User login
Study Highlights Atopic Dermatitis Features, Treatments Among Older Patients
.
The researchers reviewed charts of patients aged 60 years and older who were seen at either a private or county dermatology clinic in Houston between 2009 and 2020 and had been diagnosed with AD by a dermatologist. The findings of their cross-sectional study further supports that AD in this age group “presents as a unique phenotype compared to AD in younger ages, which may inform dermatologists’ diagnosis of AD in these patients” they wrote.
The 791 patients in the study had an average age of 69.3 years, were predominantly women (60.1%), and were racially diverse, with almost 40% being non-Hispanic White individuals. Others were non-Hispanic Black individuals (21.8%), Hispanics (20.4%), and non-Hispanic Asian/Pacific Islanders (11.7%).
Use of topicals, mainly topical corticosteroids (92.2%), was the most frequent treatment prescribed. Oral corticosteroids and antihistamines were “frequent systemic treatments” in this population, prescribed to 10.4% and 12.1%, respectively, “likely due to management prior to a diagnosis of AD by a dermatologist,” wrote first author Hannah Y. Wang, Baylor College of Medicine, Houston, and her coauthors, including Soo Jung Kim, MD, PhD, of the department of dermatology at Baylor.
Other treatments included dupilumab in 5.4%, systemic immunosuppressants (including methotrexate, cyclosporine, and mycophenolate) in 5.4%, and UVB-phototherapy in 2.7%.
Approximately 40% of the patients had a history of allergic rhinitis, while 20% had a history of asthma. Lichenification was noted in 14.5% of patients and nummular lesions in almost 13%. Other rash characteristics — ichthyosis and hyperpigmented patches — were less frequent, seen in 9.7% and 9.1%, respectively.
AD in this older population was most commonly documented on the extensors (49.9%) and the trunk (46%) and less commonly on the hands (19.8%) and feet (9%) — a distribution that is similar to past reports, the authors wrote.
Asked to comment on the findings, Adam Friedman, MD, professor and chair of dermatology at George Washington University, Washington, DC, told this news organization that the data relating to clinical morphology are consistent with past reports and with his own experiences. Lichenification is a “tell-tale sign of chronic disease” and may indicate undertreatment, and the frequency of nummular plaques is unsurprising because “nummular dermatitis as an independent eczema tends to occur more so in the elderly.”
More important, he said, was the finding regarding the use of oral corticosteroid and antihistamine, “both of which are advocated against in the management of AD.”
More research is “needed to elucidate the unique features of elderly AD in pathophysiology and optimal treatments,” the authors wrote, noting that age-related factors potentially affecting AD in this population include reduced skin barrier function, immune dysregulation, and environmental exposures.
The study, Dr. Friedman said, “shines a spotlight on this demographic — they exist, they suffer, and they are at times being managed with less-than-optimal options.” Clinical trials of “the welcome additions to our historically limited armament often lack a substantial elderly study population,” he said, and Medicare makes it “painful to get these game-changing drugs for this large patient population.”
The study authors and Dr. Friedman, who was not involved with the study, reported no conflicts of interest.
A version of this article appeared on Medscape.com.
.
The researchers reviewed charts of patients aged 60 years and older who were seen at either a private or county dermatology clinic in Houston between 2009 and 2020 and had been diagnosed with AD by a dermatologist. The findings of their cross-sectional study further supports that AD in this age group “presents as a unique phenotype compared to AD in younger ages, which may inform dermatologists’ diagnosis of AD in these patients” they wrote.
The 791 patients in the study had an average age of 69.3 years, were predominantly women (60.1%), and were racially diverse, with almost 40% being non-Hispanic White individuals. Others were non-Hispanic Black individuals (21.8%), Hispanics (20.4%), and non-Hispanic Asian/Pacific Islanders (11.7%).
Use of topicals, mainly topical corticosteroids (92.2%), was the most frequent treatment prescribed. Oral corticosteroids and antihistamines were “frequent systemic treatments” in this population, prescribed to 10.4% and 12.1%, respectively, “likely due to management prior to a diagnosis of AD by a dermatologist,” wrote first author Hannah Y. Wang, Baylor College of Medicine, Houston, and her coauthors, including Soo Jung Kim, MD, PhD, of the department of dermatology at Baylor.
Other treatments included dupilumab in 5.4%, systemic immunosuppressants (including methotrexate, cyclosporine, and mycophenolate) in 5.4%, and UVB-phototherapy in 2.7%.
Approximately 40% of the patients had a history of allergic rhinitis, while 20% had a history of asthma. Lichenification was noted in 14.5% of patients and nummular lesions in almost 13%. Other rash characteristics — ichthyosis and hyperpigmented patches — were less frequent, seen in 9.7% and 9.1%, respectively.
AD in this older population was most commonly documented on the extensors (49.9%) and the trunk (46%) and less commonly on the hands (19.8%) and feet (9%) — a distribution that is similar to past reports, the authors wrote.
Asked to comment on the findings, Adam Friedman, MD, professor and chair of dermatology at George Washington University, Washington, DC, told this news organization that the data relating to clinical morphology are consistent with past reports and with his own experiences. Lichenification is a “tell-tale sign of chronic disease” and may indicate undertreatment, and the frequency of nummular plaques is unsurprising because “nummular dermatitis as an independent eczema tends to occur more so in the elderly.”
More important, he said, was the finding regarding the use of oral corticosteroid and antihistamine, “both of which are advocated against in the management of AD.”
More research is “needed to elucidate the unique features of elderly AD in pathophysiology and optimal treatments,” the authors wrote, noting that age-related factors potentially affecting AD in this population include reduced skin barrier function, immune dysregulation, and environmental exposures.
The study, Dr. Friedman said, “shines a spotlight on this demographic — they exist, they suffer, and they are at times being managed with less-than-optimal options.” Clinical trials of “the welcome additions to our historically limited armament often lack a substantial elderly study population,” he said, and Medicare makes it “painful to get these game-changing drugs for this large patient population.”
The study authors and Dr. Friedman, who was not involved with the study, reported no conflicts of interest.
A version of this article appeared on Medscape.com.
.
The researchers reviewed charts of patients aged 60 years and older who were seen at either a private or county dermatology clinic in Houston between 2009 and 2020 and had been diagnosed with AD by a dermatologist. The findings of their cross-sectional study further supports that AD in this age group “presents as a unique phenotype compared to AD in younger ages, which may inform dermatologists’ diagnosis of AD in these patients” they wrote.
The 791 patients in the study had an average age of 69.3 years, were predominantly women (60.1%), and were racially diverse, with almost 40% being non-Hispanic White individuals. Others were non-Hispanic Black individuals (21.8%), Hispanics (20.4%), and non-Hispanic Asian/Pacific Islanders (11.7%).
Use of topicals, mainly topical corticosteroids (92.2%), was the most frequent treatment prescribed. Oral corticosteroids and antihistamines were “frequent systemic treatments” in this population, prescribed to 10.4% and 12.1%, respectively, “likely due to management prior to a diagnosis of AD by a dermatologist,” wrote first author Hannah Y. Wang, Baylor College of Medicine, Houston, and her coauthors, including Soo Jung Kim, MD, PhD, of the department of dermatology at Baylor.
Other treatments included dupilumab in 5.4%, systemic immunosuppressants (including methotrexate, cyclosporine, and mycophenolate) in 5.4%, and UVB-phototherapy in 2.7%.
Approximately 40% of the patients had a history of allergic rhinitis, while 20% had a history of asthma. Lichenification was noted in 14.5% of patients and nummular lesions in almost 13%. Other rash characteristics — ichthyosis and hyperpigmented patches — were less frequent, seen in 9.7% and 9.1%, respectively.
AD in this older population was most commonly documented on the extensors (49.9%) and the trunk (46%) and less commonly on the hands (19.8%) and feet (9%) — a distribution that is similar to past reports, the authors wrote.
Asked to comment on the findings, Adam Friedman, MD, professor and chair of dermatology at George Washington University, Washington, DC, told this news organization that the data relating to clinical morphology are consistent with past reports and with his own experiences. Lichenification is a “tell-tale sign of chronic disease” and may indicate undertreatment, and the frequency of nummular plaques is unsurprising because “nummular dermatitis as an independent eczema tends to occur more so in the elderly.”
More important, he said, was the finding regarding the use of oral corticosteroid and antihistamine, “both of which are advocated against in the management of AD.”
More research is “needed to elucidate the unique features of elderly AD in pathophysiology and optimal treatments,” the authors wrote, noting that age-related factors potentially affecting AD in this population include reduced skin barrier function, immune dysregulation, and environmental exposures.
The study, Dr. Friedman said, “shines a spotlight on this demographic — they exist, they suffer, and they are at times being managed with less-than-optimal options.” Clinical trials of “the welcome additions to our historically limited armament often lack a substantial elderly study population,” he said, and Medicare makes it “painful to get these game-changing drugs for this large patient population.”
The study authors and Dr. Friedman, who was not involved with the study, reported no conflicts of interest.
A version of this article appeared on Medscape.com.
FROM JAAD INTERNATIONAL
Commentary: Interrelationships Between AD and Other Conditions, June 2024
Traidl and colleagues report that obesity was linked to worse AD in German patients. The authors hit the nail on the head with their conclusions: "In this large and well-characterized AD patient cohort, obesity is significantly associated with physician- and patient-assessed measures of AD disease severity. However, the corresponding effect sizes were low and of questionable clinical relevance." What might account for the small difference in disease severity? Adherence to treatment is highly variable among patients with AD. A small tendency toward worse adherence in patients with obesity could easily explain the small differences seen in disease severity.
Eichenfeld and colleagues report that topical ruxolitinib maintained good efficacy over a year in open-label use. Topical ruxolitinib is a very effective treatment for AD. If real-life AD patients on topical ruxolitinib were to lose efficacy over time, I'd consider the possibility that they've developed mutant Janus kinase (JAK) enzymes that are no longer responsive to the drug. Just kidding. I doubt that such mutations ever occur. If topical ruxolitinib in AD patients were to lose efficacy over time, I'd strongly consider the possibility that patients' adherence to the treatment is no longer as good as it was before. Long-term adherence to topical treatment can be abysmal. Adherence in clinical trials is probably a lot better than in clinical practice. When we see topical treatments that are effective in clinical trials failing in real-life patients with AD, it may be prudent to address the possibility of poor adherence.
I'd love to see a head-to-head trial of tralokinumab vs dupilumab in the treatment of moderate to severe AD. Lacking that, Torres and colleagues report an indirect comparison of the two drugs in patients also treated with topical steroids. This study, funded by the manufacturer of tralokinumab, reported that the two drugs have similar efficacy. How much of the efficacy was due to the topical steroid use is not clear to me. I'd still love to see a head-to-head trial of tralokinumab vs dupilumab to have a better, more confident sense of their relative efficacy.
Is AD associated with brain cancer, as reported by Xin and colleagues? I'm not an expert in their methodology, but they did find a statistically significant increased risk, with an odds ratio of 1.0005. I understand the odds ratio for smoking and lung cancer to be about 80. Even if the increased odds of 1.005 — no, wait, that's 1.0005 — is truly due to AD, this tiny difference doesn't seem meaningful in any way.
Traidl and colleagues report that obesity was linked to worse AD in German patients. The authors hit the nail on the head with their conclusions: "In this large and well-characterized AD patient cohort, obesity is significantly associated with physician- and patient-assessed measures of AD disease severity. However, the corresponding effect sizes were low and of questionable clinical relevance." What might account for the small difference in disease severity? Adherence to treatment is highly variable among patients with AD. A small tendency toward worse adherence in patients with obesity could easily explain the small differences seen in disease severity.
Eichenfeld and colleagues report that topical ruxolitinib maintained good efficacy over a year in open-label use. Topical ruxolitinib is a very effective treatment for AD. If real-life AD patients on topical ruxolitinib were to lose efficacy over time, I'd consider the possibility that they've developed mutant Janus kinase (JAK) enzymes that are no longer responsive to the drug. Just kidding. I doubt that such mutations ever occur. If topical ruxolitinib in AD patients were to lose efficacy over time, I'd strongly consider the possibility that patients' adherence to the treatment is no longer as good as it was before. Long-term adherence to topical treatment can be abysmal. Adherence in clinical trials is probably a lot better than in clinical practice. When we see topical treatments that are effective in clinical trials failing in real-life patients with AD, it may be prudent to address the possibility of poor adherence.
I'd love to see a head-to-head trial of tralokinumab vs dupilumab in the treatment of moderate to severe AD. Lacking that, Torres and colleagues report an indirect comparison of the two drugs in patients also treated with topical steroids. This study, funded by the manufacturer of tralokinumab, reported that the two drugs have similar efficacy. How much of the efficacy was due to the topical steroid use is not clear to me. I'd still love to see a head-to-head trial of tralokinumab vs dupilumab to have a better, more confident sense of their relative efficacy.
Is AD associated with brain cancer, as reported by Xin and colleagues? I'm not an expert in their methodology, but they did find a statistically significant increased risk, with an odds ratio of 1.0005. I understand the odds ratio for smoking and lung cancer to be about 80. Even if the increased odds of 1.005 — no, wait, that's 1.0005 — is truly due to AD, this tiny difference doesn't seem meaningful in any way.
Traidl and colleagues report that obesity was linked to worse AD in German patients. The authors hit the nail on the head with their conclusions: "In this large and well-characterized AD patient cohort, obesity is significantly associated with physician- and patient-assessed measures of AD disease severity. However, the corresponding effect sizes were low and of questionable clinical relevance." What might account for the small difference in disease severity? Adherence to treatment is highly variable among patients with AD. A small tendency toward worse adherence in patients with obesity could easily explain the small differences seen in disease severity.
Eichenfeld and colleagues report that topical ruxolitinib maintained good efficacy over a year in open-label use. Topical ruxolitinib is a very effective treatment for AD. If real-life AD patients on topical ruxolitinib were to lose efficacy over time, I'd consider the possibility that they've developed mutant Janus kinase (JAK) enzymes that are no longer responsive to the drug. Just kidding. I doubt that such mutations ever occur. If topical ruxolitinib in AD patients were to lose efficacy over time, I'd strongly consider the possibility that patients' adherence to the treatment is no longer as good as it was before. Long-term adherence to topical treatment can be abysmal. Adherence in clinical trials is probably a lot better than in clinical practice. When we see topical treatments that are effective in clinical trials failing in real-life patients with AD, it may be prudent to address the possibility of poor adherence.
I'd love to see a head-to-head trial of tralokinumab vs dupilumab in the treatment of moderate to severe AD. Lacking that, Torres and colleagues report an indirect comparison of the two drugs in patients also treated with topical steroids. This study, funded by the manufacturer of tralokinumab, reported that the two drugs have similar efficacy. How much of the efficacy was due to the topical steroid use is not clear to me. I'd still love to see a head-to-head trial of tralokinumab vs dupilumab to have a better, more confident sense of their relative efficacy.
Is AD associated with brain cancer, as reported by Xin and colleagues? I'm not an expert in their methodology, but they did find a statistically significant increased risk, with an odds ratio of 1.0005. I understand the odds ratio for smoking and lung cancer to be about 80. Even if the increased odds of 1.005 — no, wait, that's 1.0005 — is truly due to AD, this tiny difference doesn't seem meaningful in any way.
Upadacitinib Improves Standards of Care in Adults With Moderate to Severe Atopic Dermatitis
Key clinical point: Treatment with 15 mg or 30 mg upadacitinib demonstrated rapid and durable improvements in symptoms and quality of life in adults with moderate to severe atopic dermatitis (AD), based on a treat-to-target approach.
Major finding: Overall, >80%, >78%, and ≥87% of patients achieved the 3-month initial acceptable target, whereas ≥53%, >61%, and >73% of patients achieved the 6-month optimal target goal with 15 mg or 30 mg upadacitinib vs placebo at weeks 2, 16, and 52, respectively. The proportion of patients achieving a higher number of individual target criteria increased over time for both 3- and 6-month target goals.
Study details: This treat-to-target analysis of Measure Up 1 and Measure Up 2 phase 3 studies included 1282 adults with moderate to severe AD who were randomly assigned to receive 15 mg upadacitinib (n = 428), 30 mg upadacitinib (n = 424), or placebo (n = 430).
Disclosures: This study was funded by AbbVie. Five authors declared being employees of AbbVie or holding AbbVie stock, stock options, or patents. Several authors declared having ties with various sources, including AbbVie.
Source: Kwatra SG, de Bruin-Weller M, Silverberg JI, et al. Targeted combined endpoint improvement in patient and disease domains in atopic dermatitis: A treat-to-target analysis of adults with moderate-to-severe atopic dermatitis treated with upadacitinib. Acta Derm Venereol. 2024;104:adv18452 (May 6). doi: 10.2340/actadv.v104.18452 Source
Key clinical point: Treatment with 15 mg or 30 mg upadacitinib demonstrated rapid and durable improvements in symptoms and quality of life in adults with moderate to severe atopic dermatitis (AD), based on a treat-to-target approach.
Major finding: Overall, >80%, >78%, and ≥87% of patients achieved the 3-month initial acceptable target, whereas ≥53%, >61%, and >73% of patients achieved the 6-month optimal target goal with 15 mg or 30 mg upadacitinib vs placebo at weeks 2, 16, and 52, respectively. The proportion of patients achieving a higher number of individual target criteria increased over time for both 3- and 6-month target goals.
Study details: This treat-to-target analysis of Measure Up 1 and Measure Up 2 phase 3 studies included 1282 adults with moderate to severe AD who were randomly assigned to receive 15 mg upadacitinib (n = 428), 30 mg upadacitinib (n = 424), or placebo (n = 430).
Disclosures: This study was funded by AbbVie. Five authors declared being employees of AbbVie or holding AbbVie stock, stock options, or patents. Several authors declared having ties with various sources, including AbbVie.
Source: Kwatra SG, de Bruin-Weller M, Silverberg JI, et al. Targeted combined endpoint improvement in patient and disease domains in atopic dermatitis: A treat-to-target analysis of adults with moderate-to-severe atopic dermatitis treated with upadacitinib. Acta Derm Venereol. 2024;104:adv18452 (May 6). doi: 10.2340/actadv.v104.18452 Source
Key clinical point: Treatment with 15 mg or 30 mg upadacitinib demonstrated rapid and durable improvements in symptoms and quality of life in adults with moderate to severe atopic dermatitis (AD), based on a treat-to-target approach.
Major finding: Overall, >80%, >78%, and ≥87% of patients achieved the 3-month initial acceptable target, whereas ≥53%, >61%, and >73% of patients achieved the 6-month optimal target goal with 15 mg or 30 mg upadacitinib vs placebo at weeks 2, 16, and 52, respectively. The proportion of patients achieving a higher number of individual target criteria increased over time for both 3- and 6-month target goals.
Study details: This treat-to-target analysis of Measure Up 1 and Measure Up 2 phase 3 studies included 1282 adults with moderate to severe AD who were randomly assigned to receive 15 mg upadacitinib (n = 428), 30 mg upadacitinib (n = 424), or placebo (n = 430).
Disclosures: This study was funded by AbbVie. Five authors declared being employees of AbbVie or holding AbbVie stock, stock options, or patents. Several authors declared having ties with various sources, including AbbVie.
Source: Kwatra SG, de Bruin-Weller M, Silverberg JI, et al. Targeted combined endpoint improvement in patient and disease domains in atopic dermatitis: A treat-to-target analysis of adults with moderate-to-severe atopic dermatitis treated with upadacitinib. Acta Derm Venereol. 2024;104:adv18452 (May 6). doi: 10.2340/actadv.v104.18452 Source
Dupilumab Boosts Clinical and Molecular Responses in Pediatric Atopic Dermatitis
Key clinical point: Dupilumab treatment was well-tolerated and demonstrated improved clinical and molecular responses in pediatric patients with moderate to severe atopic dermatitis (AD).
Major finding: Dupilumab significantly reduced Eczema Area and Severity Index, SCORing Atopic Dermatitis index, and Investigator’s Global Assessment scores at 3 and 6 months (all P < .05), along with significant reduction in AD-associated stratum corneum biomarker levels at 3 months (P < .01). Dupilumab showed good tolerability, with adverse events reported in only four patients.
Study details: This study included 314 pediatric patients with moderate to severe AD from the German TREATkids registry, of whom 87 received dupilumab.
Disclosures: TREATkids is the child and adolescent section of the TREATgermany registry, which is supported by AbbVie Deutschland GmbH & Co. KG, Almirall Hermal GmbH, Galderma S.A., LEO Pharma GmbH, Lilly Deutschland GmbH, Pfizer Inc., and Sanofi. Several authors declared receiving research grants, lecture, or consultancy fees from or having other ties with various sources, including the supporters of TREATgermany.
Source: Stölzl D, Sander N, Siegels D, et al, and the TREATgermany study group. Clinical and molecular response to dupilumab treatment in pediatric atopic dermatitis: Results of the German TREATkids registry. Allergy. 2024 (May 7). doi: 0.1111/all.16147 Source
Key clinical point: Dupilumab treatment was well-tolerated and demonstrated improved clinical and molecular responses in pediatric patients with moderate to severe atopic dermatitis (AD).
Major finding: Dupilumab significantly reduced Eczema Area and Severity Index, SCORing Atopic Dermatitis index, and Investigator’s Global Assessment scores at 3 and 6 months (all P < .05), along with significant reduction in AD-associated stratum corneum biomarker levels at 3 months (P < .01). Dupilumab showed good tolerability, with adverse events reported in only four patients.
Study details: This study included 314 pediatric patients with moderate to severe AD from the German TREATkids registry, of whom 87 received dupilumab.
Disclosures: TREATkids is the child and adolescent section of the TREATgermany registry, which is supported by AbbVie Deutschland GmbH & Co. KG, Almirall Hermal GmbH, Galderma S.A., LEO Pharma GmbH, Lilly Deutschland GmbH, Pfizer Inc., and Sanofi. Several authors declared receiving research grants, lecture, or consultancy fees from or having other ties with various sources, including the supporters of TREATgermany.
Source: Stölzl D, Sander N, Siegels D, et al, and the TREATgermany study group. Clinical and molecular response to dupilumab treatment in pediatric atopic dermatitis: Results of the German TREATkids registry. Allergy. 2024 (May 7). doi: 0.1111/all.16147 Source
Key clinical point: Dupilumab treatment was well-tolerated and demonstrated improved clinical and molecular responses in pediatric patients with moderate to severe atopic dermatitis (AD).
Major finding: Dupilumab significantly reduced Eczema Area and Severity Index, SCORing Atopic Dermatitis index, and Investigator’s Global Assessment scores at 3 and 6 months (all P < .05), along with significant reduction in AD-associated stratum corneum biomarker levels at 3 months (P < .01). Dupilumab showed good tolerability, with adverse events reported in only four patients.
Study details: This study included 314 pediatric patients with moderate to severe AD from the German TREATkids registry, of whom 87 received dupilumab.
Disclosures: TREATkids is the child and adolescent section of the TREATgermany registry, which is supported by AbbVie Deutschland GmbH & Co. KG, Almirall Hermal GmbH, Galderma S.A., LEO Pharma GmbH, Lilly Deutschland GmbH, Pfizer Inc., and Sanofi. Several authors declared receiving research grants, lecture, or consultancy fees from or having other ties with various sources, including the supporters of TREATgermany.
Source: Stölzl D, Sander N, Siegels D, et al, and the TREATgermany study group. Clinical and molecular response to dupilumab treatment in pediatric atopic dermatitis: Results of the German TREATkids registry. Allergy. 2024 (May 7). doi: 0.1111/all.16147 Source
Lebrikizumab Shows Prompt Clinical Response in Moderate to Severe Atopic Dermatitis
Key clinical point: Lebrikizumab monotherapy rapidly and consistently reduced atopic dermatitis (AD) extent and severity in patients with moderate to severe AD across all Eczema Area and Severity Index (EASI) clinical signs and body regions.
Major finding: At week 16, lebrikizumab vs placebo led to greater improvements in EASI scores and clinical signs (both P < .001) across all body regions in ADvocate1 and ADvocate2, with improvements observed as early as week 2 for all signs except erythema on head/neck (P < .05) and lower extremity erythema, edema/papulation, and lichenification (all P < .001), which improved significantly only by week 4 in ADvocate2.
Study details: This post hoc analysis of ADvocate1 (n = 424) and ADvocate2 (n = 427) included adolescent and adult patients with moderate to severe AD who were randomly assigned to receive 250 mg lebrikizumab biweekly or placebo.
Disclosures: This study was funded by Dermira, Inc., a wholly owned subsidiary of Eli Lilly and Company. Several authors declared having various ties with Dermira, Eli Lilly, and others. Five authors declared being employees or stockholders of Eli Lilly.
Source: Simpson EL, de Bruin-Weller M, Hong HC, et al. Lebrikizumab provides rapid clinical responses across all Eczema Area and Severity Index body regions and clinical signs in adolescents and adults with moderate-to-severe atopic dermatitis. Dermatol Ther (Heidelb). 2024 (May 3). doi: 10.1007/s13555-024-01158-4 Source
Key clinical point: Lebrikizumab monotherapy rapidly and consistently reduced atopic dermatitis (AD) extent and severity in patients with moderate to severe AD across all Eczema Area and Severity Index (EASI) clinical signs and body regions.
Major finding: At week 16, lebrikizumab vs placebo led to greater improvements in EASI scores and clinical signs (both P < .001) across all body regions in ADvocate1 and ADvocate2, with improvements observed as early as week 2 for all signs except erythema on head/neck (P < .05) and lower extremity erythema, edema/papulation, and lichenification (all P < .001), which improved significantly only by week 4 in ADvocate2.
Study details: This post hoc analysis of ADvocate1 (n = 424) and ADvocate2 (n = 427) included adolescent and adult patients with moderate to severe AD who were randomly assigned to receive 250 mg lebrikizumab biweekly or placebo.
Disclosures: This study was funded by Dermira, Inc., a wholly owned subsidiary of Eli Lilly and Company. Several authors declared having various ties with Dermira, Eli Lilly, and others. Five authors declared being employees or stockholders of Eli Lilly.
Source: Simpson EL, de Bruin-Weller M, Hong HC, et al. Lebrikizumab provides rapid clinical responses across all Eczema Area and Severity Index body regions and clinical signs in adolescents and adults with moderate-to-severe atopic dermatitis. Dermatol Ther (Heidelb). 2024 (May 3). doi: 10.1007/s13555-024-01158-4 Source
Key clinical point: Lebrikizumab monotherapy rapidly and consistently reduced atopic dermatitis (AD) extent and severity in patients with moderate to severe AD across all Eczema Area and Severity Index (EASI) clinical signs and body regions.
Major finding: At week 16, lebrikizumab vs placebo led to greater improvements in EASI scores and clinical signs (both P < .001) across all body regions in ADvocate1 and ADvocate2, with improvements observed as early as week 2 for all signs except erythema on head/neck (P < .05) and lower extremity erythema, edema/papulation, and lichenification (all P < .001), which improved significantly only by week 4 in ADvocate2.
Study details: This post hoc analysis of ADvocate1 (n = 424) and ADvocate2 (n = 427) included adolescent and adult patients with moderate to severe AD who were randomly assigned to receive 250 mg lebrikizumab biweekly or placebo.
Disclosures: This study was funded by Dermira, Inc., a wholly owned subsidiary of Eli Lilly and Company. Several authors declared having various ties with Dermira, Eli Lilly, and others. Five authors declared being employees or stockholders of Eli Lilly.
Source: Simpson EL, de Bruin-Weller M, Hong HC, et al. Lebrikizumab provides rapid clinical responses across all Eczema Area and Severity Index body regions and clinical signs in adolescents and adults with moderate-to-severe atopic dermatitis. Dermatol Ther (Heidelb). 2024 (May 3). doi: 10.1007/s13555-024-01158-4 Source
Causal Relationship Exists Between Atopic Dermatitis and Brain Cancer
Key clinical point: A causal relationship was observed between genetically related atopic dermatitis (AD) and brain cancer, delineating AD as a potential risk factor for brain cancer.
Major finding: The presence of AD led to an increased risk for brain cancer (odds ratio 1.0005; P = .0096); however, no significant causal association was observed on conducting reverse Mendelian randomization analysis.
Study details: This cohort study analyzed the data on AD-associated single nucleotide polymorphisms of patients with AD (n = 15,208) and control individuals without AD (n = 367,046) from the FinnGen database (10th release) and the summary data of patients with brain cancer (n = 606) and control individuals without cancer (n = 372,016) from the IEU Open GWAS database.
Disclosures: This study did not disclose any funding source. The authors declared no conflicts of interest.
Source: Xin Y, Yuan T, Wang J. The causal relationship between atopic dermatitis and brain cancer: A bidirectional Mendelian randomization study. Skin Res Technol. 2024;30(4):e13715. doi: 10.1111/srt.13715 Source
Key clinical point: A causal relationship was observed between genetically related atopic dermatitis (AD) and brain cancer, delineating AD as a potential risk factor for brain cancer.
Major finding: The presence of AD led to an increased risk for brain cancer (odds ratio 1.0005; P = .0096); however, no significant causal association was observed on conducting reverse Mendelian randomization analysis.
Study details: This cohort study analyzed the data on AD-associated single nucleotide polymorphisms of patients with AD (n = 15,208) and control individuals without AD (n = 367,046) from the FinnGen database (10th release) and the summary data of patients with brain cancer (n = 606) and control individuals without cancer (n = 372,016) from the IEU Open GWAS database.
Disclosures: This study did not disclose any funding source. The authors declared no conflicts of interest.
Source: Xin Y, Yuan T, Wang J. The causal relationship between atopic dermatitis and brain cancer: A bidirectional Mendelian randomization study. Skin Res Technol. 2024;30(4):e13715. doi: 10.1111/srt.13715 Source
Key clinical point: A causal relationship was observed between genetically related atopic dermatitis (AD) and brain cancer, delineating AD as a potential risk factor for brain cancer.
Major finding: The presence of AD led to an increased risk for brain cancer (odds ratio 1.0005; P = .0096); however, no significant causal association was observed on conducting reverse Mendelian randomization analysis.
Study details: This cohort study analyzed the data on AD-associated single nucleotide polymorphisms of patients with AD (n = 15,208) and control individuals without AD (n = 367,046) from the FinnGen database (10th release) and the summary data of patients with brain cancer (n = 606) and control individuals without cancer (n = 372,016) from the IEU Open GWAS database.
Disclosures: This study did not disclose any funding source. The authors declared no conflicts of interest.
Source: Xin Y, Yuan T, Wang J. The causal relationship between atopic dermatitis and brain cancer: A bidirectional Mendelian randomization study. Skin Res Technol. 2024;30(4):e13715. doi: 10.1111/srt.13715 Source
Preventive Effect of Maternal Probiotic Supplementation in Atopic Dermatitis
Key clinical point: Maternal probiotic supplementation was effective in preventing atopic dermatitis (AD) in children regardless of their filaggrin (FLG) gene mutation status.
Major finding: Heterozygous FLG mutations were observed in 7% of children. The risk for AD after maternal probiotic supplementation was similar between children who expressed a FLG mutation (risk ratio [RR] 0.6; 95% CI 0.1-4.1) and those having a wild-type FLG (RR 0.6; 95% CI 0.4-0.9).
Study details: This exploratory study included the data of 228 children from the Probiotic in the Prevention of Allergy among Children in Trondheim (ProPACT) study who did or did not have FLG mutations and whose mothers received probiotic or placebo milk from 36 weeks of gestation until 3 months post delivery while breastfeeding.
Disclosures: This study was funded by the Liaison Committee between the Central Norway Regional Health Authority and the Norwegian University of Science and Technology, and the Norwegian Research Council. The authors declared no conflicts of interest.
Source: Zakiudin DP, Thyssen JP, Zachariae C, Videm V, Øien T, Simpson MR. Filaggrin mutation status and prevention of atopic dermatitis with maternal probiotic supplementation. Acta Derm Venereol. 2024;104:adv24360 (Apr 24). doi: 10.2340/actadv.v104.24360 Source
Key clinical point: Maternal probiotic supplementation was effective in preventing atopic dermatitis (AD) in children regardless of their filaggrin (FLG) gene mutation status.
Major finding: Heterozygous FLG mutations were observed in 7% of children. The risk for AD after maternal probiotic supplementation was similar between children who expressed a FLG mutation (risk ratio [RR] 0.6; 95% CI 0.1-4.1) and those having a wild-type FLG (RR 0.6; 95% CI 0.4-0.9).
Study details: This exploratory study included the data of 228 children from the Probiotic in the Prevention of Allergy among Children in Trondheim (ProPACT) study who did or did not have FLG mutations and whose mothers received probiotic or placebo milk from 36 weeks of gestation until 3 months post delivery while breastfeeding.
Disclosures: This study was funded by the Liaison Committee between the Central Norway Regional Health Authority and the Norwegian University of Science and Technology, and the Norwegian Research Council. The authors declared no conflicts of interest.
Source: Zakiudin DP, Thyssen JP, Zachariae C, Videm V, Øien T, Simpson MR. Filaggrin mutation status and prevention of atopic dermatitis with maternal probiotic supplementation. Acta Derm Venereol. 2024;104:adv24360 (Apr 24). doi: 10.2340/actadv.v104.24360 Source
Key clinical point: Maternal probiotic supplementation was effective in preventing atopic dermatitis (AD) in children regardless of their filaggrin (FLG) gene mutation status.
Major finding: Heterozygous FLG mutations were observed in 7% of children. The risk for AD after maternal probiotic supplementation was similar between children who expressed a FLG mutation (risk ratio [RR] 0.6; 95% CI 0.1-4.1) and those having a wild-type FLG (RR 0.6; 95% CI 0.4-0.9).
Study details: This exploratory study included the data of 228 children from the Probiotic in the Prevention of Allergy among Children in Trondheim (ProPACT) study who did or did not have FLG mutations and whose mothers received probiotic or placebo milk from 36 weeks of gestation until 3 months post delivery while breastfeeding.
Disclosures: This study was funded by the Liaison Committee between the Central Norway Regional Health Authority and the Norwegian University of Science and Technology, and the Norwegian Research Council. The authors declared no conflicts of interest.
Source: Zakiudin DP, Thyssen JP, Zachariae C, Videm V, Øien T, Simpson MR. Filaggrin mutation status and prevention of atopic dermatitis with maternal probiotic supplementation. Acta Derm Venereol. 2024;104:adv24360 (Apr 24). doi: 10.2340/actadv.v104.24360 Source
Pharmacological Interventions in Atopic Dermatitis Reduce Anxiety and Depression
Key clinical point: Pharmacological interventions aimed at reducing disease severity in patients with moderate to severe atopic dermatitis (AD) are also effective for improving anxiety and depression.
Major finding: Pharmacologic interventions for AD led to significant improvements in anxiety levels (standardized mean difference [SMD] −0.29; 95% CI −0.49 to −0.09) and depression severity (SMD −0.27; 95% CI −0.45 to −0.08) and an overall significant improvement in Hospital Anxiety and Depression scale scores (SMD −0.50; 95% CI −0.064 to −0.35).
Study details: This meta-analysis of seven phase 2b or 3 randomized controlled trials included 4723 patients with AD who were treated with either abrocitinib, baricitinib, dupilumab, tralokinumab, or placebo.
Disclosures: This study did not disclose any funding source. The authors declared no conflicts of interest.
Source: Hartono SP, Chatrath S, Aktas ON, et al. Interventions for anxiety and depression in patients with atopic dermatitis: A systematic review and meta-analysis. Sci Rep. 2024;14:8844 (Apr 17). Source
Key clinical point: Pharmacological interventions aimed at reducing disease severity in patients with moderate to severe atopic dermatitis (AD) are also effective for improving anxiety and depression.
Major finding: Pharmacologic interventions for AD led to significant improvements in anxiety levels (standardized mean difference [SMD] −0.29; 95% CI −0.49 to −0.09) and depression severity (SMD −0.27; 95% CI −0.45 to −0.08) and an overall significant improvement in Hospital Anxiety and Depression scale scores (SMD −0.50; 95% CI −0.064 to −0.35).
Study details: This meta-analysis of seven phase 2b or 3 randomized controlled trials included 4723 patients with AD who were treated with either abrocitinib, baricitinib, dupilumab, tralokinumab, or placebo.
Disclosures: This study did not disclose any funding source. The authors declared no conflicts of interest.
Source: Hartono SP, Chatrath S, Aktas ON, et al. Interventions for anxiety and depression in patients with atopic dermatitis: A systematic review and meta-analysis. Sci Rep. 2024;14:8844 (Apr 17). Source
Key clinical point: Pharmacological interventions aimed at reducing disease severity in patients with moderate to severe atopic dermatitis (AD) are also effective for improving anxiety and depression.
Major finding: Pharmacologic interventions for AD led to significant improvements in anxiety levels (standardized mean difference [SMD] −0.29; 95% CI −0.49 to −0.09) and depression severity (SMD −0.27; 95% CI −0.45 to −0.08) and an overall significant improvement in Hospital Anxiety and Depression scale scores (SMD −0.50; 95% CI −0.064 to −0.35).
Study details: This meta-analysis of seven phase 2b or 3 randomized controlled trials included 4723 patients with AD who were treated with either abrocitinib, baricitinib, dupilumab, tralokinumab, or placebo.
Disclosures: This study did not disclose any funding source. The authors declared no conflicts of interest.
Source: Hartono SP, Chatrath S, Aktas ON, et al. Interventions for anxiety and depression in patients with atopic dermatitis: A systematic review and meta-analysis. Sci Rep. 2024;14:8844 (Apr 17). Source
Comparable Efficacy of Tralokinumab and Dupilumab in Moderate to Severe Atopic Dermatitis
Key clinical point: When combined with topical corticosteroids (TCS), tralokinumab and dupilumab demonstrate similar efficacy in the treatment of patients with moderate to severe atopic dermatitis (AD) at 32 weeks of therapy.
Major finding: At week 32, tralokinumab and dupilumab treatment, both in combination with TCS, led to a similar proportion of patients achieving an Investigator's Global Assessment score of 0 or 1 (49.9% vs 39.3%; P = .95) or 75% improvement in the Eczema Area Severity Index scores (71.5% vs 71.9%; P = .95).
Study details: This unanchored matching-adjusted indirect comparison study analyzed the individual patient data of adults with moderate to severe AD (sample size 123.4) treated with tralokinumab plus TCS in ECZTRA 3, which were matched with the aggregate data of 106 patients treated with dupilumab plus TCS in the LIBERTY AD CHRONOS trial.
Disclosures: This study was funded by LEO Pharma. Four authors declared being employees of LEO Pharma. The other authors declared receiving consultancy or speaker honoraria from or having other ties with various sources, including LEO Pharma.
Source: Torres T, Sohrt Petersen A, Ivens U, et al. Matching-adjusted indirect comparison of the efficacy at week 32 of tralokinumab and dupilumab in the treatment of moderate-to-severe atopic dermatitis. Dermatol Ther (Heidelb). 2024;14:983-992 (Apr 13). doi: 10.1007/s13555-024-01143-x Source
Key clinical point: When combined with topical corticosteroids (TCS), tralokinumab and dupilumab demonstrate similar efficacy in the treatment of patients with moderate to severe atopic dermatitis (AD) at 32 weeks of therapy.
Major finding: At week 32, tralokinumab and dupilumab treatment, both in combination with TCS, led to a similar proportion of patients achieving an Investigator's Global Assessment score of 0 or 1 (49.9% vs 39.3%; P = .95) or 75% improvement in the Eczema Area Severity Index scores (71.5% vs 71.9%; P = .95).
Study details: This unanchored matching-adjusted indirect comparison study analyzed the individual patient data of adults with moderate to severe AD (sample size 123.4) treated with tralokinumab plus TCS in ECZTRA 3, which were matched with the aggregate data of 106 patients treated with dupilumab plus TCS in the LIBERTY AD CHRONOS trial.
Disclosures: This study was funded by LEO Pharma. Four authors declared being employees of LEO Pharma. The other authors declared receiving consultancy or speaker honoraria from or having other ties with various sources, including LEO Pharma.
Source: Torres T, Sohrt Petersen A, Ivens U, et al. Matching-adjusted indirect comparison of the efficacy at week 32 of tralokinumab and dupilumab in the treatment of moderate-to-severe atopic dermatitis. Dermatol Ther (Heidelb). 2024;14:983-992 (Apr 13). doi: 10.1007/s13555-024-01143-x Source
Key clinical point: When combined with topical corticosteroids (TCS), tralokinumab and dupilumab demonstrate similar efficacy in the treatment of patients with moderate to severe atopic dermatitis (AD) at 32 weeks of therapy.
Major finding: At week 32, tralokinumab and dupilumab treatment, both in combination with TCS, led to a similar proportion of patients achieving an Investigator's Global Assessment score of 0 or 1 (49.9% vs 39.3%; P = .95) or 75% improvement in the Eczema Area Severity Index scores (71.5% vs 71.9%; P = .95).
Study details: This unanchored matching-adjusted indirect comparison study analyzed the individual patient data of adults with moderate to severe AD (sample size 123.4) treated with tralokinumab plus TCS in ECZTRA 3, which were matched with the aggregate data of 106 patients treated with dupilumab plus TCS in the LIBERTY AD CHRONOS trial.
Disclosures: This study was funded by LEO Pharma. Four authors declared being employees of LEO Pharma. The other authors declared receiving consultancy or speaker honoraria from or having other ties with various sources, including LEO Pharma.
Source: Torres T, Sohrt Petersen A, Ivens U, et al. Matching-adjusted indirect comparison of the efficacy at week 32 of tralokinumab and dupilumab in the treatment of moderate-to-severe atopic dermatitis. Dermatol Ther (Heidelb). 2024;14:983-992 (Apr 13). doi: 10.1007/s13555-024-01143-x Source
Topical Ruxolitinib Provides Long-Term Disease Control in Adolescents With Atopic Dermatitis
Key clinical point: Topical 1.5% ruxolitinib was effective and well-tolerated and offered long-term disease control with as-needed use in adolescents with atopic dermatitis (AD).
Major finding: At week 8, a substantially higher number of patients receiving 1.5% ruxolitinib vs vehicle achieved an Investigator's Global Assessment (IGA) score of 0 or 1 with ≥2 grade improvement from baseline (50.6% vs 14.0%) and ≥75% improvement in the Eczema Area and Severity Index score (60.9% vs 34.9%), with sustained or increased proportion of patients achieving an IGA score of 0 or 1 during the long-term safety (LTS) period. No serious adverse events were reported.
Study details: This study used pooled data from two phase 3 trials (TRuE-AD1 and TRuE-AD2) and included 137 adolescents (age, 12-17 years) with AD who were randomly assigned to receive 0.75% or 1.5% ruxolitinib cream or vehicle twice daily for 8 weeks, followed by an LTS period lasting up to 52 weeks.
Disclosures: This study was funded by Incyte Corporation. Four authors declared being employees or shareholders of Incyte Corporation. Several authors declared ties with various sources, including Incyte Corporation.
Source: Eichenfield LF, Simpson EL, Papp K, et al. Efficacy, safety, and long-term disease control of ruxolitinib cream among adolescents with atopic dermatitis: Pooled results from two randomized phase 3 studies. Am J Clin Dermatol. 2024 (May 2). doi: 10.1007/s40257-024-00855-2 Source
Key clinical point: Topical 1.5% ruxolitinib was effective and well-tolerated and offered long-term disease control with as-needed use in adolescents with atopic dermatitis (AD).
Major finding: At week 8, a substantially higher number of patients receiving 1.5% ruxolitinib vs vehicle achieved an Investigator's Global Assessment (IGA) score of 0 or 1 with ≥2 grade improvement from baseline (50.6% vs 14.0%) and ≥75% improvement in the Eczema Area and Severity Index score (60.9% vs 34.9%), with sustained or increased proportion of patients achieving an IGA score of 0 or 1 during the long-term safety (LTS) period. No serious adverse events were reported.
Study details: This study used pooled data from two phase 3 trials (TRuE-AD1 and TRuE-AD2) and included 137 adolescents (age, 12-17 years) with AD who were randomly assigned to receive 0.75% or 1.5% ruxolitinib cream or vehicle twice daily for 8 weeks, followed by an LTS period lasting up to 52 weeks.
Disclosures: This study was funded by Incyte Corporation. Four authors declared being employees or shareholders of Incyte Corporation. Several authors declared ties with various sources, including Incyte Corporation.
Source: Eichenfield LF, Simpson EL, Papp K, et al. Efficacy, safety, and long-term disease control of ruxolitinib cream among adolescents with atopic dermatitis: Pooled results from two randomized phase 3 studies. Am J Clin Dermatol. 2024 (May 2). doi: 10.1007/s40257-024-00855-2 Source
Key clinical point: Topical 1.5% ruxolitinib was effective and well-tolerated and offered long-term disease control with as-needed use in adolescents with atopic dermatitis (AD).
Major finding: At week 8, a substantially higher number of patients receiving 1.5% ruxolitinib vs vehicle achieved an Investigator's Global Assessment (IGA) score of 0 or 1 with ≥2 grade improvement from baseline (50.6% vs 14.0%) and ≥75% improvement in the Eczema Area and Severity Index score (60.9% vs 34.9%), with sustained or increased proportion of patients achieving an IGA score of 0 or 1 during the long-term safety (LTS) period. No serious adverse events were reported.
Study details: This study used pooled data from two phase 3 trials (TRuE-AD1 and TRuE-AD2) and included 137 adolescents (age, 12-17 years) with AD who were randomly assigned to receive 0.75% or 1.5% ruxolitinib cream or vehicle twice daily for 8 weeks, followed by an LTS period lasting up to 52 weeks.
Disclosures: This study was funded by Incyte Corporation. Four authors declared being employees or shareholders of Incyte Corporation. Several authors declared ties with various sources, including Incyte Corporation.
Source: Eichenfield LF, Simpson EL, Papp K, et al. Efficacy, safety, and long-term disease control of ruxolitinib cream among adolescents with atopic dermatitis: Pooled results from two randomized phase 3 studies. Am J Clin Dermatol. 2024 (May 2). doi: 10.1007/s40257-024-00855-2 Source