- L S van der Schoot
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - E M Baerveldt
- Department of Dermatology, IJsselland Ziekenhuis, Capelle aan den IJssel, the Netherlands
| | - W A van Enst
- Dutch Association for Dermatology and Venereology, Utrecht, the Netherlands
| | - S P Menting
- Department of Dermatology, OLVG, Amsterdam, the Netherlands
| | - M M B Seyger
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - S L Wanders
- Dutch Association for Dermatology and Venereology, Utrecht, the Netherlands
| | - I van Ee
- Psoriasispatiënten Nederland, Dutch National Psoriasis Patient Association, Nijkerk, the Netherlands
| | - A H Pieterse
- Psoriasispatiënten Nederland, Dutch National Psoriasis Patient Association, Nijkerk, the Netherlands
| | - J M P A van den Reek
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - E M G J de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
- Radboud University, Nijmegen, the Netherlands
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31
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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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32
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BOESJES CM, KAMPHUIS E, ZUITHOFF NPA, BAKKER DS, LOMAN L, SPEKHORST LS, HAECK I, KAMSTEEG M, VAN LYNDEN-VAN NES AMT, GARRITSEN FM, POLITIEK K, OLDHOFF M, DE GRAAF M, SCHUTTELAAR MLA, DE BRUIN-WELLER MS. Daily Practice Experience of Baricitinib Treatment for Patients with Difficult-to-Treat Atopic Dermatitis: Results from the BioDay Registry. Acta Derm Venereol 2022; 102:adv00820. [PMID: 36420885 PMCID: PMC9811281 DOI: 10.2340/actadv.v102.3978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Clinical trials have shown that baricitinib, an oral selective Janus kinase 1/2 inhibitor, is effective for the treatment of moderate-to-severe atopic dermatitis. However, daily practice data are limited. Therefore, this multicentre prospective study evaluated the effectiveness and safety of 16-weeks' treatment with baricitinib in adult patients with moderate-to-severe atopic dermatitis in daily practice. A total of 51 patients from the BioDay registry treated with baricitinib were included and evaluated at baseline and after 4, 8 and 16 weeks of treatment. Effectiveness was assessed using clinician- and patient-reported outcome measurements. Adverse events and laboratory assessments were evaluated at every visit. At week 16, the probability (95% confidence interval) of achieving Eczema Area and Severity Index ≤ 7 and numerical rating scale pruritus ≤ 4 was 29.4% (13.1-53.5) and 20.5% (8.8-40.9), respectively. No significant difference in effectiveness was found between dupilumab non-responders and responders. Twenty-two (43.2%) patients discontinued baricitinib treatment due to ineffectiveness, adverse events or both (31.4%, 9.8% and 2.0%, respectively). Most frequently reported adverse events were nausea (n = 6, 11.8%), urinary tract infection (n = 5, 9.8%) and herpes simplex infection (n = 4, 7.8%). In conclusion, baricitinib can be an effective treatment option for moderate-to-severe atopic dermatitis, including patients with non-responsiveness on dupilumab. However, effectiveness of baricitinib is heterogeneous, which is reflected by the high discontinuation rate in this difficult-to-treat cohort.
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Affiliation(s)
- Celeste M. BOESJES
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht
| | - Esmé KAMPHUIS
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen
| | - Nicolaas P. A. ZUITHOFF
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht
| | - Daphne S. BAKKER
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht
| | - Laura LOMAN
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen
| | - Lotte S. SPEKHORST
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht
| | - Inge HAECK
- Department of Dermatology, Reinier de Graaf Gasthuis, Delft
| | - Marijke KAMSTEEG
- Department of Dermatology, Radboud University Medical Center, Radboud University, Nijmegen
| | | | | | - Klaziena POLITIEK
- Department of Dermatology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Marja OLDHOFF
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen
| | - Marlies DE GRAAF
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht
| | - Marie L. A. SCHUTTELAAR
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen
| | - Marjolein S. DE BRUIN-WELLER
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht
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33
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Lobefaro F, Gualdi G, Di Nuzzo S, Amerio P. Atopic Dermatitis: Clinical Aspects and Unmet Needs. Biomedicines 2022; 10:biomedicines10112927. [PMID: 36428493 PMCID: PMC9687804 DOI: 10.3390/biomedicines10112927] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/18/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
Atopic dermatitis is a common chronic-relapsing, inflammatory and itchy eczematous skin disorder which occurs in both children and adults. AD pathogenesis is complex and several factors are implicated. Pruritus plays a pivotal role in disease's burden, significantly worsening atopic patient quality of life by limiting productivity and daily activities. AD diagnosis relies still on the experience of the healthcare professional and there are several unmet needs as for the diagnostic criteria, the management and the recognition of the burden of the disease. In this paper we present an indeep focus on the main clinical features of AD and the major unmet needs that should be addressed in the next research.
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Affiliation(s)
- Fabio Lobefaro
- Dermatology Department of Medicine and Aging Science, University of Chieti Pescara, 66100 Chieti, Italy
| | - Giulio Gualdi
- Dermatology Department of Medicine and Aging Science, University of Chieti Pescara, 66100 Chieti, Italy
| | - Sergio Di Nuzzo
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Paolo Amerio
- Dermatology Department of Medicine and Aging Science, University of Chieti Pescara, 66100 Chieti, Italy
- Correspondence:
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de Graaf M, Janmohamed S, Schuttelaar M, Agner T, Alfonso J, De Schepper S, Deleuran M, Despontin K, Elenius V, Ghislain P, Huilaja L, Johansson E, Kvenshagen B, Mandelin J, Olset H, Svensson A, van Tuyll van Serooskerken A, Thyssen J, Vestergaard C. Systemic treatment of children and adolescents with atopic dermatitis aged ≥2 years: a Delphi consensus project mapping expert opinion in Northern Europe. J Eur Acad Dermatol Venereol 2022; 36:2153-2165. [PMID: 35793471 PMCID: PMC9796032 DOI: 10.1111/jdv.18410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/14/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Paediatric atopic dermatitis (AD) can be burdensome, affecting mental health and impairing quality of life for children and caregivers. Comprehensive guidelines exist for managing paediatric AD, but practical guidance on using systemic therapy is limited, particularly for new therapies including biologics and Janus kinase (JAK) inhibitors, recently approved for various ages in this indication. OBJECTIVES This expert consensus aimed to provide practical recommendations within this advancing field to enhance clinical decision-making on the use of these and other systemics for children and adolescents aged ≥2 years with moderate-to-severe AD. METHODS Nineteen physicians from Northern Europe were selected for their expertise in managing childhood AD. Using a two-round Delphi process, they reached full or partial consensus on 37 statements. RESULTS Systemic therapy is recommended for children aged ≥2 years with a clear clinical diagnosis of severe AD and persistent disease uncontrolled after optimizing non-systemic therapy. Systemic therapy should achieve long-term disease control and reduce short-term interventions. Recommended are cyclosporine A for short-term use (all ages) and dupilumab or methotrexate for long-term use (ages ≥6 years). Consensus was not reached on the best long-term systemics for children aged 2-6 years, although new systemic therapies will likely become favourable: New biologics and JAK inhibitors will soon be approved for this age group, and more trial and real-world data will become available. CONCLUSIONS This article makes practical recommendations on the use of systemic AD treatments for children and adolescents, to supplement international and regional guidelines. It considers the systemic medication that was available for children and adolescents with moderate-to-severe AD at the time this consensus project was done: azathioprine, cyclosporine A, dupilumab, methotrexate, mycophenolate mofetil and oral glucocorticosteroids. We focus on the geographically similar Northern European countries, whose healthcare systems, local preferences for AD management and reimbursement structures nonetheless differ significantly.
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Affiliation(s)
- M. de Graaf
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, Wilhelmina Children's HospitalUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - S.R. Janmohamed
- Department of Dermatology, Unit Pediatric Dermatology, SKIN Research Group, Universitair Ziekenhuis Brussel (UZ Brussel)Vrije Universiteit Brussel (VUB)BrusselsBelgium
| | - M.L.A. Schuttelaar
- Department of Dermatology, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - T. Agner
- Department of Dermatology and VenereologyBispebjerg HospitalCopenhagenDenmark
| | - J.H. Alfonso
- Department of DermatologyOslo University Hospital, RikshospitaletOsloNorway
| | - S. De Schepper
- Department of DermatologyGent University HospitalGentBelgium
| | - M. Deleuran
- Department of DermatologyAarhus University HospitalAarhusDenmark
| | - K. Despontin
- Department of Dermatology and VenereologyCHU UCL NamurNamurBelgium
| | - V. Elenius
- Department of PediatricsTurku University HospitalTurkuFinland
| | - P.‐D. Ghislain
- Department of Dermatology, UCL St‐LucLouvain UniversityBrusselsBelgium
| | - L. Huilaja
- PEDEGO Research UnitUniversity of OuluOuluFinland,Department of Dermatology and Medical Research Center OuluOulu University HospitalOuluFinland
| | - E.K. Johansson
- Dermatology and Venereology Unit, Department of Medicine SolnaKarolinska InstitutetStockholmSweden,Department of DermatologyKarolinska University HospitalStockholmSweden
| | | | - J.M. Mandelin
- Department of DermatologyHelsinki University Central HospitalHelsinkiFinland
| | - H. Olset
- Department of DermatologyHaukeland University HospitalBergenNorway
| | - A. Svensson
- Department of Dermatology and VenereologyMalmö University HospitalMalmöSweden
| | | | - J.P. Thyssen
- Department of Dermatology and VenereologyBispebjerg HospitalCopenhagenDenmark
| | - C. Vestergaard
- Department of DermatologyAarhus University HospitalAarhusDenmark
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Spekhorst LS, Bakker D, Drylewicz J, Rispens T, Loeff F, Boesjes CM, Thijs J, Romeijn GLE, Loman L, Schuttelaar ML, van Wijk F, de Graaf M, de Bruin-Weller MS. Patient-centered dupilumab dosing regimen leads to successful dose reduction in persistently controlled atopic dermatitis. Allergy 2022; 77:3398-3407. [PMID: 35837880 DOI: 10.1111/all.15439] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/14/2022] [Accepted: 06/19/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND At present, no real-world studies are available on different dupilumab dosing regimens in controlled atopic dermatitis (AD). The aim of this study was to clinically evaluate a patient-centered dupilumab dosing regimen in patients with controlled AD and to relate this to serum drug levels and serum biomarkers. METHODS Ninety adult AD patients from the prospective BioDay registry were included based on their dupilumab administration interval according to a predefined patient-centered dosing regimen. Group A (n = 30) did not fulfill the criteria for interval prolongation and continued using the standard dupilumab dosage (300 mg/2 weeks), group B (n = 30) prolonged dupilumab interval with 50% (300 mg/4 weeks), and group C (n = 30) prolonged dupilumab interval with 66%-75% (300 mg/6-8 weeks). AD severity score, patient-reported outcomes, serum dupilumab levels, and serum biomarkers were analyzed over time. RESULTS Disease severity scores did not significantly change over time during the tapering period in any of the groups. In groups B and C, the Numeric Rating Scale (NRS)-pruritus temporarily significantly increased after interval prolongation but remained low (median NRS-pruritus≤4). Median dupilumab levels remained stable in group A (standard dosage), but significantly decreased in groups B and C (24.1 mg/L (IQR = 17.1-45.6); 12.5 mg/L (IQR = 1.7-22.3)) compared with the levels during the standard dosage (88.2 mg/L [IQR = 67.1-123.0, p < .001]). Disease severity biomarker levels (CCL17/CCL18) remained low in all study groups during the whole observation period. CONCLUSIONS This study showed that dose reduction was successful in a subgroup of patients with controlled AD by using a patient-centered dosing regimen. These patients showed stable low disease activity and low severity biomarkers over time.
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Affiliation(s)
- Lotte S Spekhorst
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Daphne Bakker
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Julia Drylewicz
- Division Laboratories, Pharmacy and Biomedical Genetics, Center for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research, and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Floris Loeff
- Sanquin Diagnostic Services, Sanquin, Amsterdam, The Netherlands
| | - Celeste M Boesjes
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Judith Thijs
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geertruida L E Romeijn
- Department of Dermatology, University Medical Center Groningen, Groningen, The Netherlands
| | - Laura Loman
- Department of Dermatology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Femke van Wijk
- Division Laboratories, Pharmacy and Biomedical Genetics, Center for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marlies de Graaf
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marjolein S de Bruin-Weller
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
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Paller AS, Yosipovitch G, Weidinger S, DiBenedetti D, Whalley D, Gadkari A, Guillemin I, Zhang H, Eckert L, Chao J, Bansal A, Chuang CC, Delevry D. Development, Psychometric Validation and Responder Definition of Worst Itch Scale in Children with Severe Atopic Dermatitis. Dermatol Ther (Heidelb) 2022; 12:2839-2850. [PMID: 36269504 DOI: 10.1007/s13555-022-00804-z] [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: 07/14/2022] [Accepted: 08/26/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Itch associated with atopic dermatitis (AD) has a profoundly negative effect on patients of all ages. Therefore, itch is a main target for AD therapeutic approaches, and treatments are perceived as beneficial when they achieve an itch reduction. In the absence of a validated scale for children aged 6-11 years that is suitable for assessing itch intensity in clinical trial settings, the Worst Itch Scale was developed. METHODS Qualitative interviews, comprising concept elicitation and cognitive debriefing, were conducted to develop and evaluate the content validity of the Worst Itch Scale. Psychometric assessments used data from the LIBERTY AD PEDS phase 3 trial of dupilumab in patients aged 6-11 years with severe AD. These included test-retest reliability, construct validity, known-groups validity and responsiveness. Thresholds for clinically meaningful change were defined using anchor- and distribution-based methods. RESULTS The Worst Itch Scale consisted of two items asking about 'worst itching' experienced 'last night' and 'today'. Worst Itch Scale scores showed large, positive correlations with existing patient-reported outcome (PRO) measures of itch, and weaker correlations with clinician-reported outcome (ClinRO) measures assessing objective signs of AD. Improvements in Worst Itch Scale scores were highly correlated with improvements in other itch PROs and moderately correlated with improvements in ClinROs. The responder definition based on the primary anchor, a 1-point improvement in the Patient Global Impression of Disease, was 2.84. Supportive anchors produced response estimates ranging from 2.43 to 4.80 points. CONCLUSIONS The Worst Itch Scale is a fit-for-purpose (e.g. well-defined, reliable, responsive and valid) scale for evaluating worst itch intensity in children aged 6-11 years with severe AD. The within-patient threshold for defining a clinically meaningful response was a ≥ 3-4-point change in the Worst Itch Scale score. TRIAL REGISTRATION NCT03345914. Video: How can we reliably assess itch intensity in children 6-11 years with severe atopic dermatitis in clinical trial settings?
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Affiliation(s)
- Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Gil Yosipovitch
- Department of Dermatology and Itch Center, University of Miami, Miami, FL, USA
| | - Stephan Weidinger
- Department of Dermatology and Allergy, Center for Inflammatory Skin Diseases, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | | | - Diane Whalley
- RTI Health Solutions, Wilmslow Road, Didsbury, Manchester, UK
| | | | | | - Haixin Zhang
- Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Rd, Tarrytown, NY, USA
| | - Laurent Eckert
- Sanofi Aventis, 1 Avenue Pierre Brossolette, 91380, Chilly-Mazarin, France
| | - Jingdong Chao
- Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Rd, Tarrytown, NY, USA
| | - Ashish Bansal
- Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Rd, Tarrytown, NY, USA
| | | | - Dimittri Delevry
- Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Rd, Tarrytown, NY, USA
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Chiricozzi A, Gori N, Narcisi A, Balato A, Gambardella A, Ortoncelli M, Marzano AV, Balestri R, Palazzo G, Pellegrino M, Romanelli M, Tripepi G, Peris K, Costanzo A. Effectiveness and Safety of Upadacitinib in the Treatment of Moderate-Severe Atopic Dermatitis: A Multicentric, Prospective, Real-World, Cohort Study. Drugs R D 2022; 22:245-252. [PMID: 35922713 PMCID: PMC9362214 DOI: 10.1007/s40268-022-00396-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/21/2022] Open
Abstract
Background The efficacy and safety of upadacitinib in atopic dermatitis (AD) have been defined in clinical trials, but no real-world data are currently available. We aimed to assess the safety and effectiveness of upadacitinib in a real-world AD patient cohort that mostly included patients who failed the available systemic therapies, including dupilumab. Methods Prospective cohort study collecting data on upadacitinib-treated AD adult patients completing at least 16 weeks of therapy. Results Forty-three patients showed rapid and marked response to upadacitinib with significant reduction of all disease severity scores since the first follow-up visit. At week 16, Eczema Area and Severity Index (EASI) 75, EASI 90, and EASI 100 response was observed in 97.5%, 82.1%, and 69.2% of patients, respectively. EASI 90 response reflected the achievement of a clear or almost clear condition (POEM 0-2), self-evaluated by 79.5% of patients. Patients’ quality of life improved as suggested by the achievement of DLQI 0/1 by 38.5% of patients at week 4, and by 76.9% at week 16. Conclusion Elevated effectiveness and favorable safety of upadacitinib were confirmed in patients unresponsive to dupilumab, who were not included in upadacitinib trials.
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Affiliation(s)
- Andrea Chiricozzi
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy. .,Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Niccolò Gori
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.,Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandra Narcisi
- Dermatology, Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy.,Skin Pathology Laboratory, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Anna Balato
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Michela Ortoncelli
- Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | | | | | | | | | - Giovanni Tripepi
- Istituto di Fisiologia Clinica del CNR, Sede di Reggio Calabria, Calabria, Italy
| | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.,Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Costanzo
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.,Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
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Establishing Consensus on the Treatment of Toxicodendron Dermatitis. Dermatitis 2022; 33:220-226. [PMID: 35481848 DOI: 10.1097/der.0000000000000894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Toxicodendron dermatitis (TD) is a common form of allergic contact dermatitis that affects millions of Americans every year. Studies have shown that although there are general recommendations for the treatment of TD, there are no treatment algorithms for clinicians to follow when patients present with TD. OBJECTIVE The objective of this study was to achieve consensus on the treatment of TD to create practical guidelines for physicians who treat TD. METHODS Data were collected from March 2020 to April 2021. This study included semistructured focus groups and a Delphi Study with dermatologists to achieve consensus. RESULTS A total of 51 dermatologists were included in the Delphi. Final agreement with proposed severity criteria ranged from 90.9% to 100.0%. Primary indicators of disease severity were body surface area, presence and severity of pruritus, and anatomic locations of eruptions with 77.4% agreement. Final agreement for the treatment algorithm was over the threshold majority agreement at 67.6%. CONCLUSIONS Literature guiding the treatment of TD is scarce. The use of the Delphi method and focus groups can help expand dermatological resources both within dermatology and to other specialties that may need to treat skin conditions.
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Dal Bello G, Schena D, Girolomoni G. Upadacitinib in patients with resistant atopic dermatitis: a retrospective case‐series. J Eur Acad Dermatol Venereol 2022; 36:1499-1500. [DOI: 10.1111/jdv.18139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/04/2022] [Accepted: 03/29/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Giacomo Dal Bello
- Section of Dermatology, Department of Medicine University of Verona 37126 Verona Italy
| | - Donatella Schena
- Section of Dermatology, Department of Medicine University of Verona 37126 Verona Italy
| | - Giampiero Girolomoni
- Section of Dermatology, Department of Medicine University of Verona 37126 Verona Italy
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Torres T, Gonçalo M, Paiva Lopes MJ, Claro C, Ramos L, Selores M, Mendes Bastos P, Rocha J, Carvalho R, Mota A, Filipe P. Portuguese recommendations for the treatment of atopic dermatitis with biologic therapy and JAK inhibitors in adult patients. Drugs Context 2022; 10:dic-2021-9-5. [PMID: 35035495 PMCID: PMC8722771 DOI: 10.7573/dic.2021-9-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022] Open
Abstract
Atopic dermatitis is a highly prevalent chronic, immune-mediated inflammatory skin disease with a significant burden on patients, families and healthcare systems. This article presents recommendations developed by the Atopic Dermatitis Group of the Portuguese Society of Dermatology and Venereology addressing several clinical questions that arise in the management and care of moderate-to-severe atopic dermatitis with biologic agents and Janus kinase (JAK) inhibitors based on the available evidence. The recommendations were generated after a thorough evaluation of existing guidelines on the treatment of atopic dermatitis, publications concerning new biologics and JAK inhibitors not yet incorporated into existing guidelines, and expert-based recommendations. It also includes considerations on atopic dermatitis severity, indications for initiating biologic agents and JAK inhibitors, parameters to be considered in the treatment choice, in particular treatment goals, and recommendations for the use, screening and monitoring of these therapies.
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Affiliation(s)
- Tiago Torres
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - Margarida Gonçalo
- Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maria João Paiva Lopes
- Department of Dermatology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,CEDOC, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Cristina Claro
- Dermatology Department, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Leonor Ramos
- Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Manuela Selores
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | | | - Joana Rocha
- Department of Dermatology, Hospital de Pedro Hispano, Matosinhos, Portugal
| | - Rodrigo Carvalho
- Department of Dermatology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Alberto Mota
- Department of Dermatovenereology, Centro Hospitalar Universitário de São João EPE, Porto, Portugal.,Faculty of Medicine, Porto University, Porto, Portugal
| | - Paulo Filipe
- Department of Dermatology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,Dermatology Research Unit, iMM João Lobo Antunes, University of Lisbon, Lisbon, Portugal
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Costanzo A, Amerio P, Asero R, Chiricozzi A, Corazza M, Cristaudo A, Cusano F, Ferrucci SM, Nettis E, Patrizi A, Patruno C, Peris K, Picozza M, Stingeni L, Girolomoni G. Long-term management of moderate-to-severe adult atopic dermatitis: a consensus by the Italian Society of Dermatology and Venereology (SIDeMaST), the Association of Italian Territorial and Hospital Allergists and Immunologists (AAIITO ), the Italian Association of Hospital Dermatologists (ADOI), the Italian Society of Allergological, Environmental and Occupational Dermatology (SIDAPA), and the Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC). Ital J Dermatol Venerol 2021; 157:1-12. [PMID: 34929995 DOI: 10.23736/s2784-8671.21.07129-2] [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
Atopic dermatitis (AD) is a common chronic-relapsing inflammatory skin disease, burdened by various comorbidities. AD most commonly occurs in children but may persist or present in adulthood becoming a lifelong condition. Therefore, AD requires an effective long-term treatment improving disease signs and symptoms but also of patients' quality of life (QoL). However continuous long-term use of most traditional AD immunosuppressive treatments is not recommended for safety reasons or insufficient efficacy data. Despite the available guidelines, there is still need for knowledge of AD long-term treatment, taking into account new disease measures and recent treatment options. Five Italian scientific societies implemented a joint consensus procedure to define the most appropriate clinical practice for the long-term management of adult moderate-severe AD. Through a modified Delphi procedure, consensus was reached by overall 51 Italian dermatologists and allergists (The Italian AD Study Group) experienced in the management of adult AD on 14 statements covering three AD areas of interest, namely diagnosis, definition of disease severity and clinimetrics, and a treat-to-target approach. This paper reports and discusses the agreed statements, which define disease and patient impact measures, therapeutic approach, and a treatment decision algorithm to support clinicians in the long-term management of adult patients with moderate-to-severe AD in their daily clinical practice.
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Affiliation(s)
- Antonio Costanzo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Unit of Dermatology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
| | - Paolo Amerio
- Unit of Dermatology, Department of Medicine and Aging Science, G. D'Annunzio University, Chieti, Chieti-Pescara, Italy
| | - Riccardo Asero
- Department of Allergology, San Carlo Clinic, Paderno Dugnano, Milan, Italy
| | - Andrea Chiricozzi
- Unit of Dermatology, Department of Surgical and Medical Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Unit of Dermatology, Department of Medicine and Translational Surgery, Sacred Heart Catholic University, Rome, Italy
| | - Monica Corazza
- Section of Dermatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Antonio Cristaudo
- Department of Dermatology, IRCCS San Gallicano Dermatological Institute, Rome, Italy
| | - Francesco Cusano
- Unit of Dermatology, San Pio Hospital - G. Rummo Hospital, Benevento, Italy
| | - Silvia M Ferrucci
- Section of Dermatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eustachio Nettis
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, Aldo Moro University, Bari, Italy
| | - Annalisa Patrizi
- Dermatology of Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Bologna, Italy - .,Unit of Dermatology, IRCCS S. Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Cataldo Patruno
- Department of Health Sciences, Magna Grecia University, Catanzaro, Italy
| | - Ketty Peris
- Unit of Dermatology, Department of Surgical and Medical Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Unit of Dermatology, Department of Medicine and Translational Surgery, Sacred Heart Catholic University, Rome, Italy
| | - Mario Picozza
- National Association of Atopic Dermatitis (ANDeA), Prato, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Giampiero Girolomoni
- Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy
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de Bruin-Weller M, Merola JF, Hong CH, Baldrich ES, Ettler K, Sierka D, Delevry D, Chen Z, Rossi AB. Efficacy of Dupilumab in Atopic Dermatitis: The Patient's Perspective. Dermatol Ther (Heidelb) 2021; 11:2123-2131. [PMID: 34767181 PMCID: PMC8611144 DOI: 10.1007/s13555-021-00621-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/25/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction Atopic dermatitis (AD), a predominantly type 2 inflammatory skin disease, affects approximately 2–5% of adults, with a high burden of disease. In moderate-to-severe AD, lesions can be extensive and pruritus intense with patients experiencing skin pain, sleep and mental health disturbances, and diminished quality of life (QoL). Methods The objective of this study was to evaluate the efficacy of dupilumab for the treatment of AD from the patients’ perspective using patient-reported outcome data from four clinical trials (CHRONOS, SOLO 1&2, and CAFÉ) in patients (N = 1553) receiving either the approved 300 mg q2w dupilumab with/without topical corticosteroids (TCS) dose or control (placebo or placebo + TCS). Patient Global Assessment of Disease Status (PGADS) was used to measure patients’ well-being and Patient Global Assessment of Treatment Effect (PGATE) was used to measure treatment efficacy. Patients were asked “Considering all the ways in which your eczema affects you, indicate how well you are doing” to assess their perception of well-being and “How would you rate the way your eczema responded to the study medication?” to assess their perception of treatment effect. Possible responses for both metrics included poor, fair, good, very good, and excellent. Results In all four studies, a significantly higher proportion of dupilumab-treated patients reported “Good”/”Very Good”/”Excellent” disease status from week 2 through study end versus control (CHRONOS, 52 weeks: 69.8% vs. 25.1%; SOLO 1&2, 16 weeks: 59.5% vs. 24.6%; CAFÉ, 16 weeks: 84.1% vs. 45.4%; all P < 0.0001), and significantly more dupilumab-treated patients reported “Good”/”Very Good”/”Excellent” treatment efficacy versus control (CHRONOS: 72.6% vs. 24.8%; SOLO 1&2: 65.0% vs. 21.1%; CAFÉ, 16 weeks: 85.0% vs. 36.1%; all P < 0.0001). Conclusion Adult patients with AD perceived that dupilumab with/without concomitant TCS was highly efficacious and improved overall disease status and well-being as early as week 2 and throughout treatment periods up to 1 year. Video Abstract (MP4 90521 kb)
Electronic Supplementary Material The online version of this article (10.1007/s13555-021-00621-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marjolein de Bruin-Weller
- Department of Dermatology and Allergology, National Expertise Center of Atopic Dermatitis, University Medical Center, Utrecht, The Netherlands
| | - Joseph F Merola
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Chih-Ho Hong
- Department of Dermatology and Skin Science, University of British Columbia, Surrey, BC, Canada.,Probity Medical Research, Waterloo, ON, Canada
| | | | - Karel Ettler
- University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | | | | | - Zhen Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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Silverberg JI, Simpson EL, Boguniewicz M, De Bruin-Weller MS, Foley P, Kataoka Y, Bégo-Le-Bagousse G, Chen Z, Shumel B, Chao J, Rossi AB. Dupilumab Provides Rapid and Sustained Clinically Meaningful Responses in Adults with Moderate-to-severe Atopic Dermatitis. Acta Derm Venereol 2021; 101:adv00585. [PMID: 34618162 PMCID: PMC9455327 DOI: 10.2340/actadv.v101.307] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Optimal management of atopic dermatitis requires a comprehensive assessment of response to treatment in order to inform therapeutic decisions. In a realworld setting, successful response to atopic dermatitis treatment is measured by sustained improvements in signs, symptoms, and quality of life. Post-hoc analyses of a 1-year, randomized, double-blinded, placebo-controlled trial (NCT02260986) of dupilumab with concomitant topical corticosteroids in 421 adults with moderate-to-severe atopic dermatitis (of whom 315/106 received placebo/dupilumab (of whom 315 received placebo and 106 received dupilumab) was performed to assess the proportion of responders to dupilumab through a multidimensional composite endpoint. At 6-months, 80.2% of dupilumab-treated vs 40.0% placebo patients (p < 0.0001) achieved improvement in signs (Eczema Area and Severity Index ≤ 7), symptoms (worst itch score ≤ 4), or quality of life (Dermatology Life Quality Index ≤5), representative of minimal/clear atopic dermatitis. All 3 endpoints, indicative of no/minimal atopic dermatitis, were achieved by 44.3% of dupilumab-treated vs 10.2% placebo patients (p < 0.0001) and sustained through 1 year. Dupilumab treatment provided sustained clinically meaningful improvement in signs, symptoms, and quality of life in adults with moderate-to-severe atopic dermatitis.
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Affiliation(s)
- Jonathan I Silverberg
- George Washington University School of Medicine of Health Sciences, Ross Hall, 300 Eye Street NW, Washington 20037, DC, USA.
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Chiricozzi A, Gori N, Di Nardo L, Antonelli F, Caruso C, Caldarola G, Calabrese L, Guerriero C, De Simone C, Peris K. Therapeutic Impact and Management of Persistent Head and Neck Atopic Dermatitis in Dupilumab-Treated Patients. Dermatology 2021; 238:717-724. [PMID: 34710866 DOI: 10.1159/000519361] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Localization of atopic dermatitis (AD) in exposed areas such as the hands, head, and neck has been considered as a negative factor impacting on dupilumab response, although a comparison of exposed versus unexposed areas is not currently available. OBJECTIVES The aim of this study is to evaluate the clinical response to dupilumab depending on the presence or persistency of AD skin manifestations in specific body areas. METHODS The study retrospectively collected clinical and demographic data of adult patients affected by moderate to severe AD. Based on the anatomical sites involved, 5 subcohorts of patients were identified. RESULTS A total of 41 patients were included in the study. Disease amelioration was detected during the study period, although baseline head/neck and hand localization was associated with a significantly lower likelihood of achieving an Eczema Area Severity Index (EASI) ≤1. In addition, patients with head/neck persistency showed a significantly lower response when compared to patients without persistency of head/neck AD in terms of both mean EASI and Dermatology Life Quality Index (DLQI) reduction. CONCLUSION AD localization in exposed areas at the baseline and AD persistency at the head/neck may have a negative impact on certain treatment response parameters to dupilumab therapy.
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Affiliation(s)
- Andrea Chiricozzi
- Dermatologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Niccolò Gori
- Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lucia Di Nardo
- Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Flaminia Antonelli
- Dermatologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristiano Caruso
- Allergy Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Giacomo Caldarola
- Dermatologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Laura Calabrese
- Dermatologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristina Guerriero
- Dermatologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Clara De Simone
- Dermatologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ketty Peris
- Dermatologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
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Papp KA, Hong CH, Lansang MP, Turchin I, Adam DN, Beecker JR, Bissonnette R, Gooderham MJ, Jack C, Joseph M, Lynde CW, Shear NH. Practical Management of Patients with Atopic Dermatitis on Dupilumab. Dermatol Ther (Heidelb) 2021; 11:1805-1828. [PMID: 34510403 PMCID: PMC8435113 DOI: 10.1007/s13555-021-00586-w] [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: 06/02/2021] [Accepted: 07/25/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Dupilumab is approved to treat moderate-to-severe atopic dermatitis (AD) in several countries in patients as young as 6 years of age. Since its approval, practical issues related to the use of dupilumab for AD have arisen, with particular interest in transitioning from current therapies and managing medication overlap, considerations for special populations of patients with AD, and management of potential adverse events. METHODS This article aims to review the literature addressing several practical management issues related to dupilumab use for AD and to provide a framework for clinical decision-making in these circumstances and sub-populations. Each statement was reviewed, revised and voted on by authors to provide their level of agreement and degree of uncertainty for each statement. RESULTS An agreement level > 80% was achieved for all of the statements. CONCLUSION The expert panel provides statements considering the practical management of patients with AD taking dupilumab to inform clinical decision-making in specific but frequently encountered clinical situations.
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Affiliation(s)
- Kim A Papp
- Probity Medical Research, Waterloo, ON, Canada.
- K. Papp Clinical Research, 135 Union St E, Waterloo, ON, N2J 1C4, Canada.
| | - Chih-Ho Hong
- Probity Medical Research, Waterloo, ON, Canada
- Dr. Chih-ho Hong Medical, Inc, Surrey, BC, Canada
| | - M Perla Lansang
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Irina Turchin
- Probity Medical Research, Waterloo, ON, Canada
- Brunswick Dermatology Centre, Fredericton, NB, Canada
| | - David N Adam
- Probity Medical Research, Waterloo, ON, Canada
- Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- CCA Medical Research, Ajax, ON, Canada
| | - Jennifer R Beecker
- Probity Medical Research, Waterloo, ON, Canada
- Division of Dermatology, The Ottawa Hospital, Ottawa, ON, Canada
- Division of Dermatology, University of Ottawa, Ottawa, ON, Canada
| | | | - Melinda J Gooderham
- Probity Medical Research, Waterloo, ON, Canada
- SKiN Centre for Dermatology, Peterborough, ON, Canada
| | - Carolyn Jack
- Division of Dermatology, McGill University, Montreal, QC, Canada
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Marissa Joseph
- Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Dermatology, Women's College Hospital, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Charles W Lynde
- Probity Medical Research, Waterloo, ON, Canada
- Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Lynderm Research, Markham, ON, Canada
| | - Neil H Shear
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Kunimoto M, Imai Y, Matsutani M, Nakatani‐Kusakabe M, Nagai M, Natsuaki M, Yamanishi K, Kanazawa N. Evaluation of long‐term disease control with dupilumab therapy using the Atopic Dermatitis Control Tool in real‐world clinical practice. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2021. [DOI: 10.1002/cia2.12212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Marin Kunimoto
- Department of Dermatology Hyogo College of Medicine Nishinomiya Japan
| | - Yasutomo Imai
- Department of Dermatology Hyogo College of Medicine Nishinomiya Japan
| | - Masako Matsutani
- Department of Dermatology Hyogo College of Medicine Nishinomiya Japan
| | | | - Makoto Nagai
- Department of Dermatology Hyogo College of Medicine Nishinomiya Japan
| | - Masaru Natsuaki
- Department of Dermatology Hyogo College of Medicine Nishinomiya Japan
| | | | - Nobuo Kanazawa
- Department of Dermatology Hyogo College of Medicine Nishinomiya Japan
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Balakirski G, Novak N. Novel therapies and the potential for a personalized approach to atopic dermatitis. Curr Opin Allergy Clin Immunol 2021; 21:368-377. [PMID: 34074875 DOI: 10.1097/aci.0000000000000759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To provide a cutting-edge overview of recent developments in topical and systemic therapeutic approaches for the treatment of atopic dermatitis (AD). RECENT FINDINGS Growing knowledge about key pathways in AD and stratification of patient's subgroups have set the basis for a new era of targeted topical and systemic therapy in AD.Different aspects have to be considered in the decision process for topical versus systemic therapy. Further on, co-factors from the patient's side as well as the side of the substances determine the choice of a particular drug/drug type.Tailored medicine in AD treatment comprises drugs of the group of small molecules such as topical Janus kinases-signal transducer and activator of transcription (JAK-STAT) inhibitors or phosphodiesterase 4 inhibitors, and JAK-STAT inhibitors for oral use, as well as monoclonal antibodies for subcutaneous use, which target key cytokines or cytokine receptors in AD pathogenesis. SUMMARY The current stepwise treatment approaches, which are settled on basic therapy and structured patient education and gradually expanded depending on the severity of the disease by stronger topical or even systemic measures, will have to be adapted to the rapid development in the therapeutic field, mirrored by an impressive high number of ongoing clinical studies as well as novel drugs at late stages of clinical trials with so far quite promising results.
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Affiliation(s)
- Galina Balakirski
- Department of Dermatology, Allergology and Dermatosurgery, HELIOS University Hospital Wuppertal, University of Witten/Herdecke, Wuppertal
| | - Natalija Novak
- Department of Dermatology and Allergology, University Hospital of Bonn, Bonn, Germany
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Kamei K, Hirose T, Yoshii N, Tanaka A. Burden of illness, medication adherence, and unmet medical needs in Japanese patients with atopic dermatitis: A retrospective analysis of a cross-sectional questionnaire survey. J Dermatol 2021; 48:1491-1498. [PMID: 34231235 PMCID: PMC9291885 DOI: 10.1111/1346-8138.16054] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022]
Abstract
Atopic dermatitis (AD) negatively affects patients' daily lives. Poor medication adherence is a major barrier to treatment success. However, factors causing patients' poor adherence are unclear. This study aimed to identify factors associated with improvement of medication adherence in Japanese patients with AD and to evaluate illness burden and unmet medical needs for AD. We retrospectively analyzed Web-based questionnaire surveys conducted in 2018 in patients with AD aged 15 years and above who had been in- or outpatients within the past year from the survey. Quality of life using the EuroQol 5-Dimension (EQ-5D), and work productivity and activity impairment using Work Productivity and Activity Impairment Questionnaire (WPAI) were compared between patients and matched controls who had not visited a hospital for any disease within the past year. Subpopulation analysis was performed to explore factors affecting medication adherence. Unmet medical needs in AD treatment were identified by the percentage of patients who rated issues on the questionnaire as important but who were unsatisfied with them. In this study, we identified 1739 patients with AD. The scores of EQ-5D and WPAI showed that patients had statistically lower quality of life and higher impairment of work and activities than controls. High medication adherence scores were seen in patients with high health literacy levels and those who were well satisfied with communication with health-care providers, information received from them, or explanations of AD. Current unmet medical needs for AD were medical treatment costs, ease of hospital visits and explanations about disease prognosis. Patients tended to put a higher priority on communication with physicians than on that with nurses and pharmacists. In conclusion, we have identified patients' higher health literacy levels and satisfaction with the communication with their health-care provider as potential factors to improve medication adherence.
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Affiliation(s)
- Kazumasa Kamei
- Inflammation and Immunology Medical Affairs, Pfizer Japan Inc., Tokyo, Japan
| | - Tomohiro Hirose
- Inflammation and Immunology Medical Affairs, Pfizer Japan Inc., Tokyo, Japan
| | - Noritoshi Yoshii
- Inflammation and Immunology Medical Affairs, Pfizer Japan Inc., Tokyo, Japan
| | - Akio Tanaka
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Griffiths C, de Bruin-Weller M, Deleuran M, Fargnoli MC, Staumont-Sallé D, Hong CH, Sánchez-Carazo J, Foley P, Seo SJ, Msihid J, Chen Z, Cyr SL, Rossi AB. Dupilumab in Adults with Moderate-to-Severe Atopic Dermatitis and Prior Use of Systemic Non-Steroidal Immunosuppressants: Analysis of Four Phase 3 Trials. Dermatol Ther (Heidelb) 2021; 11:1357-1372. [PMID: 34142350 PMCID: PMC8322347 DOI: 10.1007/s13555-021-00558-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/24/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Dupilumab is approved as first-line systemic treatment for adults/adolescents with moderate-to-severe atopic dermatitis (AD) in Europe and elsewhere owing to its favourable benefit-risk profile. However, systemic non-steroidal immunosuppressants (NSISS) are often used as first-line therapy in clinical practice. Impact of prior therapy with NSISS on dupilumab's treatment effect vs. control has not been described previously. This study assessed dupilumab's efficacy vs. control in patients with moderate-to-severe AD, comparing treatment effect in patients with/without prior systemic NSISS therapy, in four phase 3 trials. METHODS This post hoc analysis included 1553 patients randomized to placebo or dupilumab (300 mg q2w) as monotherapy for 16 weeks, or with concomitant topical corticosteroids (TCS) for 16/52 weeks, from four randomized, double-blind, placebo-controlled, phase 3 trials. Patients were stratified by prior use of systemic NSISS and dupilumab-treated patients were analysed against control groups (treated with placebo or placebo + TCS). RESULTS Dupilumab-treated patients, regardless of prior treatment with NSISS, achieved a significantly higher percentage reduction from baseline in Eczema Area and Severity Index (EASI), SCORing Atopic Dermatitis (SCORAD), Dermatology life Quality Index (DLQI), and Patient-Oriented Eczema Measure (POEM) vs. control; significantly more achieved EASI score ≤ 7, Peak Pruritus Numerical Rating Scale ≤ 4, POEM ≤ 7, and DLQI ≤ 5 by week 4. These rapid, significant improvements were seen with or without concomitant TCS and sustained through end-of-treatment. CONCLUSIONS Dupilumab treatment (monotherapy or + TCS) provides rapid, significant, sustained improvements in signs, symptoms, and quality of life in patients with moderate-to-severe AD compared with control, regardless of prior systemic NSISS use. CLINICAL TRIAL REGISTRATION LIBERTY AD SOLO 1: ClinicalTrials.gov identifier NCT02277743, EudraCT 2014-001198-15. LIBERTY AD SOLO 2: ClinicalTrials.gov identifier NCT02277769, EudraCT 2014-002619-40. LIBERTY AD CHRONOS ClinicalTrials.gov identifier NCT02260986, EudraCT 2013-003254-24. LIBERTY AD CAFÉ: ClinicalTrials.gov identifier NCT02755649, EudraCT 2015-002653-35.
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Affiliation(s)
- Christopher Griffiths
- The Dermatology Centre, NIHR Manchester Biomedical Research Centre, Salford Royal Hospital, University of Manchester, Manchester, UK
| | - Marjolein de Bruin-Weller
- Department of Dermatology and Allergology, National Expertise Center of Atopic Dermatitis, University Medical Center, Utrecht, Netherlands
| | - Mette Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Maria Concetta Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Chih-Ho Hong
- Department of Dermatology and Skin Science, University of British Columbia, Surrey, BC, Canada.,Probity Medical Research, Waterloo, ON, Canada
| | | | - Peter Foley
- Department of Medicine, St. Vincent's Hospital Melbourne, The University of Melbourne, Parkville, Australia.,Probity Medical Research, Skin Health Institute, Carlton, VIC, Australia
| | | | | | - Zhen Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - Sonya L Cyr
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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