Dupilumab: safer and more efficient than immunosuppressive drugs in severe atopic dermatitis

Abstract

Atopic dermatitis is a prevalent, high burden and challenging disease. Until few years ago we had only immunosupressants to manage the severe cases. The present study aims to evaluate the efficacy and safety of Dupilumab in patients with severe atopic dermatitis in whom immunosuppressive treatment was switched to the monoclonal antibody. Case series with 5 patients with severe atopic dermatitis who were under immunosuppressant therapy that was switched to Dupilumab (antibody anti-IL4/IL13 receptor). We reviewed patients charts to assess demographic data, co-morbidities, worsening factors, SCORAD index, topical and systemic treatment, adverse effects of it, eosinophil count, total IgE and serum specific IgE for allergens before and after the use of Dupilumab. All patients were able to suspend the immunosuppressive treatment and had a significant decrease of SCORAD. The mean SCORAD indexes were 75.1, 52.2 and 14.2, pretreatment, during immunosuppressive and Dupilumab therapy, respectively. The amount and frequency of topical treatment used decreased, as well as secondary S. aureus and recurrent labial and ocular herpes infection. Adverse effects were mild. Two patient presented new facial dermatosis, one of them had also conjunctivitis. Total and serum specific IgE levels dropped and 3 out of 5 patients had transient eosinophils count increase without clinical manifestations. All five patients with severe atopic dermatitis achieved better control of atopic dermatitis with Dupilumab than with immunosuppressive therapy. The frequency and the severity of adverse effects, secondary infections, and total and specific lgE levels were greatly reduced.