Abstract
Background: The clinical features of adult-onset atopic dermatitis (AD) are heterogeneous and the diagnosis can be a challenge. A new biologic drug (dupilumab) has been approved for moderate to severe AD in adult patients. The efficacy and safety have been demonstrated in clinical trials, but these studies do not reflect conditions in daily practice and do not consider the different clinical manifestations of AD. Objectives: Analyzing the dupilumab activity in a real-world setting and comparing its efficacy on different AD phenotypes. Methods: We retrospectively evaluated 221 AD patients treated with dupilumab, stratified into six clinical phenotypes: classic, generalized eczema inflammatory and lichenoid patterns, prurigo, nummular eczema, and erythroderma. At baseline and at weeks 4, 16, and 52, the disease severity was assessed through the Eczema Area and Severity Index (EASI) and the quality of life was assessed through the Dermatology Life Quality Index (DLQI) questionnaire, Peak Pruritus Numerical Rating Scale (itch NRS), and Peak Sleep NRS. Results: We found a significant improvement after 16 weeks of treatment (p < 0.0001) in all six phenotypes for all the assessed scores mentioned above, persisting up to week 52. The best improvement was seen in the more severe phenotypes, particularly the erythrodermic one. Conclusions: The present study confirmed the efficacy and safety of dupilumab in the treatment of severe AD. Its strength was in the stratification of AD patients in six different phenotypes based on their clinical presentation, all of whom markedly improved in terms of both clinically evident and reported symptoms, as well as their quality of life.
Highlights
Atopic dermatitis (AD), or atopic eczema, is a chronic inflammatory skin disease affecting 7–10% of adults [1]
At baseline and at weeks 4, 16, and 52, the disease severity was assessed through the Eczema Area and Severity Index (EASI) and the quality of life was assessed through the Dermatology Life Quality Index (DLQI) questionnaire, Peak Pruritus Numerical Rating Scale, and Peak Sleep NRS
We divided all the patients into six subgroups by considering the different clinical forms of atopic dermatitis (AD) according to the paper of Silvestre et al [19]; we considered only six phenotypes of AD because in this study, we investigated only the patients treated with dupilumab, which is approved in Italy for only severe AD with an EASI ≥ 24; some of the phenotypes described by Silvestre et al could not be considered because of their limited extension
Summary
Atopic dermatitis (AD), or atopic eczema, is a chronic inflammatory skin disease affecting 7–10% of adults [1]. In cases of adult-onset AD, the clinical presentation, apart from the classical form, is either head-and-neck dermatitis, hand eczema, multiple areas of lichenification, or prurigo lesions [14,15]. The efficacy and safety were demonstrated in clinical trials [16,17,18] but these studies do not reflect conditions in daily practice and do not consider different clinical presentations of AD. The aim of our study was to analyze the activity of dupilumab in a real-world setting by comparing the efficacy on different clinical phenotypes. A new biologic drug (dupilumab) has been approved for moderate to severe AD in adult patients. The efficacy and safety have been demonstrated in clinical trials, but these studies do not reflect conditions in daily practice and do not consider the different clinical manifestations of AD. Its strength was in the stratification of AD patients in six different phenotypes based on their clinical presentation, all of whom markedly improved in terms of both clinically evident and reported symptoms, as well as their quality of life
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