Dupilumab Effective for Treating Erythrodermic Atopic Dermatitis

Dupilumab is associated with significant improvements in atopic dermatitis (AD) and has an acceptable safety profile among the subset of patients with erythrodermic AD. These study findings were published in JAMA Dermatology.

Researchers conducted a post hoc analysis pooling data from 6 randomized, placebo-controlled trials. The study interventions included receiving either dupilumab 200 mg every 2 weeks for 16 weeks, dupilumab 300 mg every 2 weeks with or without topical corticosteroids (TCS), dupilumab 300 mg weekly with or without TCS, or placebo with or without TCS.

The subset of participants (N=209) who met the criteria for erythrodermic AD and had AD affecting at least 90% of their body surface area (BSA) were included in the study. The primary outcomes were improvement in BSA, the proportion of patients achieving an at least 2-point improvement from baseline in Investigators’ Global Assessment (IGA), and change in Eczema Area and Surface Index (EASI) scores from baseline and safety.

Patients with erythrodermic AD had a median age of 31 to 39 years, and 71.3% to 74.0% were men. Compared with the original trial populations, the subset with erythrodermic AD tended to have poorer quality of life.

Overall, 86 participants received dupilumab monotherapy, 41 received dupilumab plus TCS, 50 received placebo monotherapy, and 32 received placebo plus TCS.

In the monotherapy treatment arms, the participants who received dupilumab had superior efficacy outcomes for all primary and secondary outcomes compared with placebo (all P £.03). Specifically, the mean changes in BSA from baseline were -40.7% and -17.2% (P =.02), 19.8% and 2.0% of participants achieved the IGA endpoint (P =.005), and the least squares mean difference (LSMD) in EASI scores from baseline were -58.2 and -22.3 points (P =.002) for dupilumab and placebo cohorts, respectively.

In the concomitant TCS treatment arms, all efficacy outcomes favored dupilumab over placebo (all P £.006). The rates of BSA change from baseline were -61.0% and -14.5% (P <.001), rates of achieving IGA improvement were 58.5% and 3.1% (P <.001), and the LSMD in EASI scores were -76.3 and -19.3 points from baseline (P <.001) among the dupilumab and placebo groups, respectively.

Any treatment-emergent adverse event (TEAE) was reported by 70.3% to 91.7% of dupilumab recipients and 78.0% to 78.1% of placebo recipients. A total of 33.3% and 36.7% and 20.0% to 37.5% of events were drug-related in the dupilumab and placebo groups, respectively. The TEAEs that were more common among dupilumab recipients compared with placebo were injection-site reaction, conjunctivitis, and nasopharyngitis. No dupilumab recipients discontinued treatment due to a serious adverse event and no deaths were observed.

The major limitations of this study include the post hoc design and small sample size.

Researchers conclude, “Dupilumab had an acceptable safety profile that did not substantially differ in patients with erythrodermic AD and the overall population of patients with moderate to severe AD enrolled in these trials.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

This article originally appeared on Dermatology Advisor