Conjunctivitis in adult patients with moderate-to-severe atopic dermatitis: results from five tralokinumab clinical trials.


Journal

The British journal of dermatology
ISSN: 1365-2133
Titre abrégé: Br J Dermatol
Pays: England
ID NLM: 0004041

Informations de publication

Date de publication:
03 2022
Historique:
accepted: 07 10 2021
pubmed: 13 10 2021
medline: 22 4 2022
entrez: 12 10 2021
Statut: ppublish

Résumé

Tralokinumab, a fully human IgG4 monoclonal antibody that specifically binds with high affinity to interleukin-13, effectively reduces moderate-to-severe atopic dermatitis (AD) when given every 2 weeks. The incidence of conjunctivitis is elevated vs. placebo, but severity and aetiology have not been examined. To analyse conjunctivitis data recorded in five randomized, placebo-controlled trials of tralokinumab in adult patients with moderate-to-severe AD. Overall, 2285 adults with AD were studied up to 16 weeks. Cochran-Mantel-Haenszel weights were applied to calculate the adjusted incidence of adverse events. The incidence of conjunctivitis was higher (7·5%) with tralokinumab than with placebo (3·2%). Most events were mild or moderate in severity, and 78·6% and 73·9% of events resolved during the trial in the tralokinumab and placebo groups, respectively. Two (1·4%) events led to the permanent discontinuation of tralokinumab. An increased incidence of conjunctivitis, regardless of treatment group, was associated with more severe baseline AD, and history of allergic conjunctivitis/atopic keratoconjunctivitis, as well as the number of atopic comorbidities. This analysis reports events up to week 16 only, with limited confirmation of conjunctivitis and its aetiology by an ophthalmologist, and insufficient reporting of ophthalmic treatments. Treatment with tralokinumab was associated with an increased incidence of conjunctivitis vs. placebo, but these cases were mostly mild and transient.

Sections du résumé

BACKGROUND
Tralokinumab, a fully human IgG4 monoclonal antibody that specifically binds with high affinity to interleukin-13, effectively reduces moderate-to-severe atopic dermatitis (AD) when given every 2 weeks. The incidence of conjunctivitis is elevated vs. placebo, but severity and aetiology have not been examined.
OBJECTIVE
To analyse conjunctivitis data recorded in five randomized, placebo-controlled trials of tralokinumab in adult patients with moderate-to-severe AD.
METHODS
Overall, 2285 adults with AD were studied up to 16 weeks. Cochran-Mantel-Haenszel weights were applied to calculate the adjusted incidence of adverse events.
RESULTS
The incidence of conjunctivitis was higher (7·5%) with tralokinumab than with placebo (3·2%). Most events were mild or moderate in severity, and 78·6% and 73·9% of events resolved during the trial in the tralokinumab and placebo groups, respectively. Two (1·4%) events led to the permanent discontinuation of tralokinumab. An increased incidence of conjunctivitis, regardless of treatment group, was associated with more severe baseline AD, and history of allergic conjunctivitis/atopic keratoconjunctivitis, as well as the number of atopic comorbidities.
LIMITATIONS
This analysis reports events up to week 16 only, with limited confirmation of conjunctivitis and its aetiology by an ophthalmologist, and insufficient reporting of ophthalmic treatments.
CONCLUSIONS
Treatment with tralokinumab was associated with an increased incidence of conjunctivitis vs. placebo, but these cases were mostly mild and transient.

Identifiants

pubmed: 34637142
doi: 10.1111/bjd.20810
doi:

Substances chimiques

Antibodies, Monoclonal 0
tralokinumab GK1LYB375A

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

453-465

Commentaires et corrections

Type : CommentIn

Informations de copyright

© 2021 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.

Références

Wollenberg A, Christen-Zäch S, Taieb A et al. ETFAD/EADV Eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children. J Eur Acad Dermatol Venereol 2020; 34:2717-44.
Ravn NH, Ahmadzay ZF, Christensen TA et al. Bidirectional association between atopic dermatitis, conjunctivitis and other ocular surface diseases: a systemic review and meta-analysis. J Am Acad Dermatol 2021; 85:453-61.
Thyssen JP, Toft PB, Halling-Overgaard AS et al. Incidence, prevalence, and risk of selected ocular disease in adults with atopic dermatitis. J Am Acad Dermatol 2017; 77:280-6.
Treister AD, Kraff-Cooper C, Lio PA. Risk factors for dupilumab-associated conjunctivitis in patients with atopic dermatitis. JAMA Dermatol 2018; 154:1208-11.
Akinlade B, Guttman-Yassky E, de Bruin-Weller M et al. Conjunctivitis in dupilumab clinical trials. Br J Dermatol 2019; 181:459-73.
Simpson EL, Bieber T, Guttman-Yassky E et al. Two phase 3 trials of dupilumab versus placebo in atopic dermatitis. N Engl J Med 2016; 375:2335-48.
Schneeweiss MC, Kim SC, Wyss R et al. Dupilumab and the risk of conjunctivitis and serious infection in patients with atopic dermatitis: a propensity score-matched cohort study. J Am Acad Dermatol 2021; 84:300-11.
Beck KM, Seitzman GD, Yang EJ et al. Ocular co-morbidities of atopic dermatitis. Part II: ocular disease secondary to treatments. Am J Clin Dermatol 2019; 20:807-15.
Halling AS, Loft N, Silverberg JI et al. Real-world evidence of dupilumab efficacy and risk of adverse events: a systematic review and meta-analysis. J Am Acad Dermatol 2021; 84:139-47.
Achten R, Bakker D, Ariens L et al. Long-term follow-up and treatment outcomes of conjunctivitis during dupilumab treatment in patients with moderate-to-severe atopic dermatitis. J Allergy Clin Immunol Pract 2021; 9:1389-92.
Simpson EL, Akinlade B, Ardeleanu M. Letter to the Editor: Two phase 3 trials of dupilumab versus placebo in atopic dermatitis. N Engl J Med 2017; 376:1090-1.
Bachert C, Mannent L, Naclerio RM et al. Effect of subcutaneous dupilumab on nasal polyp burden in patients with chronic sinusitis and nasal polyposis: a randomized clinical trial. JAMA 2016; 315:469-79.
Castro M, Corren J, Pavord ID et al. Dupilumab efficacy and safety in moderate-to-severe uncontrolled asthma. N Engl J Med 2018; 378:2486-96.
Hirano I, Dellon ES, Hamilton JD et al. Efficacy of dupilumab in a phase 2 randomized trial of adults with active eosinophilic esophagitis. Gastroenterology 2020; 158:111-22.
Silverberg JI, Toth D, Bieber T et al. Tralokinumab plus topical corticosteroids for the treatment of moderate-to-severe atopic dermatitis: results from the double-blind, randomized, multicentre, placebo-controlled phase III ECZTRA 3 trial. Br J Dermatol 2021; 184:450-63.
Guttman-Yassky E, Blauvelt A, Eichenfield LF et al. Efficacy and safety of lebrikizumab, a high-affinity interleukin 13 inhibitor, in adults with moderate to severe atopic dermatitis: a phase 2b randomized clinical trial. JAMA Dermatol 2020; 156:411-20.
Simpson EL, Flohr C, Eichenfield LF et al. Efficacy and safety of lebrikizumab (an anti-IL-13 monoclonal antibody) in adults with moderate-to-severe atopic dermatitis inadequately controlled by topical corticosteroids: a randomized, placebo-controlled phase II trial (TREBLE). J Am Acad Dermatol 2018; 78:863-71.
Wollenberg A, Blauvelt A, Guttman-Yassky E et al. Tralokinumab for moderate-to-severe atopic dermatitis: results from two 52-week, randomized, double-blind, multicentre, placebo-controlled phase III trials (ECZTRA 1 and ECZTRA 2). Br J Dermatol 2021; 184:437-49.
Tsoi LC, Rodriguez E, Degenhardt F et al. Atopic dermatitis is an IL-13 dominant disease with greater molecular heterogeneity compared to psoriasis. J Invest Dermatol 2019; 139:1480-9.
Bieber T. Interleukin-13: targeting an underestimated cytokine in atopic dermatitis. Allergy 2020; 75:54-62.
Popovic B, Breed J, Rees DG et al. Structural characterisation reveals mechanism of IL-13-neutralising monoclonal antibody tralokinumab as inhibition of binding to IL-13Ra1 and IL-13Ra2. J Mol Biol 2017; 429:208-19.
Wollenberg A, Howell MD, Guttman-Yassky E et al. Treatment of atopic dermatitis with tralokinumab, an anti-IL-13 mAb. J Allergy Clin Immunol 2019; 143:135-41.
Merola JF, Bagel J, Almgren P et al. Tralokinumab does not impact vaccine-induced immunity: results from a 30-week, randomized, placebo-controlled trial in adults with moderate-to-severe atopic dermatitis. J Am Acad Dermatol 2021; 85:71-8.
Agnihotri G, Shi K, Lio PA. A clinician’s guide to the recognition and management of dupilumab-associated conjunctivitis. Drugs R D 2019; 19:311-8.
Wollenberg A, Ariens L, Thurau S et al. Conjunctivitis occurring in atopic dermatitis patients treated with dupilumab-clinical characteristics and treatment. J Allergy Clin Immunol Pract 2018; 6:1778-80.
Thyssen JP, Heegaard S, Ivert L et al. Management of ocular manifestations of atopic dermatitis: a consensus meeting using a modified Delphi process. Acta Derm Venereol 2020; 100:adv00264.
Ferreira S, Torres T. Conjunctivitis in patients with atopic dermatitis treated with dupilumab. Drugs in Context 2020; 9:2020-2-3.
Wollenberg A, Beck LA, Blauvelt A et al. Laboratory safety of dupilumab in moderate-to-severe atopic dermatitis: results from three phase III trials (LIBERTY AD SOLO 1, LIBERTY AD SOLO 2, LIBERTY AD CHRONOS). Br J Dermatol 2020; 182:1120-35.
Bakker DS, Ariens LFM, van Luijk C et al. Goblet cell scarcity and conjunctival inflammation during treatment with dupilumab in patients with atopic dermatitis. Br J Dermatol 2019; 180:1248-9.
Voorberg AN, den Dunnen WFA, Wijdh RHJ et al. Letter to the Editor: Recurrence of conjunctival goblet cells after discontinuation of dupilumab in a patient with dupilumab-related conjunctivitis. J Eur Acad Dermatol Venereol 2020; 34:e64-6.
Yokoi K, Yokoi N, Kinoshita S. Impairment of ocular surface epithelium barrier function in patients with atopic dermatitis. Br J Ophthalmol 1998; 82:797-800.
Dogru M, Katakami C, Nakagawa N et al. Impression cytology in atopic dermatitis. Ophthalmology 1998; 105:1478-84.
Utine CA, Li G, Asbell P et al. Ocular surface disease associated with dupilumab treatment for atopic diseases. Ocul Surf 2020; 19:151-6.
Brøgger P, Blom LH, Simonsen S et al. Antagonism of the interleukin 4 receptor α promotes TH1-signalling among T cells from patients with atopic dermatitis after stimulation. Scand J Immunol 2019; 91:e12835.
Thyssen JP. Could conjunctivitis in patients with atopic dermatitis treated with dupilumab be caused by colonization with Demodex and increased interleukin-17 levels? Br J Dermatol 2018; 178:1220.
Stern ME, Siemasko K, Gao J et al. Role of interferon-γ in a mouse model of allergic conjunctivitis. Invest Ophthalmol Vis Sci 2005; 46:3239-46.
Reyes N, Blanco T, Mathew R et al. Novel mouse model of severe ocular allergy reveals a key role for pathogenic Th17 cells. Invest Ophthalmol Vis Sci 2014; 55:4058.
Utine CA, Stern M, Akpek EK. Immunopathological features of severe chronic atopic keratoconjunctivitis and effects of topical cyclosporine treatment. Ocul Immunol Inflamm 2019; 27:1184-93.
Thyssen JP, de Bruin-Weller MS, Paller AS et al. Conjunctivitis in atopic dermatitis patients with and without dupilumab therapy - International Eczema Council survey and opinion. J Eur Acad Dermatol Venereol 2019; 33:1224-31.
Aszodi N, Thurau S, Seegräber M et al. Management of dupilumab-associated conjunctivitis in atopic dermatitis. J Dtsch Dermatol Ges 2019; 17:488-91.
Gooderham M, McDonald J, Papp K. Diagnosis and management of conjunctivitis for the dermatologist. J Cutan Med Surg 2017; 22:200-6.
Faiz S, Giovannelli J, Podevin C et al. Effectiveness and safety of dupilumab for the treatment of atopic dermatitis in a real-life French multicenter adult cohort. J Am Acad Dermatol 2019; 81:143-51.
Simpson E, Merola JF, Silverberg J et al. Safety of specifically targeting interleukin-13 with tralokinumab in adult patients with moderate-to-severe atopic dermatitis: pooled analysis of five randomised, double-blind, placebo-controlled phase 3 and phase 2 trials. Skin 2021; 5:s11.

Auteurs

A Wollenberg (A)

Klinikum der Universität München, Klinik und Poliklinik für Dermatologie und Allergologie, Munich, Germany.

L A Beck (LA)

Department of Dermatology, Medicine and Pathology, University of Rochester Medical Center, Rochester, NY, USA.

M de Bruin Weller (M)

Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands.

E L Simpson (EL)

Department of Dermatology, Oregon Health & Science University, Portland, OR, USA.

S Imafuku (S)

Department of Dermatology, Fukuoka University Faculty of Medicine, Fukuoka, Japan.

M Boguniewicz (M)

Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health, Denver, CO, USA.

R Zachariae (R)

LEO Pharma A/S, Ballerup, Denmark.

C K Olsen (CK)

LEO Pharma A/S, Ballerup, Denmark.

J P Thyssen (JP)

Department of Dermatology and Venereology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female
Humans United States Aged Cross-Sectional Studies Medicare Part C
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH