Successful Combination of Systemic Agents for the Treatment of Atopic Dermatitis Resistant to Dupilumab Therapy.
Adult
Aged
Anti-Inflammatory Agents
/ therapeutic use
Antibodies, Monoclonal, Humanized
/ adverse effects
Combined Modality Therapy
Cyclosporine
/ therapeutic use
Dermatitis, Atopic
/ drug therapy
Dermatologic Agents
/ adverse effects
Drug Resistance
Drug Therapy, Combination
/ adverse effects
Female
Humans
Immunosuppressive Agents
/ therapeutic use
Male
Methotrexate
/ therapeutic use
Methylprednisolone
/ therapeutic use
Middle Aged
Retrospective Studies
Ultraviolet Therapy
Atopic dermatitis
Dupilumab
Phototherapy
Systemic therapy
Journal
Dermatology (Basel, Switzerland)
ISSN: 1421-9832
Titre abrégé: Dermatology
Pays: Switzerland
ID NLM: 9203244
Informations de publication
Date de publication:
2021
2021
Historique:
received:
28
09
2020
accepted:
03
11
2020
pubmed:
22
1
2021
medline:
15
12
2021
entrez:
21
1
2021
Statut:
ppublish
Résumé
Dupilumab, a monoclonal antibody inhibiting the signaling pathway of IL-4/IL-13, was shown to be safe and effective in the treatment of moderate/severe atopic dermatitis (AD) in several clinical trials and real-life experiences, with only a small percentage of patients showing to be resistant or to lose disease control. In this study, we investigated the effectiveness and safety in combining dupilumab with systemic agents or phototherapy in patients experiencing an inadequate response to dupilumab. This retrospective, monocentric, observational study consecutively included patients aged >18 years, with moderate-severe AD, under treatment with dupilumab. In this cohort of patients, we analyzed data of subjects who experienced an inadequate response to dupilumab, even when combined with topical corticosteroids, and for whom an additional systemic treatment or phototherapy was combined to dupilumab. In this study, we included a total population of 69 patients treated with dupilumab. In 12/69 patients (17.4%) showing an inadequate response to dupilumab, a combined treatment consisting of dupilumab plus methylprednisolone (n = 5), cyclosporine (n = 4), methotrexate (n = 2), or narrow band-UVB (n = 1) was administered. Overall, after 8 weeks of combined therapy, the majority of patients (11 of 12) obtained an improvement of signs and symptoms of AD. Patients treated with combined therapy did not experience any adverse events, neither did they withdraw treatment because of the occurrence of adverse events. This study suggests that the combination of dupilumab with a conventional drug or phototherapy may represent a valid therapeutic choice, maintaining a good safety profile in AD patients recalcitrant to dupilumab monotherapy.
Sections du résumé
BACKGROUND
BACKGROUND
Dupilumab, a monoclonal antibody inhibiting the signaling pathway of IL-4/IL-13, was shown to be safe and effective in the treatment of moderate/severe atopic dermatitis (AD) in several clinical trials and real-life experiences, with only a small percentage of patients showing to be resistant or to lose disease control.
OBJECTIVES
OBJECTIVE
In this study, we investigated the effectiveness and safety in combining dupilumab with systemic agents or phototherapy in patients experiencing an inadequate response to dupilumab.
METHODS
METHODS
This retrospective, monocentric, observational study consecutively included patients aged >18 years, with moderate-severe AD, under treatment with dupilumab. In this cohort of patients, we analyzed data of subjects who experienced an inadequate response to dupilumab, even when combined with topical corticosteroids, and for whom an additional systemic treatment or phototherapy was combined to dupilumab.
RESULTS
RESULTS
In this study, we included a total population of 69 patients treated with dupilumab. In 12/69 patients (17.4%) showing an inadequate response to dupilumab, a combined treatment consisting of dupilumab plus methylprednisolone (n = 5), cyclosporine (n = 4), methotrexate (n = 2), or narrow band-UVB (n = 1) was administered. Overall, after 8 weeks of combined therapy, the majority of patients (11 of 12) obtained an improvement of signs and symptoms of AD. Patients treated with combined therapy did not experience any adverse events, neither did they withdraw treatment because of the occurrence of adverse events.
CONCLUSIONS
CONCLUSIONS
This study suggests that the combination of dupilumab with a conventional drug or phototherapy may represent a valid therapeutic choice, maintaining a good safety profile in AD patients recalcitrant to dupilumab monotherapy.
Identifiants
pubmed: 33477153
pii: 000512890
doi: 10.1159/000512890
doi:
Substances chimiques
Anti-Inflammatory Agents
0
Antibodies, Monoclonal, Humanized
0
Dermatologic Agents
0
Immunosuppressive Agents
0
dupilumab
420K487FSG
Cyclosporine
83HN0GTJ6D
Methylprednisolone
X4W7ZR7023
Methotrexate
YL5FZ2Y5U1
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
535-541Informations de copyright
© 2021 S. Karger AG, Basel.