Treatment of Comorbidities of Atopic Dermatitis in One Go and Where to Refer Candidates for Biologic Therapy
Patients suffering from atopic dermatitis (AD) along with allergic comorbidities typically require a fairly complex pharmacotherapy to manage their difficulties. However, their everyday lives can be significantly simplified with biological therapy.
Problems Hand in Hand
Atopic dermatitis means much more than just itchy skin. Patients with AD have a higher prevalence of allergic rhinitis and bronchial asthma, and the more severe the dermatitis, the higher the occurrence. This relationship is explained by the concept of atopic/allergic march. The cause lies in the defective barrier function of the skin, which provokes a TH2 immune response to airborne, food, and microbial allergens. The result is multiple IgE sensitizations and the development of allergic diseases.
Effective Solution Without Polypharmacy
Comorbidities of atopic dermatitis should be considered in treatment to avoid polypharmacy and increase the effectiveness and efficiency of the therapy. One well-chosen drug can benefit the patient in many ways. Such a drug is dupilumab, a fully human monoclonal IgG4 antibody that inhibits interleukin IL-4 and IL-13 signaling.
Evaluated Patient Cohort
The real-world efficacy of dupilumab in a cohort of 123 patients with atopic dermatitis and various allergic comorbidities was verified by a study conducted in Italy in 2018–2019. The study included patients over 18 years old with an IGA (Investigator Global Assessment) score of 3–4 and an EASI (Eczema Area and Severity Index) score of ≥ 24. Another criterion was intolerance to cyclosporine treatment, insufficient response, or inability to undergo the treatment.
All participants were treated with an initial dose of 600 mg of dupilumab followed by 300 mg biweekly (subcutaneously). They continued their pre-study pharmacotherapy during the trial.
Results and Conclusion
Out of 123 patients, only one dropped out due to developing bilateral conjunctivitis and ectropium cicatriceum. The remaining 122 participants completed the study. Within 16 weeks of treatment, there was a significant decrease in EASI, SCORAD (Scoring Atopic Dermatitis), POEM (Patient-Oriented Eczema Measure) scores, reduced pruritus, improved sleep, overall quality of life, and decreased IgE levels.
Improvement in allergic rhinitis (affecting 41 participants) and asthma (affecting 32 cohort members) was demonstrated by scoring systems covering symptom severity and related quality of life. Thus, dupilumab proved effective in treating both atopic dermatitis and its comorbidities simultaneously.
Where to Refer the Patient Next
Biological therapy is conducted in specialized centers. If you conclude that this therapy is suitable for any of your patients, you can refer them to one of the centers listed here. If asthma is also a comorbidity of atopic dermatitis, you can refer to severe asthma treatment centers listed in this list.
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Source: Nettis E., Patella V., Lombardo C. et al. Efficacy of dupilumab in atopic comorbidities associated with moderate-to-severe adult atopic dermatitis. Allergy 2020 Apr 23, doi: 10.1111/all.14338 [Epub ahead of print].
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