Biomarkers and patient-related factors associated with clinical outcomes in dupilumab-treated atopic dermatitis.

Background

Atopic dermatitis (AD) is a common chronic eczematous skin disease with severe pruritus. Several new therapeutic agents for AD such as dupilumab, an anti-IL-4Rα antibody, have been developed in recent years. We need to predict which agent is the best choice for each patient, but this remains difficult.

Objective

Our aim was to examine clinical background factors and baseline biomarkers that could predict the achievement of improved clinical outcomes in patients with AD treated with dupilumab.

Methods

A multicenter, prospective observational study was conducted on 110 patients with AD. The Eczema Area and Severity Index was used as an objective assessment, and the Patient-Oriented Eczema Measure and Numerical Rating Scale for Pruritus were used as patient-reported outcomes. In addition, some clinical background factors were evaluated.

Results

The achievement of an absolute Eczema Area and Severity Index of 7 or less was negatively associated with current comorbidity of food allergy and baseline serum lactate dehydrogenase (LDH) levels. There were negative associations between achievement of a Patient-Oriented Eczema Measure score of 7 or less and duration of severe AD and between achievement of an itching Numerical Rating Scale for Pruritus score of 1 or less and current comorbidity of allergic conjunctivitis or baseline serum periostin level. Furthermore, signal detection analysis showed that a baseline serum LDH level less than 328 U/L could potentially be used as a cutoff value for predicting the efficacy of dupilumab.

Conclusion

Baseline biomarkers such as LDH and periostin and clinical background factors such as current comorbidity of food allergy and a long period of severe disease may be useful indicators when choosing dupilumab for systemic treatment for AD, as they can predict the efficacy of dupilumab.

Informations de copyright

© 2024 Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology.

Déclaration de conflit d'intérêts

Supported by 10.13039/100004339Sanofi and 10.13039/100009857Regeneron (grant SGZ-2018-11996). These companies had no influence on the design of the study, collection and analysis of the data, or decision to publish the article. Disclosure of potential conflict of interest: K. Izuhara has received grants and personal fees from Shino-test Co, Ltd. H. Saeki has received lecture fees, research costs, or scholarship donations from Mitsubishi Tanabe Pharma, Taiho Pharmaceutical, 10.13039/100016730Torii Pharmaceutical, Maruho, Kyowa Kirin, Sanofi, AbbVie, Novartis Pharma, Eli Lilly Japan, Kyorin Pharmaceutical, Eisai, Tokiwa Pharmaceutical, Japan Tobacco, and LEO Pharma. Y. Kataoka has received lecturer honoraria from Sanofi and AbbVie and research funding from Sanofi, Leo Pharma, Pfizer, Maruho, Lilly, AbbVie, and Otsuka. S. Kaneko has received grants as an investigator from Eli Lilly Japan and honoraria as a speaker from Eli Lilly Japan. A. Tanaka has received honoraria from Eli Lilly, Kaken Seiyaku, Sanofi, Taiho Pharma, AbbVie, Kyorin Pharmaceutical, Mitsubishi-Tanabe, Torii Pharmaceutical, and Maruho as a speaker and research grants from Eli Lilly, Sanofi, Teijin Pharma, Taiho Pharma, Mitsubishi-Tanabe, Torii Pharmaceutical, and Maruho. M. Hide has received lecture and/or consultation fees from AbbVie, Eli Lilly, Kaken Pharmaceutical, Kyowa Kirin, Kyorin Pharmaceutical, Maruho, Mitsubishi-Tanabe Pharma, MSD, Novartis, Sanofi, Taiho Pharma, Teikoku Seiyaku, Torii, and Uriach. R. Tamagawa-Mineoka has received research grants from Maruho and 10.13039/501100012351Mitsubishi Tanabe Pharma. K. Masuda has received honoraria as a speaker for Sanofi and grants as an investigator for Eli Lilly Japan. T. Takeichi has received grants paid to his institution (10.13039/501100004823Nagoya University) from Boehringer Ingelheim. M. Akiyama has received research support from Novartis and Boehringer Ingelheim; personal fees from Maruho and Sanofi; and grants paid to his institution (Nagoya University) from Mitsubishi-Tanabe, Taiho, AbbVie, Maruho, Ono, and Sun Pharma. Y. Ishiuji has received honoraria as a speaker for Eli Lilly Japan. Y. Hatano has received honoraria and consultancies to sponsoring organizations from 10.13039/100004339Sanofi, Taiho Pharma, Janssen Pharma, Maruho, Pfizer Japan, Sun Pharma Japan, Torii Pharmaceutical, AbbVie, KAKEN, and UCB Japan. N. Katoh has received honoraria as a speaker/consultant for Sanofi, Maruho, AbbVie, Eli Lilly Japan, and Leo Pharma and grants as an investigator from Maruho, Eli Lilly Japan, Sun Pharma, Taiho Pharmaceutical, Torii Pharmaceutical, Boehringer Ingelheim Japan, and Leo Pharma. Takeshi Nakahara has received lecture fees and research costs from Mitsubishi Tanabe Pharma, Taiho Pharmaceutical, Torii Pharmaceutical, Maruho, Sanofi, AbbVie, Eli Lilly Japan, and Sun Pharma. The rest of the authors declare that they have no relevant conflicts of interest.