Efficacy of Dupilumab on Different Phenotypes of Atopic Dermatitis: One-Year Experience of 221 Patients

Abstract

Background: The clinical features of adult-onset atopic dermatitis (AD) are heterogeneous and the diagnosis can be a challenge. A new biologic drug (dupilumab) has been approved for moderate to severe AD in adult patients. The efficacy and safety have been demonstrated in clinical trials, but these studies do not reflect conditions in daily practice and do not consider the different clinical manifestations of AD. Objectives: Analyzing the dupilumab activity in a real-world setting and comparing its efficacy on different AD phenotypes. Methods: We retrospectively evaluated 221 AD patients treated with dupilumab, stratified into six clinical phenotypes: classic, generalized eczema inflammatory and lichenoid patterns, prurigo, nummular eczema, and erythroderma. At baseline and at weeks 4, 16, and 52, the disease severity was assessed through the Eczema Area and Severity Index (EASI) and the quality of life was assessed through the Dermatology Life Quality Index (DLQI) questionnaire, Peak Pruritus Numerical Rating Scale (itch NRS), and Peak Sleep NRS. Results: We found a significant improvement after 16 weeks of treatment (p < 0.0001) in all six phenotypes for all the assessed scores mentioned above, persisting up to week 52. The best improvement was seen in the more severe phenotypes, particularly the erythrodermic one. Conclusions: The present study confirmed the efficacy and safety of dupilumab in the treatment of severe AD. Its strength was in the stratification of AD patients in six different phenotypes based on their clinical presentation, all of whom markedly improved in terms of both clinically evident and reported symptoms, as well as their quality of life.

Dupilumab shows slow, steady effectiveness for intractable prurigo in patients with atopic dermatitis

“…8 Although TEA of concomitant therapeutic agents and classification of PN was not evaluated, a group from Italy also reported that prurigo may be one of the slow-responding AD phenotypes. 29 In EASI-75 assessment, the prurigo group in the present study appeared to show even slower improvement (8.3% at intractable prurigo in patients with AD via itch soothing through the multimodal mechanisms mentioned above as well as through attenuating the Th2 immunity that is vital in the etiology of AD.…”

Untitled

“…Dupilumab shows clear and maintained effectiveness over a 76week treatment duration, decreased skin lesions and pruritus, and increased quality of life reported by Deleuran, et al [27]. Tavecchio, et al reported a possible change in AD classical and erythroderma phenotypes after 16 weeks of dupilumab therapy (p<0.0001) and progressed until week 52 [21].…”

“…Dupilumab shows a substantial increase in the disease after 16 weeks of therapy, as shown by a decline in EASI and DLQI ratings. Similarly, Tavecchio, et al reported a significant increase in nummular eczema [21], generalized inflammatory eczema and generalized phenotypic lichenoid pattern eczema after 16 weeks of therapy with dupilumab (p<0.0001) and continued until week 52. In addition, the authors stated that decreases in EASI were slower in nummular eczema phenotypes than in other phenotypes, suggesting that treatment should not be halted until an adequate therapeutic result has been obtained.…”

“…A retrospective study by Chiricozzi, et al conducted among 27 patients with chronic prurigo nodularis reported that the dupilumab was effectively reduced the itch and also improving chronic prurigo nodularis skin lesions [26]. Similarly, a substantial change in prurigo phenotype was noted after 16 weeks of therapy with dupilumab (p < 0.0001) and lasted until week 52 [21]. Also, several retrospective studies have reported the efficacy of dupilumab on prurigo nodularis [24,25].…”

“…Among the included 7 articles, 6 studies retrospective design and one study randomized controlled trail [21][22][23][24][25][26][27]. Furthermore, 3 of the articles were published in the America [22,26,27], 2 articles were published in Italy [21,23], one article was published in Europe and one article was published in Australia [24,25]. The sample size ranged from 16 to 1491 patients, with a total of 2349 patients involved in the current systematic review and the age of the patients was 18 to 87 years.…”