Treatment With Dupilumab in Patients With Atopic Dermatitis: Systematic Review and Meta-Analysis

Abstract

Atopic dermatitis (AD) is a type 2 chronic skin disorder associated with systemic and psychosocial comorbidities decreasing the quality of life for many patients. Dupilumab, a human monoclonal antibody that blocks interleukins IL-4 and IL-13, is a recently added systematic treatment option with an emerging evidence base. Here, we assessed the safety and efficacy of dupilumab in patients with AD. We conducted a systematic review and meta-analysis of placebo-controlled randomized clinical trials evaluating the safety and efficacy of dupilumab on AD-related outcomes including clinical symptoms, quality of life and adverse events (AE). Subgroup analysis was further performed in adults and children/adolescents. Fourteen trials were included: twelve in adults (n = 3,817) and two in children/adolescents (n = 618). Dupilumab decreased the Eczema Area Severity Index (EASI) score [standardized mean difference (SMD) = −0.98; 95% confidence interval (95% CI) = (−1.09, −0.88)], the percent change difference in Scoring Atopic Dermatitis (SCORAD) [mean difference (MD) = −31.56, 95% CI = (−33.75, −29.36)], and in pruritus Numeric Rating Scale (pNRS) [MD = −29.24, 95% CI = (−32.11, −26.37)]. It also achieved a reduction of at least ≥75% in the EASI score [Risk Ratio (RR) = 2.89, 95% CI = (2.47, 3.38)], the Investigator’s Global Assessment (IGA) score ≤1 [RR = 3.47, 95% CI = (2.96, 4.06)] and eight additional endpoints with no signs of increased AE compared to placebo. In subgroup analysis, the results were concordant for both groups. Dupilumab improved clinical symptoms and quality of life in adults and children/adolescents with a safety profile comparable to placebo.

New Perspectives in the Management of Chronic Hand Eczema: Lessons from Pathogenesis

“…It is currently marked for moderate-to-severe atopic dermatitis. In adults, the usual posology consists of 600 mg at time 0 by subcutaneous injections followed by 300 mg every 2 weeks [ 53 ]. Some studies proved its efficacy also in the management of CHE.…”

Efficacy of dupilumab plus topical corticosteroids in children with atopic dermatitis: A meta‐analysis of randomized controlled trials

“…Additionally, the positive influence of dupilumab on patient‐reported outcomes, such as the CDLQI, has been established. Numerous systematic reviews of trials conducted in adults have supported the effectiveness of dupilumab and concomitant topical corticosteroids in children 15 . According to large sample clinical studies conducted abroad in 2017, dupilumab with concurrent topical corticosteroids might considerably lower overall disease severity in patients with AD and enhance pruritus and associated quality of life in patients.…”

The Effectiveness of Allergen Immunotherapy in Adult Patients with Atopic Dermatitis Allergic to House Dust Mites

“…It is a human monoclonal antibody that is directed against the alpha subunit of the interleukin-4 receptor and inhibits the signalling of IL-4 and IL-13 as an IL-4/IL-13 receptor blocker. Dupilumab is approved for treating asthma and other type-2 inflammatory diseases [ 20 ]. Many studies have confirmed the effectiveness of dupilumab, but they have not yet been associated with AIT [ 20 , 21 ].…”

“…Dupilumab is approved for treating asthma and other type-2 inflammatory diseases [ 20 ]. Many studies have confirmed the effectiveness of dupilumab, but they have not yet been associated with AIT [ 20 , 21 ]. Dupilumab improved clinical symptoms and quality of life in adults and children/adolescents with these diseases.…”