Dupilumab yields rapid, lasting improvement in erythrodermic atopic dermatitis

Treatment with dupilumab helps improve the signs and symptoms of erythrodermic atopic dermatitis (AD), with the improvements occurring as early as the first week and being sustained over time, according to a study. The drug has an acceptable safety profile.

The study was a post hoc analysis of six multicentre, multinational, randomized, double-blind, placebo-controlled trials. The pooled population included 3,075 patients with moderate to severe AD who were randomly assigned to placebo or dupilumab once weekly or every 2 weeks. Of these patients, 209 met the criteria for erythrodermic AD (defined as at least 90 percent body surface area [BSA] affected by AD and Global Individual Sign Score for erythema of at least 1) and were included in the analysis.

Of the patients with erythrodermic AD, 183 completed up to 16 weeks of treatment. The median age of the patients was 31 and 39 years in the monotherapy and concomitant topical corticosteroid trials, respectively, and 71.3 percent and 74.0 percent of patients were men.

Compared with placebo, treatment with dupilumab once weekly and every 2 weeks resulted in significant improvements in the percentage of BSA affected by AD (monotherapy: −42.0 percent and −39.9 percent vs −17.2 percent; p=0.03; concomitant topical corticosteroid (TCS): −63.2 percent and −56.1 percent vs −14.5 percent; p<0.001), Eczema Area and Severity Index (EASI) score (monotherapy: −58.5 percent and −58.3 percent vs −22.3 percent; p=0.004 and p=0.003, respectively; concomitant TCS: −78.9 percent and −70.6 percent vs 19.3 percent; p<0.001), and Peak Pruritus Numerical Rating Scale (PP-NRS) score (monotherapy: −45.9 percent and −33.9 percent vs −0.6 percent; p<0.001; concomitant TCS: −53.0 percent and −55.7 percent vs −26.0 percent; p=0.006 and p=0.01, respectively).

The improvements were evident at week 1 (EASI and PP-NRS scores with monotherapy). Also, biomarker levels were significantly lower with dupilumab vs placebo.

In terms of safety, the most frequent adverse events among dupilumab-treated patients were injection-site reaction, conjunctivitis, and nasopharyngitis.