Justification of the efficacy of combined therapy with dupilumab and cyclosporine in children with severe dermato-respiratory syndrome

Abstract

BACKGROUND: Atopic dermatitis is characterized by a clear upward trend in the prevalence and development of severe forms of dermatosis, which represents an important medical and social problem.
 AIM: Pathogenetic justification and study of clinical efficacy of combined use of dupilumab and cyclosporine in children with severe refractory atopic dermatitis.
 MATERIALS AND METHODS: The study included 30 children and adolescents over 6 years of age, with a diagnosis of atopic dermatitis with severe disease severity. The control group consisted of 15 people. EASI, Pruritus VAS score, CDLQI index were used to assess the dynamics of disease symptoms. The content of interleukins in blood serum was determined by enzyme immunoassay. Children included in the study were divided into two groups of 15 patients by randomization. Group 1 patients received dupilumab monotherapy, Group 2 patients were treated with a combination of dupilumab and cyclosporine.
 RESULTS: Positive dynamics in the course of the cutaneous pathological process was observed in all patients. A more pronounced and persistent tendency to further decrease of EASI values was preserved in patients receiving combined therapy. During dupilumab monotherapy and combined treatment there was a significant reduction in nasal obstruction, a decrease in the number of bronchial obstruction/cough attacks. In the course of therapy in all patients it was possible to achieve a significant reduction in the negative impact of atopic dermatitis on the quality of life of children and adolescents. Dupilumab therapy contributed to normalization of cytokine status, eosinophil levels and total immunoglobulin E. However, after 12 weeks of dupilumab monotherapy, signs of Th1-response activation were revealed.
 CONCLUSION: Combined therapy reduces the duration of treatment with dupilumab to 12 weeks, avoids side effects and complications, and significantly increases clinical efficacy of therapeutic measures in children and adolescents with severe atopic dermatitis.