scholarly journals Dupilumab in the treatment of moderate-to-severe atopic dermatitis: A focused review

2021 ◽  
Vol 0 ◽  
pp. 1-5
Author(s):  
Eman Deif ◽  
Sheerja Bali ◽  
Asha Rajeev
Keyword(s):  
Atopic Dermatitis ◽  
Treatment Option ◽  
Topical Therapy ◽  
Human Monoclonal Antibody ◽  
Injection Site Reaction ◽  
Life Quality ◽  
Severity Index ◽  
Skin Condition ◽  
Severe Atopic Dermatitis ◽  
Helper Cell Type

Atopic dermatitis (AD) is a chronic inflammatory skin condition causing significant decline in quality of life. Moderate-to-severe AD is refractory to first-line topical therapy, while systemic immunosuppressants can have significant adverse effects. Dupilumab is a fully human monoclonal antibody and the first food and drug administration approved biologic therapy for the treatment of adults with moderate-to-severe AD. It inhibits the actions of both interleukin (IL)-4 and IL-13, two T helper cell type 2 cytokines involved in the pathogenesis of AD. Dupilumab has been found to be an efficacious treatment option in AD with its main adverse reactions being conjunctivitis, injection site reaction, and facial redness. Dupilumab is known to improve the severity and extent of AD, as measured by the eczema area severity index and dermatology life quality index. A similar observation was made by the authors in 30 patients. Thus, dupilumab represents a valuable new treatment option for moderate-to-severe AD, however, high cost remains a major consideration.

Pathophysiology and Management of Atopic Dermatitis: A Laconic Review

2020 ◽  
Vol 15 (4) ◽  
pp. 321-336
Author(s):  
Pravin Kumar ◽  
Dinesh Kumar Sharma ◽  
Mahendra Singh Ashawat
Keyword(s):  
Monoclonal Antibody ◽  
Atopic Dermatitis ◽  
Topical Therapy ◽  
Human Monoclonal Antibody ◽  
Life Quality ◽  
Calcineurin Inhibitors ◽  
Developed Countries ◽  
Skin Lesions ◽  
Lymphoid Cells ◽  
Immunological Factors

Conclusion: : Atopic Dermatitis (AD) is long-lasting degenerating skin disease with a characteristic phenotype and stereotypically spread skin lesions. The AD results due to a complex interface among genetic factors, host’s surroundings, pharmacological anomalies and immunological factors. In previous decades, researchers had shown marked interest due to increased prevalence in developed countries. In this review, basics along with the advances in pathogenesis and management of AD have been discussed. The immunological factors i.e. Innate Lymphoid Cells, IL-22 and Toll-like receptors have an important role in the pathogenesis. The proactive topical therapy by skincare, topical glucocorticosteroids and calcineurin inhibitors have improved effect in the management of AD. The human monoclonal antibody-based systemic drug (Duplimab) is a considerable advancement in the management of AD. Other monoclonal antibody-based drugs (Lebrikizumab, Tralokinumab, Apremilast and Nemolizumab) are in different phases of clinical trials. A better understanding of genetics and immunoregulatory cascade will lead to the development of efficacious drugs and better management therapy preventing the relapse of flares and improved life quality of AD patients.

scholarly journals Dupilumab Treatment in Atopic Dermatitis: Real-World Evidence from a Portuguese Tertiary Center

2021 ◽  
Vol 79 (2) ◽  
pp. 113-116
Author(s):  
Tomás Pessoa e Costa ◽  
B. Duarte ◽  
M. Caldeira ◽  
M. Rocha Páris ◽  
M. J. Paiva-Lopes
Keyword(s):  
Atopic Dermatitis ◽  
Side Effect ◽  
Treatment Effectiveness ◽  
Human Monoclonal Antibody ◽  
Severity Index ◽  
Adult Patients ◽  
Interleukin 4 ◽  
Severe Atopic Dermatitis ◽  
Biologic Treatment ◽  
Tertiary Center

Introduction: Dupilumab is a fully human monoclonal antibody that blocks interleukin-4 and interleukin-13, key drivers of type 2 helper T-cell (Th2)-mediated inflammatory response. It was the first biologic treatment approved for adult patients with inadequately-controlled moderate-to-severe atopic dermatitis (AD). Continuous collection of daily data practice is important in order to evaluate the real effectiveness and safety of dupilumab treatment. Methods: In this observational cohort study, we prospectively included all adult patients with moderate to severe AD treated with dupilumab in our portuguese dermatology center from July 2019 to April 2020. Baseline clinical data was initially collected and treatment effectiveness and safety were assessed after 16 weeks. Results: Twenty-five patients were included. All patients had been previously treated with systemic immunosuppressants. The estimated mean Eczema Area and Severity Index Score (EASI) decreased from 27.8 at baseline to 8.8 at week 16 (+/- 4 weeks). A ΔEASI 75 response was achieved by 58.3% of patients (ΔEASI 90 - 29.1%). Conjunctivitis was the main reported side-effect, affecting 20.8% of patients. Discussion: Our study showed a significant EASI reduction during the first 16-weeks of dupilumab treatment in adult patients with AD. Despite its overall safety, daily-practice data tend to report a higher risk of conjunctivitis than previously expected and we hence recommend that patients should be specifically informed about this possible side-effect.

Inhibition of IL-13: A New Pathway for Atopic Dermatitis

2020 ◽  
pp. 120347542098255
Author(s):  
Kayadri Ratnarajah ◽  
Michelle Le ◽  
Anastasiya Muntyanu ◽  
Steve Mathieu ◽  
Simon Nigen ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Atopic Dermatitis ◽  
Severity Index ◽  
Severe Atopic Dermatitis ◽  
Treatment Alternative ◽  
Control Groups ◽  
Rapid Improvement ◽  
Common Receptor ◽  
The Common ◽  
And Control

Dupilumab, a monoclonal antibody against the common receptor of interleukin (IL)-4 and IL-13, was the first biologic therapy approved in Canada for treatment of moderate-to-severe atopic dermatitis (AD). While it is considered safe and effective, dupilumab is not universally effective and 8%-38% of patients develop conjunctivitis, while some patients develop head and neck dermatitis. Thus, new therapeutic options are warranted. While both IL-4 and IL-13 play important roles in the pathogenesis of AD, it has been recently demonstrated that IL-13 is the primary upregulated cytokine in AD skin biopsy samples. A placebo-controlled phase 2b clinical trial evaluating the efficacy and safety of lebrikizumab, an IL-13 inhibitor, in AD demonstrated that, at 16 weeks, Eczema Area and Severity Index (EASI) 75 and Investigator’s Global Assessment (IGA) 0/1 were achieved by 60.6% and 44.6% of patients taking lebrikizumab at its highest dose (vs 24.3% and 15.3% of patients taking placebo, respectively). Moreover, treatment with lebrikizumab was associated with rapid improvement of pruritus and low rates of conjunctivitis (1.4%-3.8%). Another IL-13 monoclonal antibody, tralokinumab, was evaluated for safety and efficacy in moderate-to-severe AD. By week 12, among adults receiving 300 mg tralokinumab, 42.5% achieved EASI-75 and 26.7% achieved IGA 0/1 score (vs 15.5% and 11.8% in the placebo group, respectively). Both lebrikizumab and tralokinumab demonstrated acceptable safety profiles in AD (and non-AD) trials with adverse events often being comparable between treatment and control groups. Thus, IL-13 inhibitors may provide a safe and effective treatment alternative for patients with moderate-to-severe AD.

Remission of Alopecia Universalis after 1 Year of Treatment with Dupilumab in a Patient with Severe Atopic Dermatitis

2021 ◽  
pp. 1-4
Author(s):  
Maurizio Romagnuolo ◽  
Mauro Barbareschi ◽  
Simona Tavecchio ◽  
Luisa Angileri ◽  
Silvia Mariel Ferrucci
Keyword(s):  
Atopic Dermatitis ◽  
Skin Disorder ◽  
Human Monoclonal Antibody ◽  
Severe Atopic Dermatitis ◽  
T Helper ◽  
T Helper 1 ◽  
Th2 Response ◽  
Alopecia Universalis ◽  
T Helper 2 ◽  
Relapsing Remitting

Alopecia areata (AA), an autoimmune disease with a relapsing-remitting course, represents the second cause of non­scarring alopecia worldwide and is associated with several comorbidities, notably atopic dermatitis (AD). In particular, AD is related to its more severe forms alopecia totalis (AT) and alopecia universalis (AU) [Nat Rev Dis Primers. 2017;3:17011]. Considering that AA has been classified as T helper 1-driven disease, whereas AD is the prototypical T helper 2 (Th2)-driven skin disorder, recent studies suggest that these forms may underlie a different chemokine expression resulting in a Th2 skewing as a key pathomechanism that could explain this association [JAMA Dermatol. 2015 May;151(5):522–8]. Several reports showed that dupilumab, a fully human monoclonal antibody targeting the interleukin 4α receptor and thus downregulating Th2 response, led to an improvement of AA associated with AD; most of these patients were females with AT or AU, early-onset AD, and atopic comorbidities [Exp Dermatol. 2020 Aug;29(8):726–32]. We report here a case to further support this hypothesis.

scholarly journals Clinical Response and Quality of Life in Patients with Severe Atopic Dermatitis Treated with Dupilumab: A Single-Center Real-Life Experience

2020 ◽  
Vol 9 (3) ◽  
pp. 791 ◽  
Author(s):  
Silvia Ferrucci ◽  
Giovanni Casazza ◽  
Luisa Angileri ◽  
Simona Tavecchio ◽  
Francesca Germiniasi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atopic Dermatitis ◽  
Rating Scale ◽  
Real Life ◽  
Life Quality ◽  
Depression Scale ◽  
Interleukin 4 ◽  
Severe Atopic Dermatitis ◽  
Single Center

Dupilumab is an anti-interleukin-4 receptor monoclonal antibody that was recently approved for the treatment of atopic dermatitis (AD). In this single-center retrospective study, clinical baseline data of 117 severe AD patients treated with dupilumab were collected. At baseline and at weeks 4 and 16, disease severity was assessed through the Eczema Area and Severity Index (EASI) and quality of life through the Dermatology Life Quality Index (DLQI) questionnaire, Patient-Oriented Eczema Measure (POEM), Hospital Anxiety and Depression Scale (HADS), Peak Pruritus Numerical Rating Scale (NRS-itch), and VAS-sleep. Response to dupilumab was defined as an improvement of ≥75% in EASI from baseline (EASI75). At multivariate analysis, AD onset before 18 years [OR, 2.9; 95% CI, 1.2–7.2; p = 0.0207] and absence of hypereosinophilia [OR, 2.24; 95% CI, 1.03–4.86; p = 0.0412] were identified as significant predictive parameters for response to dupilumab in terms of EASI75 at week 4 but not at week 16. Significant reductions in EASI, DLQI, POEM, HADS, NRS-itch, and VAS-sleep were found between week 4 versus baseline (p < 0.0001 for all) and week 16 versus baseline (p < 0.0001 for all). Early AD onset and absence of hypereosinophilia may be suggested as predictive markers of early response to dupilumab. We confirmed the efficacy and safety of this agent along with the improvement of life quality in severe AD patients.

scholarly journals Experience of combined topical therapy with methylprednisoloni aceponatis and «Bepanten Plus»® in treatment of adult patients with moderate and severe atopic dermatitis

2015 ◽  
Vol 12 (6) ◽  
pp. 80-83
Author(s):  
O K Shtyrbul ◽  
O A Erina ◽  
E S Fedenko
Keyword(s):  
Staphylococcus Aureus ◽  
Atopic Dermatitis ◽  
Combined Therapy ◽  
Topical Therapy ◽  
Adult Patients ◽  
Severe Atopic Dermatitis ◽  
Bacterial Isolation ◽  
Treatment Results ◽  
Lesional Skin ◽  
Days Of Therapy

Background. To estimate efficiency of combined therapy with methylprednisolone aceponatis and «Bepanten Plus»® in adult patients with moderate and severe atopic dermatitis. Methods. We examined 32 adult patients, who were treated with TGCS methylprednisolone aceponatis and «Bepanten Plus»®. The efficiency of therapy was estimated with index SCORAD, IGA and subjective patients assessment. For 15 of 32 patients swabs for bacterial isolation to estimate Staphylococcus aureus growth were taken from lesional skin before therapy and on the 14 th or 20 th days of treatment. Results. The аverage value of index SCORAD decreased after 15 days of therapy, Me 41,7 to Me 23,3 a point (p

Therapeutic Impact and Management of Persistent Head and Neck Atopic Dermatitis in Dupilumab-Treated Patients

Dermatology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Andrea Chiricozzi ◽  
Niccolò Gori ◽  
Lucia Di Nardo ◽  
Flaminia Antonelli ◽  
Cristiano Caruso ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Head And Neck ◽  
Dermatology Life Quality Index ◽  
Negative Impact ◽  
Demographic Data ◽  
Life Quality ◽  
Severity Index ◽  
Negative Factor ◽  
Lower Likelihood ◽  
Head Neck

<b><i>Background:</i></b> 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. <b><i>Objectives:</i></b> 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. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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. <b><i>Conclusion:</i></b> 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.

Approach to the Assessment and Management of Adult Patients With Atopic Dermatitis: A Consensus Document. Section II: Tools for Assessing the Severity of Atopic Dermatitis

2018 ◽  
Vol 22 (1_suppl) ◽  
pp. 10S-16S ◽  
Author(s):  
Melinda J. Gooderham ◽  
Robert Bissonnette ◽  
Parbeer Grewal ◽  
Perla Lansang ◽  
Kim A. Papp ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Disease Severity ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Life Quality ◽  
Severity Index ◽  
Adult Patients ◽  
Physician Global Assessment ◽  
Atopic Dermatitis Severity ◽  
Patient Reported

Clinicians rely on clinical measures to define the severity of atopic dermatitis and assess outcomes of therapy. These measures can be objective (ie, physician assessments of disease severity) or subjective (ie, patient-reported symptoms and quality of life outcomes). In this review, the most commonly used tools for assessing atopic dermatitis severity in adult patients are presented and compared. These include Eczema Area and Severity Index (EASI); SCORing Atopic Dermatitis (SCORAD); Physician Global Assessment (PGA); body surface area (BSA); Atopic Dermatitis Severity Index (ADSI); Six Area, Six Sign Atopic Dermatitis (SASSAD); Patient Oriented Eczema Measure (POEM); Dermatology Life Quality Index (DLQI); and pruritus Numerical Rating Scale (NRS). Available severity strata for the tools are summarized, although the use of severity strata in clinical practice is not recommended. Since both objective and subjective assessments of disease severity are important to assess, consideration of clinical characteristics such as disease recurrence or persistence, as well as location of the affected areas, should be considered in the overall judgement of disease severity and consideration of therapy choice.

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