Frequency and Management of Sleep Disturbance in Adults with Atopic Dermatitis: A Systematic Review

Jeon, Caleb; Yan, Di; Nakamura, Mio; Sekhon, Sahil; Bhutani, Tina; Berger, Timothy G.; Liao, Wilson

doi:10.1007/s13555-017-0192-3

Cited by 87 publications

(95 citation statements)

References 70 publications

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Section: Discussionmentioning

confidence: 99%

“…Patients with moderate‐to‐severe atopic dermatitis who need systemic therapy experience a significant burden of disease . Atopic dermatitis symptoms can profoundly affect sleep, daily functioning, mental/emotional state, concomitant medication use and HRQoL, particularly in patients with untreated or inadequately treated atopic dermatitis . Improvement in patient‐reported outcomes was significant in both the dupilumab + TCS treatment groups, except for the proportion of patients who achieved HADS‐A and HADS‐D scores < 8 (among patients with HADS‐A or HADS‐D ≥ 8 at baseline), which was significantly greater with dupilumab q2w + TCS, but not qw + TCS; however, both dupilumab + TCS dose regimens showed significant improvement in mean change in HADS score from baseline.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Dupilumab with concomitant topical corticosteroid treatment in adults with atopic dermatitis with an inadequate response or intolerance to ciclosporin A or when this treatment is medically inadvisable: a placebo-controlled, randomized phase III clinical t

et al. 2018

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SummaryBackground Atopic dermatitis is a chronic inflammatory skin disease that may require systemic therapy. Ciclosporin A (CsA) is a widely used, potent immunosuppressant but it is not effective in all patients with atopic dermatitis, and sideeffects limit its use. Dupilumab, a fully human anti-interleukin 4 receptor-alpha monoclonal antibody, inhibits signaling of IL-4 and IL-13, key drivers of Type 2/Th2-mediated inflammation, and is approved in the U.S.A. and the European Union for the treatment of inadequately-controlled moderate-to-severe atopic dermatitis in adults. Objectives To evaluate efficacy and safety of dupilumab with concomitant topical corticosteroids (TCS) in adults with atopic dermatitis with inadequate response to/intolerance of CsA, or for whom CsA treatment was medically inadvisable. Methods In this 16-week, double-blind, randomized, placebo-controlled, phase III trial, patients were randomized 1 : 1 : 1 to subcutaneous dupilumab 300 mg weekly (qw) or every 2 weeks (q2w) or placebo. All received concomitant medium-potency TCS from Week À2 through Week 16; dosage could be tapered if lesions cleared, or stopped for adverse reactions to TCS. Results In total, 390 patients were screened, 325 were randomized, and 318 completed the trial. Treatment groups had similar baseline characteristics. Significantly more patients in the dupilumab qw + TCS and q2w + TCS groups achieved ≥ 75% improvement from baseline in the Eczema Area and Severity Index at Week 16 vs. the placebo + TCS group (primary end point) (59Á1% and 62Á6% vs. 29Á6%, respectively; P < 0Á001 vs. placebo + TCS, both doses). Other clinical outcomes and atopic dermatitis symptoms were significantly improved in the dupilumab qw + TCS and q2w + TCS groups, including pruritus, pain, sleep disturbance, symptoms of anxiety and depression, and quality of life (QoL). Treatment groups had similar overall rates of adverse events (qw + TCS, q2w + TCS

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Dupilumab with concomitant topical corticosteroid treatment in adults with atopic dermatitis with an inadequate response or intolerance to ciclosporin A or when this treatment is medically inadvisable: a placebo-controlled, randomized phase III clinical t

et al. 2018

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“…Pruritus, scratching and disturbed sleep are known to have major impact on QoL in patients with AD . Hence, assessment of these symptoms is important when evaluating treatment response in the clinical setting.…”

Section: Discussionmentioning

confidence: 99%

“…Pruritus, scratching and disturbed sleep are known to have major impact on QoL in patients with AD. 16 Hence, assessment of these symptoms is important when evaluating treatment response in the clinical setting. The finding that the median pruritus score was reduced from 8 at baseline to 2 at 1-and 3month follow-up, and that median sleep score was reduced from 7 at baseline to 0 at 1-and 3-month follow-up, emphasizes how treatment with dupilumab markedly improves key symptoms of AD and positively influences patients' daily living.…”

Section: Discussionmentioning

confidence: 99%

Treatment of atopic dermatitis with dupilumab: experience from a tertiary referral centre

Olesen

Holm

Nørreslet

et al. 2019

Acad Dermatol Venereol

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Background Management of moderate‐to‐severe atopic dermatitis (AD) frequently requires treatment with systemic therapies. Dupilumab is the first biological agent approved for treatment of moderate‐to‐severe AD. Although promising results have appeared in clinical trials, real‐life data on efficacy and safety are lacking. Objectives To assess effectiveness and safety of treatment with dupilumab in the real‐life clinical setting at a Danish tertiary referral centre. Methods All patients with AD treated with dupilumab from October 2017 to October 2018 at Bispebjerg Hospital, Denmark, were included in the study. Patients were evaluated three times: at treatment initiation and at 1 and 3 months after first dupilumab injection. At each visit, disease activity was assessed by severity score (Eczema Area and Severity Index, EASI), patient‐reported outcomes (Dermatology Life Quality Index, DLQI, pruritus and sleep score) and serological markers [immunoglobulin (Ig)E, eosinophil count and lactate dehydrogenase (LDH)]. Results A total of 43 patients were included in the study. The mean reduction in EASI score from baseline was 19.6 points (72.4%) at 1‐month and 22.6 points (76.7%) at 3‐month follow‐up. EASI, DLQI, pruritus score, sleep score, IgE and LDH were all statistically significantly reduced between baseline and 1‐ and 3‐month follow‐up. Mean reductions in EASI score and LDH at 3‐month follow‐up were significantly correlated (P = 0.003). One patient (2.3%) discontinued treatment due to side‐effects, and seven patients (18.4%) developed conjunctivitis during the study period. Conclusion The effectiveness and safety of dupilumab treatment in a real‐life clinical setting are comparable to that of phase 3 clinical trials. LDH is suggested as a potential serological marker predictive of treatment response.

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“…Some features of the clinical presentation of atopic dermatitis contribute to this: patients with eczematous lesions on the hands and feet may have limited physical activity because of that; fatigue from sleep disturbances and depression may be indirectly associated with reduced physical activity; at the same time, heat, sweat and exercise are the most frequently reported circumstances leading to exacerbation of symptoms. Additionally, adult patients with atopic dermatitis, apart from reduced physical activity, also have significantly higher cardiovascular risk 53,54,55 .…”

Section: Proach To Skin Diseasesmentioning

confidence: 99%

Psychoneuroimmunology and skin diseases

Mihić¹,

Mihatović²,

Šitum³

2019

Rad Hrvatske akademije znanosti i umjetnosti

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Psychoneuroimmunology has emerged as a broad interdisciplinary field examining the interaction between the psychological state, the nervous system, the endocrine system, and the immune system. Psychodermatology or psychocutaneous medicine is an intersection of psychiatry, psychology and dermatology. There is a growing awareness of the connection between psychosocial stress and somatic illnesses, including dermatological diseases. Psychosomatic factors are considered significant in more than a third of people suffering from skin diseases. Communication between the psyche and the skin is a complex interaction of psychological, immunologic and endocrine factors with the skin, involving a number of neuropeptides, interleukins and immune system mediators. The skin, being the largest organ of the body, is equipped with metabolic and endocrinological capacities that facilitate homeostatic control between internal and external environments. In addition to psychosocial stress, factors relevant for a psychoneuroimmunological approach to skin diseases include nutrition, gut and skin microbiota, sleep and circadian rhythm, physical activity, and orthomolecular medicine. Knowledge of psychoneuroimmunological mechanisms and factors relevant for a holistic approach is very important for a better and broader understanding of skin diseases, and for better therapeutic outcomes for patients. Sažetak:Psihoneuroimunologija se pojavila kao široko interdisciplinarno područje koje obuhvaća povezanost psihičkog stanja, živčanog sustava, endokrinološkog sustava i imunološkog sustava. Psihodermatologija ili psihokutana medicina područje je ispreplitanja psihijatrije, psihologije i dermatologije. Sve je veći broj spoznaja koja govore o vezi psihosocijalnog stresa i somatskih bolesti, uključujući dermatološke bolesti. Psihosomatski čimbenici smatraju se značajnima u više od trećine osoba oboljelih od kožnih bolesti. Komunikacija između psihe i kože uključuje složene interakcije između psiholoških, imunoloških i endokrinoloških čimbenika sa kožnim sustavom, u čemu sudjeluje niz stvorenih neuropeptida, interleukina i posrednika imunološkog sustava. Pritom je koža, kao najveći organ tijela, opremljena metaboličkim i endokrinološkim sposobnostima koje olakšavaju homeostatsku kontrolu između unutarnjih i vanjskih okruženja. Uz psihosocijalni stresa, čimbenici važni unutar psihoneuroimunološkog pristupa kožnim bolestima uključuju prehranu, mikrobiom crijeva i kože, spavanje i cirkadijalni ritam, fizičku aktivnost i ortomolekularnu medicinu. Poznavanje psihoneuroimunoloških mehanizama i čimbenika relevantnih za holistički pristup vrlo je važno zbog boljeg razumijevanje kožnih bolesti, a ujedno i za bolji terapijski ishod u bolesnika. ključne riječi: psihoneuroimunologija, psihodermatologija, kožne bolesti, stres, psorijaza, atopijski dermatitis OPEN ACCESS

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Frequency and Management of Sleep Disturbance in Adults with Atopic Dermatitis: A Systematic Review

Cited by 87 publications

References 70 publications

Dupilumab with concomitant topical corticosteroid treatment in adults with atopic dermatitis with an inadequate response or intolerance to ciclosporin A or when this treatment is medically inadvisable: a placebo-controlled, randomized phase III clinical t

Dupilumab with concomitant topical corticosteroid treatment in adults with atopic dermatitis with an inadequate response or intolerance to ciclosporin A or when this treatment is medically inadvisable: a placebo-controlled, randomized phase III clinical t

Treatment of atopic dermatitis with dupilumab: experience from a tertiary referral centre

Psychoneuroimmunology and skin diseases

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