Dupilumab effective against atopic dermatitis regardless of age-of-onset

Dupilumab (Dupixent; Sanofi and Regeneron)is effective for treating atopic dermatitis (AD) in adults regardless of age-of-onset, according to a recent study.

AD, a skin disease which leads to red, itchy patches on the skin, is most often developed during childhood. In some patients, it may dissipate by adolescence. However, recent evidence has indicated that adult-onset AD is more common than what has been believed.

About 25% of AD cases are estimated to start during adulthood, with unique clinical characteristics such as lesions on the hand, head, and neck. There are also different laboratory characteristics in adult AD, such as lower immunoglobulin E responses.

Dupilumabin an anti-body which inhibits the leukin (IL)-4 and IL-13 drivers responsible for type 2 mediated inflammation. This type 2 inflammation is a symptom of AD across all age groups, leading investigators to predict that dupilumab is effective for treating AD in adults regardless of age-of-onset.

To evaluate the efficacy to dupilumab, investigators conducted a post hoc analysis of 2 phase 3 trials of dupilumab in adults with AD. Participants were aged 18 years and older and presented with moderate-to-severe AD which topical corticosteroids failed to properly control. Conditions for chronic AD also had to be met, with a diagnosis given at least 3 years prior.

Participants received 300 mg of dupilumab or placebo either once weekly or once every 2 weeks, with the results from every 2 weeks used in the analysis. Severity metrics were used to determine if AD symptoms were clear, mild, moderate, or severe. Patients were divided into subgroups based on age of AD onset.

There were 460 patients in the placebo group and 457 in the dupilumab group. Patients were aged an average of 38 years, and the average duration of AD was about 28 years. AD onset was most common in childhood, with 53.2% of patients experiencing onset when aged 0 to 4 years, while 18.5% of patients experienced onset when aged 20 years or more.

Age of onset was balanced between treatment groups for the analysis, along with most baseline demographics. At week 16 of treatment, Eczema Area and Severity Index (EASI)-75 was achieved in 38% to 54% of patients treated with dupilumab, compared to 10% to 19% of patients treated with placebo.

EASI-50 and EASI-90 were also more often seen in the dupilumab group compared to the placebo group. These results remained consistent across age-of-onset subgroups. Head and neck, upper extremities, lower extremities, and trunk regions all saw significantly greater improvements in the dupilumab group. 

Quality of life also saw consistent improvement in patients treated with dupilumab. Severe adverse events were either balanced or more often seen in patients treated with placebo. Adverse events were consistent across age-of-onset subgroups, and less than 2% of patients ended treatment because of adverse events.

Overall, dupilumab showed significant improvements in AD symptoms regardless of age-of-onset. This indicates that dupilumab is generally effective at treating AD.

Reference

Silverberg JI, Boguniewicz M, Hanifin J, Papp KA, Zhang H, Rossi AB, et al. Dupilumab treatment in adults with moderate-to-severe atopic dermatitis is efficacious regardless of age of disease onset: a post hoc analysis of two phase 3 clinical trials. Dermatol Ther (Heidelb). 2022;12:2731–2746. doi:10.1007/s13555-022-00822-x