Abstract
BackgroundThe evidence for systemic treatments for severe childhood eczema is limited and largely based on extrapolation of data from adult studies. Current therapies are often immunosuppressant and may be associated with both short- and long-term side effects. There is increasing in vitro and murine-model evidence for the role of IgE in the immunopathogenesis of atopic eczema. The aim of the study is to assess whether anti-IgE treatment (omalizumab) improves eczema, compared to placebo.Methods/designThe Atopic Dermatitis Anti-IgE Paediatric Trial (ADAPT) is a randomised, double-blind, placebo-controlled study assessing the role of anti-IgE in the management of severe paediatric eczema. Children with severe atopic eczema, with an objective SCORing Atopic Dermatitis (SCORAD) score of over 40 will be recruited. These children are candidates for systemic therapy, have failed systemic therapy or have experienced side effects from systemic therapy. Sixty-two patients aged between 4 and 19 years will receive anti-IgE for 6 months. The primary outcome measure will be the validated eczema score, the objective SCORAD at 24 weeks. This study has 90% power to detect a 33% relative reduction in SCORAD between active and placebo groups, with 5% significance.DiscussionIgE may have a role to play in eczema, particularly in childhood. This forms the basis for the hypothesis that anti-IgE may be an effective treatment in this patient population.This will be the largest study to evaluate the efficacy of anti-IgE (omalizumab) versus placebo in children with severe eczema. The findings will help to clarify the role of anti-IgE as a potential treatment option in patients with severe childhood eczema.Trial registrationEuropean Clinical Trials Database (EudraCT) Number: 2010-020841-29. Assigned on 14 May 2010.ISRCTN Registry, Identifier: ISRCTN15090567. Retrospectively assigned on 3 December 2014.ClinicalTrials.gov, Identifier: NCT02300701. First received 21 November 2014.
Highlights
The evidence for systemic treatments for severe childhood eczema is limited and largely based on extrapolation of data from adult studies
Immunoglobulin E (IgE) may have a role to play in eczema, in childhood
This forms the basis for the hypothesis that anti-IgE may be an effective treatment in this patient population
Summary
The evidence for systemic treatments for severe childhood eczema is limited and largely based on extrapolation of data from adult studies. Current therapies are often immunosuppressant and may be associated with both short- and long-term side effects. There is increasing in vitro and murine-model evidence for the role of IgE in the immunopathogenesis of atopic eczema. AE is associated with a significant economic and psychosocial burden. There is increasing in vitro and murine-model evidence for the role of IgE in the immunopathogenesis of atopic dermatitis, with higher IgE levels linked with more severe disease [2, 3]. This study focusses on a paediatric atopic population, to target patients in whom IgE is more likely to be relevant
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