Effect of dupilumab on atopic manifestations in patients treated for atopic dermatitis in real‐life practice

Tauber, M.; Apoil, Pôl-André; Richet, C.; Laurent, J.; Bonnecaze, Guillaume de; Mouchon, E.; Cassagne, Myriam; Marguery, M.C.; Hegazy, S.; Konstantinou, M.P.; Severino, Manuel José Soler; Uthurriague, C.; Giordano‐Labadie, F.; Didier, A.; Paul, C.

doi:10.1111/bjd.17629

Cited by 26 publications

(42 citation statements)

References 9 publications

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“…Although Dutch regulations do not require patients to have a minimum severity score to warrant dupilumab treatment, they do require patients to have failed treatment with at least one systemic immunosuppressant in a sufficient dose for at least 4 months with intensive guidance and instructions (Appendix S1; see Supporting Information). The majority of patients in our study (72%), and a similar proportion of patients in the daily practice studies available, had been treated with at least two different conventional systemic immunosuppressants, in contrast to a minority (26–28%) who used at least one systemic immunosuppressant in the SOLO trials . This suggests that patients in daily practice are at the end of the ‘severity spectrum’.…”

Section: Discussionmentioning

confidence: 58%

“…In our cohort, 62% (59 of 95) of the patients presented with eye symptoms suggestive for conjunctivitis, sicca and/or blepharitis, whereas conjunctivitis was observed in only 4–5% of the patients in the SOLO trials . However, the limited daily practice literature available also showed conjunctivitis incidence ranges up to 50% in patients treated with dupilumab . Literature on ocular comorbidities in AD shows that several ocular comorbidities are more prevalent among patients with AD than among the general population .…”

Section: Discussionmentioning

confidence: 62%

“…Overall, dupilumab was well tolerated in most patients, although 62% of the patients reported eye symptoms (Table S1; see Supporting Information). In contrast to the case in previous clinical trials and the limited daily practice literature, in this study, dupilumab treatment was combined with concomitant systemic immunosuppressants in 45% (43 of 95) of the patients . Continuation of conventional systemic immunosuppressants in the first weeks of dupilumab treatment seems to be an effective and safe way to transition to monotherapy with dupilumab but this needs to be studied in larger numbers of patients.…”

Section: Discussionmentioning

confidence: 80%

“…Although the methodology and follow‐up visits used in our study, clinical trials and the limited daily practice literature available were different, we tried to compare results …”

Section: Discussionmentioning

confidence: 99%

“…In contrast to the case in previous clinical trials and the limited daily practice literature, in this study, dupilumab treatment was combined with concomitant systemic immunosuppressants in 45% (43 of 95) of the patients. 11,33 Continuation of conventional systemic immunosuppressants in the first weeks of dupilumab treatment seems to be an effective and safe way to transition to monotherapy with dupilumab but this needs to be studied in larger numbers of patients. This emphasizes the importance of the introduction of registries such as the national registries of the TREatment of ATopic eczema (TREAT) Registry Taskforce for monitoring systemic treatments in daily practice.…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness of dupilumab treatment in 95 patients with atopic dermatitis: daily practice data

et al. 2019

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Summary Background Dupilumab is the first biologic registered for the treatment of moderate‐to‐severe atopic dermatitis (AD), and efficacy was shown in phase III clinical trials (primary outcome at week 16 was reached in 38% of patients). Currently, there are limited daily practice data available for dupilumab, especially when it is combined with systemic immunosuppressants. Objectives To evaluate dupilumab treatment in daily practice in patients with AD. Methods In this observational cohort study, we prospectively included all adult patients with AD who had been treated with dupilumab in two university hospitals in the Netherlands. Concomitant systemic immunosuppressive treatment was monitored. Physician‐reported outcome measures and patient‐reported outcome measures (PROMs) after ≥ 12 weeks of follow‐up were analysed. We used a linear mixed‐effects model to determine changes in scores during follow‐up. Results Ninety‐five patients were included. Of these, 62 patients were using systemic immunosuppressants at baseline; the use of systemic immunosuppressants was continued during dupilumab treatment in 43 patients. From baseline to 16 weeks of treatment, the estimated mean Eczema Area and Severity Index score (0–72) decreased from 18·6 [95% confidence interval (CI) 16·0–21·4)] to 7·3 (95% CI 5·4–10·0), and the estimated mean PROMs showed a decrease of 41–66%. Investigator's Global Assessment 0 or 1 (clear/almost clear) was reached in 38% of the patients. Five patients discontinued dupilumab treatment due to side‐effects or ineffectiveness. Eye symptoms and orofacial (nonocular) herpes simplex virus (HSV) reactivation were reported in 62% and 8% of the patients, respectively. Conclusions Dupilumab treatment in daily practice shows a clinically relevant improvement of physician‐reported outcome measures and PROMs, which is in line with efficacy data from clinical trials. Besides frequently reported eye symptoms and orofacial (nonocular) HSV reactivation, there were no apparent safety concerns. What's already known about this topic? Dupilumab has been shown to be an efficacious treatment for atopic dermatitis in several clinical trials. However, it is known that there may be considerable differences in patient characteristics and treatment responses between clinical trials and daily practice. What does this study add? This study presents the first experience with dupilumab treatment in 95 patients with atopic dermatitis in daily practice in two Dutch university hospitals. Less stringent inclusion and exclusion criteria and follow‐up schedules, in contrast to those used in clinical trials, might better represent daily practice. Dupilumab treatment shows a clinically relevant improvement of physician‐ and patient‐reported outcome measures; besides patient‐reported eye symptoms (in 59 of 95 patients; 62%) and an apparent increase in orofacial (nonocular) herpes simplex virus reactivation (eight of 95 patients; 8%), there were no other safety concerns during follow‐up up to 16 weeks of dupilumab treatment.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 80%

“…Although the methodology and follow‐up visits used in our study, clinical trials and the limited daily practice literature available were different, we tried to compare results …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effectiveness of dupilumab treatment in 95 patients with atopic dermatitis: daily practice data

et al. 2019

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Dupilumab-Associated Adverse Events During Treatment of Allergic Diseases

Kychygina

Cassagne

Tauber

et al. 2022

Clinic Rev Allerg Immunol

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Real-World Experience and Laboratory Monitoring of Dupilumab in Patients with Moderate to Severe Atopic Dermatitis in a Tertiary Centre

Kreeshan

Al‐Janabi

Warren

et al. 2020

Dermatol Ther (Heidelb)

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Introduction Dupilumab is a biologic therapy approved for treatment of moderate to severe atopic dermatitis (AD). Our objective was to assess the real-world effectiveness, safety and laboratory monitoring practices for dupilumab in a tertiary centre. Methods A retrospective review of medical records of all patients receiving dupilumab between September 2017 and October 2019 was undertaken. Eczema Area and Severity Index (EASI) and Dermatology Life Quality Index (DLQI) were collected at weeks 0, 12–16 and 26–30. Data on laboratory tests undertaken for dupilumab screening and monitoring were also collected. Results At 12–16 weeks, 58.9% and 37.3% of patients achieved ≥ EASI 75 and ≥ EASI 90, respectively ( n = 156). Ninety-four patients underwent further analysis at weeks 26–30 with those achieving ≥ EASI 75 increasing from 61.7% (12–16 weeks) to 75.31%, and EASI 90 increasing from 35.8% (12–16 weeks) to 49.8%. The most common side effects were eye symptoms occurring in 43.1% of patients, with 16.3% developing conjunctivitis. The mean treatment duration was 255 days, during which an average of three sets of blood tests were performed ( n = 149). Of all laboratory abnormalities recorded, 24% started after initiation of dupilumab, and 93% were classified as ‘mild’. Dupilumab was not documented as causative in any of the cases, nor was treatment stopped on account of laboratory abnormalities. Conclusion Dupilumab provides an effective and safe treatment option for patients with AD. Clinical response continued to improve past 16 weeks in this real-world population. No laboratory abnormalities were felt to be secondary to dupilumab; screening and monitoring tests did not influence dupilumab prescribing. Electronic supplementary material The online version of this article (10.1007/s13555-020-00469-6) contains supplementary material, which is available to authorised users.

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Effect of dupilumab on atopic manifestations in patients treated for atopic dermatitis in real‐life practice

Cited by 26 publications

References 9 publications

Effectiveness of dupilumab treatment in 95 patients with atopic dermatitis: daily practice data

Effectiveness of dupilumab treatment in 95 patients with atopic dermatitis: daily practice data

Dupilumab-Associated Adverse Events During Treatment of Allergic Diseases

Real-World Experience and Laboratory Monitoring of Dupilumab in Patients with Moderate to Severe Atopic Dermatitis in a Tertiary Centre

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