A practical guide for transitioning from classical immunosuppressants to dupilumab in atopic dermatitis

Ludwig, Catherine; Krase, Jeffrey M.; Price, Kyla N.; Lio, Peter A.; Shi, Vivian Y.

doi:10.1080/09546634.2019.1682498

Cited by 8 publications

(8 citation statements)

References 19 publications

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“…In cases where patients respond sufficiently with dupilumab, there is reduced need for treatment with topical therapies, and dupilumab-associated improvement in AD symptoms is likely to explain the decrease in topical therapy use in this study. Although treatment with dupilumab has been recommended to overlap with prior systemic treatments by Ludwig et al and de Wijs et al, we discovered that in a real-life setting, most patients do not receive the recommended treatment overlap of two systemic therapies for AD [ 25 , 26 ]. Furthermore, patients receiving dupilumab also received antihistamines, which are minimally effective in the management of AD-related itch [ 27 ]; however, frequency of patients receiving antihistamines decreased over time with dupilumab treatment.…”

Section: Discussionmentioning

confidence: 99%

Dupilumab Demonstrates Rapid Onset of Action in Improving Signs, Symptoms and Quality of Life in Adults with Atopic Dermatitis

Augustin

Bauer

Ertner³

et al. 2023

Dermatol Ther (Heidelb)

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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 propor-

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Section: Discussionmentioning

confidence: 99%

Dupilumab Demonstrates Rapid Onset of Action in Improving Signs, Symptoms and Quality of Life in Adults with Atopic Dermatitis

Augustin

Bauer

Ertner³

et al. 2023

Dermatol Ther (Heidelb)

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“…TCS, topical calcineurin inhibitors (TCIs), and oral antihistamines during follow-up were mainly first prescribed during the first month, but there were gradual increases beyond this time (Figure 3b,c). However, nearly all the patients who received nonsteroidal systemic immunosuppressants or oral corticosteroids during follow-up first received these within the month after starting dupilumab (Figure 3c), indicating that these could have been used during transition from systemic immunosuppressants to dupilumab 11,12 rather than treatment augmentation. S1.…”

Section: Ad Treatmentsmentioning

confidence: 99%

Reduction in hospitalisations with dupilumab in Japanese adults with atopic dermatitis in a real‐world setting

Igawa

Fujita

Tajima

et al. 2023

JEADV Clinical Practice

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BackgroundIn a recent post hoc analysis of multinational clinical trial data, dupilumab treatment for patients with moderate or severe atopic dermatitis (AD) reduced all‐cause and AD‐related hospitalisations.ObjectivesWe studied the impact of dupilumab on health care resource utilisation (HCRU) and AD medication by comparing use during the 6 months either side of starting dupilumab (index) in a real‐world setting.MethodsThis observational, retrospective, cohort study used Japanese hospital claims data (1 April 2018 to 28 February 2019). A total of 357 patients (mean [range] age 45 [15–92] years; 65.5% male) with ≥1 AD diagnosis and ≥1 dupilumab prescription were included. Outcome variables included AD treatments and HCRU during the 6 months pre‐ and post‐index.ResultsThe number of all‐cause hospitalisations decreased by 43.1% (from 51 in the 6 months before to 29 in the 6 months after dupilumab initiation), with a 96.0% reduction in skin/subcutaneous tissue disease‐related hospitalisations (25 to 1). Use of nonsteroidal systemic immunosuppressants, phototherapy and systemic corticosteroids decreased (by 59.8%, 59.5% and 30.6%, respectively) after dupilumab initiation. At 180 days after dupilumab initiation, 86.8% of patients were still taking dupilumab.ConclusionsOverall, these results suggest that dupilumab can reduce skin/soft tissue‐related hospitalisations and use of various other AD medications in a real‐world setting.

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“…A previous article highlighted a recommended schedule for transitioning to dupilumab in adults that allows discontinuation of immunosuppressants at 12 weeks, which correlates to dupilumab reaching greater than 90% of its full clinical efficacy in percent EASI and NRS reduction. 12 There are currently no known drug interactions between immunosuppressants and dupilumab in children that would preclude a similar tapering approach. Tracking percentage changes in EASI and NRS scores is a reasonable way to estimate the clinical effect of dupilumab relative to its maximum effect.…”

Section: Approach To Transitioningmentioning

confidence: 99%

Transitioning From Immunosuppressants to Dupilumab in Pediatric Atopic Dermatitis

Ludwig

Hsiao

Lio³

et al. 2020

Dermatitis

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Dupilumab has recently been approved by the Food and Drug Administration for use for treatment of moderate to severe atopic dermatitis in children aged 6 to 11 years. It presents a novel treatment option with a favorable safety profile for patients who are currently reliant on immunosuppressants, including cyclosporine A, methotrexate, and mycophenolate mofetil. Particularly during the current COVID-19 pandemic, immunosuppression should be avoided to retain intrinsic antiviral immunity. Transitioning to dupilumab should be executed strategically-tapering immunosuppressants and minimizing risk of flare by overlapping with the biologic. Herein, we use results of outcome measurements from LIBERTY AD ADOL and LIBERTY AD PEDS trials of dupilumab in adolescents aged 12 to 18 years and children aged 6 to 11 years, respectively, to propose a schematic for an 8-week transition between medications.

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A practical guide for transitioning from classical immunosuppressants to dupilumab in atopic dermatitis

Cited by 8 publications

References 19 publications

Dupilumab Demonstrates Rapid Onset of Action in Improving Signs, Symptoms and Quality of Life in Adults with Atopic Dermatitis

Dupilumab Demonstrates Rapid Onset of Action in Improving Signs, Symptoms and Quality of Life in Adults with Atopic Dermatitis

Reduction in hospitalisations with dupilumab in Japanese adults with atopic dermatitis in a real‐world setting

Transitioning From Immunosuppressants to Dupilumab in Pediatric Atopic Dermatitis

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