Dupilumab therapy of atopic dermatitis of the elderly: a multicentre, real‐life study

Abstract

Background Treatment of moderate‐to‐severe atopic dermatitis (AD) in the elderly may be challenging, due to side‐effects of traditional anti‐inflammatory drugs and to comorbidities often found in this age group. Furthermore, efficacy and safety of innovative drugs such as dupilumab are not yet well known. Objectives A multicentre retrospective, observational, real‐life study on the efficacy and safety of dupilumab was conducted in a group of patients aged ≥65 years and affected by severe AD. Their main clinical features were also examined. Methods Data of elderly patients with severe (EASI ≥24) AD treated with dupilumab at label dosage for 16 weeks were retrospectively collected. Treatment outcome was assessed by comparing objective (EASI) and subjective (P‐NRS, S‐NRS and DLQI) scores at baseline and after 16 weeks of treatment. Results Two hundred and seventy‐six patients were enrolled in the study. They represented 11.37% of all patients with severe AD. Flexural eczema was the most frequent clinical phenotype, followed by prurigo nodularis. The coexistence of more than one phenotype was found in 63/276 (22.82%) subjects. Data on the 16‐week treatment with dupilumab were available for 253 (91.67%) patients. Efficacy of dupilumab was demonstrated by a significant reduction of all the scores. No statistically significant difference regarding efficacy was found in elderly patients when compared to the group of our AD patients aged 18–64 years, treated with dupilumab over the same period. Furthermore, only 18 (6.52%) patients discontinued the drug due to inefficacy. Sixty‐one (22.51%) patients reported adverse events, conjunctivitis and flushing being the most frequent. One (0.36%) patient only discontinued dupilumab due to an adverse event. Conclusions Therapy with dupilumab led to a significant improvement of AD over a 16‐week treatment period, with a good safety profile. Therefore, dupilumab could be considered as an efficacious and safe treatment for AD also in the elderly.

Nomenclature and clinical phenotypes of atopic dermatitis

“…5 Elderly-type AD (AD in patients aged ⩾60 years) has been suggested to be a distinct age-related phenotype alongside previously recognized infantile, childhood, and adult phenotypes. [5][6][7]125 As in adult-type AD, lichenified lesions are common, but tend to be localized to the cubital and popliteal extensor areas rather than the flexural areas, as is typical of adult-type AD. 5,126,127 Three forms of elderly-type AD are apparent -elderly onset, relapsing, and continuous -and are subdivided by age at onset.…”

A Literature Review of Real-World Effectiveness and Safety of Dupilumab for Atopic Dermatitis

“…Real-world evidence of the effectiveness and safety of dupilumab for atopic dermatitis Accumulating real-world evidence has ensured the effectiveness and tolerable safety of dupilumab both in the short term and in the long term. The articles searched in PubMed and Google Scholar are shown in Table 1 (Ariëns et al, 2020, Ariëns et al, 2021, Faiz et al, 2019, Fargnoli et al, 2020, Fargnoli et al, 2019, Jang et al, 2020, Jo et al, 2020a, Kreeshan et al, 2021, Matsutani et al, 2020, Nettis et al, 2020b, Nettis et al, 2020c, Olesen et al, 2019, Patruno et al, 2021a, Patruno et al, 2021b, Quint et al, 2020, Ribero et al, 2020, Sears et al, 2020, Tauber et al, 2019, Uchida et al, 2021, Uchida et al, 2019. Patruno et al reported the effectiveness and safety of dupilumab in elderly patients with AD in real life (Patruno et al, 2021a, Patruno et al, 2021b.…”

“…The articles searched in PubMed and Google Scholar are shown in Table 1 (Ariëns et al, 2020, Ariëns et al, 2021, Faiz et al, 2019, Fargnoli et al, 2020, Fargnoli et al, 2019, Jang et al, 2020, Jo et al, 2020a, Kreeshan et al, 2021, Matsutani et al, 2020, Nettis et al, 2020b, Nettis et al, 2020c, Olesen et al, 2019, Patruno et al, 2021a, Patruno et al, 2021b, Quint et al, 2020, Ribero et al, 2020, Sears et al, 2020, Tauber et al, 2019, Uchida et al, 2021, Uchida et al, 2019. Patruno et al reported the effectiveness and safety of dupilumab in elderly patients with AD in real life (Patruno et al, 2021a, Patruno et al, 2021b. Halling et al reported a systematic review and meta-analysis of real-world data on the efficacy and safety of dupilumab in patients with AD (Halling et al, 2021).…”

The Role of Photoprotection in Optimizing the Treatment of Atopic Dermatitis

“…Apart from the appearance of lichenified eczema at the antecubital and popliteal fossa, AD can present in the elderly with atypical clinical phenotypes such as prurigo nodularis, nummular eczema, or generalized eczema more frequently than in other age groups. On the other hand, older patients often suffer from asteatosis and pruritus due to physiologic skin aging and comorbidities, for which they take medications that may worsen pruritus and dry skin [22].…”