Dupilumab for Atopic Dermatitis: The Silver Bullet We Have Been Searching for?

Ahsan Tameez Ud Din,Ifrah Malik,Asim Tameez Ud Din,Daneyal Arshad

doi:10.7759/cureus.7565

Abstract

Atopic dermatitis is a chronic inflammatory condition of the skin affecting a large number of people worldwide. Historically, this condition has been managed by topical corticosteroids and general skincare measures. The inadequacy of these management strategies has always driven efforts to find better drugs. Dupilumab has been recently approved for the management of atopic dermatitis. It is a human monoclonal antibody that inhibits the binding of key interleukins involved in the pathogenesis of atopic dermatitis, thus blocking the signaling mechanisms and disrupting the disease progression. Dupilumab reduces the severity and associated symptoms of atopic dermatitis. It improves the life quality of patients and reduces the anxiety associated with the disease. Combination therapy of dupilumab and topical corticosteroids is more effective than dupilumab monotherapy. The treatment-related adverse events include headache, injection site reaction, conjunctivitis, nasopharyngitis, and herpes viral infections. Moreover, the simultaneous use of live vaccines with dupilumab is contraindicated. It is also beneficial in the management of asthma, chronic rhinosinusitis, and eosinophilic esophagitis. In this review, we have discussed the clinical efficacy and safety profile of dupilumab in the management of atopic dermatitis.

Highlights

BackgroundAtopic dermatitis is a chronic inflammatory condition of the skin characterized by pruritus and skin changes [1]
A phase 3 trial conducted by Blauvelt et al for one year reported that patients receiving dupilumab with topical corticosteroids achieved co-primary endpoints of Investigator Global Assessment (IGA) 0/1 and Eczema Area and Severity Index (EASI)-75 (75% reduction in EASI score) in a significantly higher number than the placebo groups (p < 0·0001)
There was a reduction of 75% in the anxiety score on Hospital Anxiety and Depression Scale (HADS) in patients using 300 mg dupilumab weekly as compared with 22.2% improvement seen in the placebo group (p < 0.05)

Summary

Introduction

Atopic dermatitis is a chronic inflammatory condition of the skin characterized by pruritus and skin changes [1]. It affects 2-10% of adults worldwide and may be associated with other systemic disorders like asthma [2]. Owing to the chronic nature of the disease, the treatment of moderate-to-severe atopic dermatitis tends to be long term. Topical corticosteroids and general skincare by emollients and non-irritative skin preparations have been the mainstay of management of atopic dermatitis [1,5,6]. Long-term use of systemic agents is not recommended due to the risk of adverse side effects [5,7]. The inadequacy of the current mainstream treatment options has been the driving force behind the extensive efforts to find a safe and effective drug for the treatment of this ubiquitous skin disorder

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