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.

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.

scholarly journals Painless thyroiditis in a dupilumab-treated patient

2020 ◽  
Vol 2020 ◽  
Author(s):  
Daramjav Narantsatsral ◽  
Takagi Junko ◽  
Iwayama Hideyuki ◽  
Inukai Daisuke ◽  
Takama Hiroyuki ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Treated Patient ◽  
Human Monoclonal Antibody ◽  
Allergic Diseases ◽  
Lymphocytic Infiltration ◽  
Interleukin 4 ◽  
Severe Atopic Dermatitis ◽  
List Type ◽  
First Report ◽  
Painless Thyroiditis

Summary Dupilumab an inhibitor of the interleukin (IL)-4R-alpha subunit is used for the treatment of allergic diseases. The patient was a 49-year-old man who received dupilumab for the treatment of severe atopic dermatitis. He presented hyperthyroidism with elevated thyroglobulin and anti-thyroid antibody negativity at 4 months after the initiation of therapy. On scintigraphy, the thyroid radioiodine uptake was low. Ultrasonography showed a diffuse hypoechoic area in the thyroid gland. A pathological study revealed lymphocytic infiltration. The administration of dupilumab was continued because of his atopic dermatitis that showed an excellent response. The patient`s hyperthyroidism changed to hypothyroidism 3 weeks later. Six months later his thyroid function normalized without any treatment. We herein describe the case of a patient with atopic dermatitis who developed painless thyroiditis under treatment with dupilumab. To the best of our knowledge, this is the first report of this event in the literature. Learning points: Dupilumab, a fully human monoclonal antibody that blocks interleukin-4 and interleukin-13, has been shown to be effective in the treatment atopic dermatitis and asthma with eosinophilia. Painless thyroiditis is characterized by transient hyperthyroidism and hypothyroidism and recovery without anti-thyroid treatment. This is the first report of painless thyroiditis as an adverse effect of dupilumab, although conjunctivitis and nasopharyngitis are the main adverse effects of dupilumab.

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 Economic Burden of Adult Patients with Moderate to Severe Atopic Dermatitis Indicated for Systemic Treatment

2019 ◽  
Vol 99 (9) ◽  
pp. 762-768 ◽  
Author(s):  
L Ariëns ◽  
K Nimwegen ◽  
M Shams ◽  
D Bruin ◽  
J Schaft ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Economic Burden ◽  
Systemic Treatment ◽  
Adult Patients ◽  
Severe Atopic Dermatitis

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.

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