Atopic dermatitis is associated with increased prevalence of multiple ocular comorbidities

Govind, Kishan; Whang, Katherine A.; Khanna, Raveena; Scott, Adrienne W.; Kwatra, Shawn G.

doi:10.1016/j.jaip.2018.10.009

Cited by 42 publications

(57 citation statements)

References 5 publications

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“…However, the limited daily practice literature available also showed conjunctivitis incidence ranges up to 50% in patients treated with dupilumab . Literature on ocular comorbidities in AD shows that several ocular comorbidities are more prevalent among patients with AD than among the general population . Additionally, Thyssen et al .…”

Section: Discussionmentioning

confidence: 99%

“…[33][34][35][36][37] Literature on ocular comorbidities in AD shows that several ocular comorbidities are more prevalent among patients with AD than among the general population. 39 Additionally, Thyssen et al recently showed that this increased risk and prevalence is disease-severity dependent. 40,41 We hypothesize that the difference between real-world and clinical trials may be explained by differences in (long-term) disease severity in patients in this study, as discussed above.…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness of dupilumab treatment in 95 patients with atopic dermatitis: daily practice data

et al. 2019

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Summary Background Dupilumab is the first biologic registered for the treatment of moderate‐to‐severe atopic dermatitis (AD), and efficacy was shown in phase III clinical trials (primary outcome at week 16 was reached in 38% of patients). Currently, there are limited daily practice data available for dupilumab, especially when it is combined with systemic immunosuppressants. Objectives To evaluate dupilumab treatment in daily practice in patients with AD. Methods In this observational cohort study, we prospectively included all adult patients with AD who had been treated with dupilumab in two university hospitals in the Netherlands. Concomitant systemic immunosuppressive treatment was monitored. Physician‐reported outcome measures and patient‐reported outcome measures (PROMs) after ≥ 12 weeks of follow‐up were analysed. We used a linear mixed‐effects model to determine changes in scores during follow‐up. Results Ninety‐five patients were included. Of these, 62 patients were using systemic immunosuppressants at baseline; the use of systemic immunosuppressants was continued during dupilumab treatment in 43 patients. From baseline to 16 weeks of treatment, the estimated mean Eczema Area and Severity Index score (0–72) decreased from 18·6 [95% confidence interval (CI) 16·0–21·4)] to 7·3 (95% CI 5·4–10·0), and the estimated mean PROMs showed a decrease of 41–66%. Investigator's Global Assessment 0 or 1 (clear/almost clear) was reached in 38% of the patients. Five patients discontinued dupilumab treatment due to side‐effects or ineffectiveness. Eye symptoms and orofacial (nonocular) herpes simplex virus (HSV) reactivation were reported in 62% and 8% of the patients, respectively. Conclusions Dupilumab treatment in daily practice shows a clinically relevant improvement of physician‐reported outcome measures and PROMs, which is in line with efficacy data from clinical trials. Besides frequently reported eye symptoms and orofacial (nonocular) HSV reactivation, there were no apparent safety concerns. What's already known about this topic? Dupilumab has been shown to be an efficacious treatment for atopic dermatitis in several clinical trials. However, it is known that there may be considerable differences in patient characteristics and treatment responses between clinical trials and daily practice. What does this study add? This study presents the first experience with dupilumab treatment in 95 patients with atopic dermatitis in daily practice in two Dutch university hospitals. Less stringent inclusion and exclusion criteria and follow‐up schedules, in contrast to those used in clinical trials, might better represent daily practice. Dupilumab treatment shows a clinically relevant improvement of physician‐ and patient‐reported outcome measures; besides patient‐reported eye symptoms (in 59 of 95 patients; 62%) and an apparent increase in orofacial (nonocular) herpes simplex virus reactivation (eight of 95 patients; 8%), there were no other safety concerns during follow‐up up to 16 weeks of dupilumab treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effectiveness of dupilumab treatment in 95 patients with atopic dermatitis: daily practice data

et al. 2019

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“…The study population consisted of all patients age 18 or less seen at JHHS between 1 January 2012 and 1 January 2019. Anonymized aggregate-level data was collected using the Slicer Dicer function within Johns Hopkins EPIC electronic medical records [3][4][5]13,14]. IRB approval was therefore waived.…”

Section: Methodsmentioning

confidence: 99%

“…IRB approval was therefore waived. SNOMED-CT concept terms were used to specify all data [3][4][5]13,14]. All results combined male and female patients.…”

Section: Methodsmentioning

confidence: 99%

Association between Itch and Cancer in 3836 Pediatric Pruritus Patients at a Tertiary Care Center

et al. 2019

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Background: Pruritus is a well-recognized paraneoplastic phenomenon. Previous studies have examined the association of itch with a variety of malignancies in adults. However, no large study has examined this association in a pediatric population. Methods: A retrospective study was conducted of patients age 18 or less seen at Johns Hopkins Health System between 2012 and 2019. Results: A pediatric hospital population of 1,042,976 patients was reviewed. Pruritus was observed in 3836 pediatric patients of whom 130 also had cancer. Pediatric patients with pruritus were significantly more likely to have concomitant malignancy compared to pediatric patients without pruritus (OR 12.84; 95% CI 10.73–15.35, p < 0.001). Malignancies most strongly associated with pruritus included neoplasms of the blood (OR 14.38; 95% CI 11.30–18.29, p < 0.001), bone (OR 29.02, 95% CI 18.28–46.06, p < 0.001) and skin (OR 22.76, 95% CI 9.14–56.72, p < 0.001. Conclusions: Pruritus is significantly associated with malignancy in the pediatric hospital population. Clinicians should also be aware of the high burden of itch in pediatric malignancies and the variation in pruritus across malignancies.

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“…Outras formas de hipersensibilidades são comuns nos pacientes portadores de DA, como asma, alergias alimentares, (27) rinites e conjuntivites alérgicas (28) e o quadro clínico se torna ainda mais grave quando há outras comorbidades tais como: infecções cutâneas (29) e extracutâneas, condições neuropsiquiátricas como depressão, ansiedade (30) , transtorno de déficit de atenção e hiperatividade (TDAH), (31) doenças autoimunes, (32) câncer, (33) obesidade, (34) distúrbios cardiovasculares (35) e envolvimento ocular. (36) Embora mais estudos sejam necessários para comprovar a associação da DA com a maioria das comorbidades citadas, em relação ao quadro ocular, os estudos são consistentes e demonstram risco de perda visual, se não identificados e tratados. (37) Aproximadamente 40% dos indivíduos portadores de DA apresentam acometimento ocular.…”

Section: Manifestações Oculares Na Daunclassified

Análise da expressão das proteínas de barreira epitelial, filagrina e claudina-1, na superfície ocular de pacientes portadores de dermatite atópica

Callou¹

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Análise da expressão das proteínas de barreira epitelial, filagrina e claudina-1, na superfície ocular de pacientes portadores de dermatite atópica São Paulo 2019 Tese apresentada à Faculdade de Medicina da Universidade de São Paulo para obtenção do título em doutor em Ciências Programa de Oftalmologia Orientador: Profa. Dra. Ruth Miyuki Santo Co-orientador: Profa. Dra. Monique Matsuda Dedicatória DedicatóriaAos meus pais José Lívio e Bida, pelo amor incondicional, pelo apoio incessante a minha carreira profissional, por serem meus maiores exemplos de dedicação e firmeza de caráter e a quem serei eternamente grata.Ao meu esposo Bruno, que esteve ao meu lado em todas as etapas da construção desta tese e representou minha fortaleza nas partes mais árduas; com quem pude dividir aprendizados e de quem sempre recebi carinho, compreensão e estímulo.Ao meu filho Bernardo, que faz brotar em mim diariamente um desejo cada vez maior de crescer como ser humano e como profissional.Aos meus irmãos Clarice, Eduardo e Romero, pela certeza de que juntos somos mais fortes, por serem pilares na minha vida.Aos meus tios José Luiz e Amélia e as minhas primas Natália, Alexandra e Rosa, que vibraram com cada conquista e que significaram um porto seguro na minha trajetória em São Paulo.Ao meu avô Antônio Lyrio Callou (in memorian), que me deixou o grande legado de ingressar na carreira acadêmica.

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Atopic dermatitis is associated with increased prevalence of multiple ocular comorbidities

Cited by 42 publications

References 5 publications

Effectiveness of dupilumab treatment in 95 patients with atopic dermatitis: daily practice data

Effectiveness of dupilumab treatment in 95 patients with atopic dermatitis: daily practice data

Association between Itch and Cancer in 3836 Pediatric Pruritus Patients at a Tertiary Care Center

Análise da expressão das proteínas de barreira epitelial, filagrina e claudina-1, na superfície ocular de pacientes portadores de dermatite atópica

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