MDedge Dermatology

Atopic Dermatitis (AD) is complex with heterogeneous symptoms (e.g. skin-pain, sleep disturbance), signs (e.g. lichenification, prurigo nodules, follicular accentuation), and longitudinal course (intermittent, persistent). These disparate signs and symptoms should be addressed in optimize disease control.

Multiple extracellular cytokines are upregulated in skin of AD patients, including interleukins 4, 5, 13, 22, 31 and thymic stromal lymphopoietin, all of which signal intracellularly through Janus Kinase (JAK)-Signal Transducer and Activator of Transcription (STAT) pathways. Differential cytokine expression is proposed to underlie clinical variability. It may be necessary to inhibit signaling of multiple cytokines to achieve adequate control of AD.

Dupilumab is currently the only biologic treatment approved in the United States for moderate-severe AD. Dupilumab revolutionized AD management. However, there remain unmet needs, including the need for faster and more potent efficacy, and oral treatment options. Recently, oral JAK-inhibitors were investigated as treatments for moderate-severe AD. Multiple JAK-inhibitors demonstrated strong and rapid efficacy across multiple clinician-reported and patient-reported outcomes.

• Miao et al. recently conducted a meta-analysis of 10 randomized controlled trials and found that patients receiving JAK inhibitors showed significantly higher efficacy for eczema area and severity index (EASI) and Numeric Rating Scale (NRS)-itch scores and similar rates of adverse-events.
• Kim et al. pooled data from 3 randomized controlled trials of abrocitinib and found significantly higher proportions of clinically meaningful responses for itch in patients receiving abrocitinib 200 mg and 100 mg vs placebo as early as week 2 which continued through week 12.
• Lio et al. performed a post-hoc analysis of a phase 3 study of conducted in North America and found significant improvements for itch severity and sleep disturbance in patients treated with baricitinib 1 mg and 2 mg vs placebo. In particular, patients who achieved improvement of itch or sleep disturbance compared to those who did not were more likely to report having no impact on quality of life impact and improved work productivity.

This new therapeutic class will be an important addition to our therapeutic armamentarium and has potential to transform the AD treatment landscape.

• Many patients prefer taking pills over injections.
• Rapid-onset of efficacy for JAK-inhibitors will certainly be appreciated by patients, especially when trying to control tough flares. It may even guide clinical decision-making. Patients who have a good clinical response to JAK-inhibitors tend to do so within 4-8 weeks. By 8 weeks, if patients have no clinical response, they are likely not going to respond and may benefit from switching to alternative therapies.
• JAK-inhibitors can have robust efficacy, with higher doses of upadacitinib and abrocritinib showing greater efficacy than dupilumab at 12-16 weeks. This makes them attractive options to consider in patients who previously failed dupilumab.
• On the other hand, JAK-inhibitors have laboratory monitoring requirements, including complete blood count, comprehensive metabolic panel, lipid panel, etc.
• JAK-inhibitors warrant adverse-event monitoring for headache, nausea, acne, herpesvirus infections, risk of venous thromboembolism, etc.

Future research is needed to identify patient subsets who will benefit most from JAK-inhibitor therapy and where to position these agents in treatment guidelines.

Atopic Dermatitis (AD) is complex with heterogeneous symptoms (e.g. skin-pain, sleep disturbance), signs (e.g. lichenification, prurigo nodules, follicular accentuation), and longitudinal course (intermittent, persistent). These disparate signs and symptoms should be addressed in optimize disease control.

Multiple extracellular cytokines are upregulated in skin of AD patients, including interleukins 4, 5, 13, 22, 31 and thymic stromal lymphopoietin, all of which signal intracellularly through Janus Kinase (JAK)-Signal Transducer and Activator of Transcription (STAT) pathways. Differential cytokine expression is proposed to underlie clinical variability. It may be necessary to inhibit signaling of multiple cytokines to achieve adequate control of AD.

Dupilumab is currently the only biologic treatment approved in the United States for moderate-severe AD. Dupilumab revolutionized AD management. However, there remain unmet needs, including the need for faster and more potent efficacy, and oral treatment options. Recently, oral JAK-inhibitors were investigated as treatments for moderate-severe AD. Multiple JAK-inhibitors demonstrated strong and rapid efficacy across multiple clinician-reported and patient-reported outcomes.

• Miao et al. recently conducted a meta-analysis of 10 randomized controlled trials and found that patients receiving JAK inhibitors showed significantly higher efficacy for eczema area and severity index (EASI) and Numeric Rating Scale (NRS)-itch scores and similar rates of adverse-events.
• Kim et al. pooled data from 3 randomized controlled trials of abrocitinib and found significantly higher proportions of clinically meaningful responses for itch in patients receiving abrocitinib 200 mg and 100 mg vs placebo as early as week 2 which continued through week 12.
• Lio et al. performed a post-hoc analysis of a phase 3 study of conducted in North America and found significant improvements for itch severity and sleep disturbance in patients treated with baricitinib 1 mg and 2 mg vs placebo. In particular, patients who achieved improvement of itch or sleep disturbance compared to those who did not were more likely to report having no impact on quality of life impact and improved work productivity.

This new therapeutic class will be an important addition to our therapeutic armamentarium and has potential to transform the AD treatment landscape.

• Many patients prefer taking pills over injections.
• Rapid-onset of efficacy for JAK-inhibitors will certainly be appreciated by patients, especially when trying to control tough flares. It may even guide clinical decision-making. Patients who have a good clinical response to JAK-inhibitors tend to do so within 4-8 weeks. By 8 weeks, if patients have no clinical response, they are likely not going to respond and may benefit from switching to alternative therapies.
• JAK-inhibitors can have robust efficacy, with higher doses of upadacitinib and abrocritinib showing greater efficacy than dupilumab at 12-16 weeks. This makes them attractive options to consider in patients who previously failed dupilumab.
• On the other hand, JAK-inhibitors have laboratory monitoring requirements, including complete blood count, comprehensive metabolic panel, lipid panel, etc.
• JAK-inhibitors warrant adverse-event monitoring for headache, nausea, acne, herpesvirus infections, risk of venous thromboembolism, etc.

Future research is needed to identify patient subsets who will benefit most from JAK-inhibitor therapy and where to position these agents in treatment guidelines.

Atopic Dermatitis (AD) is complex with heterogeneous symptoms (e.g. skin-pain, sleep disturbance), signs (e.g. lichenification, prurigo nodules, follicular accentuation), and longitudinal course (intermittent, persistent). These disparate signs and symptoms should be addressed in optimize disease control.

Multiple extracellular cytokines are upregulated in skin of AD patients, including interleukins 4, 5, 13, 22, 31 and thymic stromal lymphopoietin, all of which signal intracellularly through Janus Kinase (JAK)-Signal Transducer and Activator of Transcription (STAT) pathways. Differential cytokine expression is proposed to underlie clinical variability. It may be necessary to inhibit signaling of multiple cytokines to achieve adequate control of AD.

Dupilumab is currently the only biologic treatment approved in the United States for moderate-severe AD. Dupilumab revolutionized AD management. However, there remain unmet needs, including the need for faster and more potent efficacy, and oral treatment options. Recently, oral JAK-inhibitors were investigated as treatments for moderate-severe AD. Multiple JAK-inhibitors demonstrated strong and rapid efficacy across multiple clinician-reported and patient-reported outcomes.

• Miao et al. recently conducted a meta-analysis of 10 randomized controlled trials and found that patients receiving JAK inhibitors showed significantly higher efficacy for eczema area and severity index (EASI) and Numeric Rating Scale (NRS)-itch scores and similar rates of adverse-events.
• Kim et al. pooled data from 3 randomized controlled trials of abrocitinib and found significantly higher proportions of clinically meaningful responses for itch in patients receiving abrocitinib 200 mg and 100 mg vs placebo as early as week 2 which continued through week 12.
• Lio et al. performed a post-hoc analysis of a phase 3 study of conducted in North America and found significant improvements for itch severity and sleep disturbance in patients treated with baricitinib 1 mg and 2 mg vs placebo. In particular, patients who achieved improvement of itch or sleep disturbance compared to those who did not were more likely to report having no impact on quality of life impact and improved work productivity.

This new therapeutic class will be an important addition to our therapeutic armamentarium and has potential to transform the AD treatment landscape.

• Many patients prefer taking pills over injections.
• Rapid-onset of efficacy for JAK-inhibitors will certainly be appreciated by patients, especially when trying to control tough flares. It may even guide clinical decision-making. Patients who have a good clinical response to JAK-inhibitors tend to do so within 4-8 weeks. By 8 weeks, if patients have no clinical response, they are likely not going to respond and may benefit from switching to alternative therapies.
• JAK-inhibitors can have robust efficacy, with higher doses of upadacitinib and abrocritinib showing greater efficacy than dupilumab at 12-16 weeks. This makes them attractive options to consider in patients who previously failed dupilumab.
• On the other hand, JAK-inhibitors have laboratory monitoring requirements, including complete blood count, comprehensive metabolic panel, lipid panel, etc.
• JAK-inhibitors warrant adverse-event monitoring for headache, nausea, acne, herpesvirus infections, risk of venous thromboembolism, etc.

Future research is needed to identify patient subsets who will benefit most from JAK-inhibitor therapy and where to position these agents in treatment guidelines.

Key clinical point: Janus kinase (JAK) inhibitors were safe and effective in reducing the intensity of signs and symptoms of atopic dermatitis (AD) with significant improvements observed for Eczema Area and Severity Index (EASI) and pruritus numerical rating scale (NRS) scores.

Major finding: Patients receiving JAK inhibitors showed significant improvements in both total EASI score (mean difference [MD], −0.31; 95% confidence interval [CI], −0.46 to −0.17) and pruritus NRS score (MD, −1.15; 95% CI, −1.48 to −0.83). The risk of total adverse events was not significantly different between JAK inhibitor and control groups (risk ratio, 1.02; P = .745).

Study details: Findings are from a meta-analysis of 10 randomized controlled trials including 2583 patients with AD, of which 1,761 were in JAK inhibitor and 822 in control groups.

Disclosures: The study did not report any source of funding. No conflicts of interest were reported.

Source: Miao M et al. J Dermatolog Treat. 2021 Jun 16. doi: 10.1080/09546634.2021.1942422.

Key clinical point: Janus kinase (JAK) inhibitors were safe and effective in reducing the intensity of signs and symptoms of atopic dermatitis (AD) with significant improvements observed for Eczema Area and Severity Index (EASI) and pruritus numerical rating scale (NRS) scores.

Major finding: Patients receiving JAK inhibitors showed significant improvements in both total EASI score (mean difference [MD], −0.31; 95% confidence interval [CI], −0.46 to −0.17) and pruritus NRS score (MD, −1.15; 95% CI, −1.48 to −0.83). The risk of total adverse events was not significantly different between JAK inhibitor and control groups (risk ratio, 1.02; P = .745).

Study details: Findings are from a meta-analysis of 10 randomized controlled trials including 2583 patients with AD, of which 1,761 were in JAK inhibitor and 822 in control groups.

Disclosures: The study did not report any source of funding. No conflicts of interest were reported.

Source: Miao M et al. J Dermatolog Treat. 2021 Jun 16. doi: 10.1080/09546634.2021.1942422.

Key clinical point: Janus kinase (JAK) inhibitors were safe and effective in reducing the intensity of signs and symptoms of atopic dermatitis (AD) with significant improvements observed for Eczema Area and Severity Index (EASI) and pruritus numerical rating scale (NRS) scores.

Major finding: Patients receiving JAK inhibitors showed significant improvements in both total EASI score (mean difference [MD], −0.31; 95% confidence interval [CI], −0.46 to −0.17) and pruritus NRS score (MD, −1.15; 95% CI, −1.48 to −0.83). The risk of total adverse events was not significantly different between JAK inhibitor and control groups (risk ratio, 1.02; P = .745).

Study details: Findings are from a meta-analysis of 10 randomized controlled trials including 2583 patients with AD, of which 1,761 were in JAK inhibitor and 822 in control groups.

Disclosures: The study did not report any source of funding. No conflicts of interest were reported.

Source: Miao M et al. J Dermatolog Treat. 2021 Jun 16. doi: 10.1080/09546634.2021.1942422.

Key clinical point: Analysis of serum biomarker profiles in pediatric patients with atopic dermatitis (AD) indicates the existence of unique endotypes that could predict patients at risk of persistent disease and guide personalized, endotype-driven therapeutic approaches.

Major finding: Distinct biomarker profiles identified Th2/retinol dominant (mean Eczema Area Severity Index [EASI] score: 9.2), skin-homing dominant (mean EASI score: 27.8), Th1/Th2/Th17/IL-1 dominant (mean EASI score: 10.5), and Th1/IL-1/eosinophil inferior (mean EASI score: 12.3) as the 4 distinct pediatric clusters. The clusters were influenced by disease severity and not age, with the skin-homing dominant cluster having more severe AD than other clusters (P less than .001).

Study details: Findings are from an analysis of biomarker profiles of 240 pediatric patients with AD aged 0-17 years compared with previously found profiles in adult patients with AD.

Disclosures: This study was funded by Regeneron and Sanofi-Genzyme pharmaceuticals, Inc. Dr. M de Graaf, Dr. MS de Bruin-Weller, Dr. DS Bakker, Dr. E Knol, and Dr. JL Thijs declared being speaker, principal investigator, consultant, and/or advisory board member for various sources including Sanofi-Genzyme and Regeneron.

Source: Bakker DS et al. J Allergy Clin Immun. 2021 Jul 6. doi: 10.1016/j.jaci.2021.06.029.

Key clinical point: Analysis of serum biomarker profiles in pediatric patients with atopic dermatitis (AD) indicates the existence of unique endotypes that could predict patients at risk of persistent disease and guide personalized, endotype-driven therapeutic approaches.

Major finding: Distinct biomarker profiles identified Th2/retinol dominant (mean Eczema Area Severity Index [EASI] score: 9.2), skin-homing dominant (mean EASI score: 27.8), Th1/Th2/Th17/IL-1 dominant (mean EASI score: 10.5), and Th1/IL-1/eosinophil inferior (mean EASI score: 12.3) as the 4 distinct pediatric clusters. The clusters were influenced by disease severity and not age, with the skin-homing dominant cluster having more severe AD than other clusters (P less than .001).

Study details: Findings are from an analysis of biomarker profiles of 240 pediatric patients with AD aged 0-17 years compared with previously found profiles in adult patients with AD.

Disclosures: This study was funded by Regeneron and Sanofi-Genzyme pharmaceuticals, Inc. Dr. M de Graaf, Dr. MS de Bruin-Weller, Dr. DS Bakker, Dr. E Knol, and Dr. JL Thijs declared being speaker, principal investigator, consultant, and/or advisory board member for various sources including Sanofi-Genzyme and Regeneron.

Source: Bakker DS et al. J Allergy Clin Immun. 2021 Jul 6. doi: 10.1016/j.jaci.2021.06.029.

Key clinical point: Analysis of serum biomarker profiles in pediatric patients with atopic dermatitis (AD) indicates the existence of unique endotypes that could predict patients at risk of persistent disease and guide personalized, endotype-driven therapeutic approaches.

Major finding: Distinct biomarker profiles identified Th2/retinol dominant (mean Eczema Area Severity Index [EASI] score: 9.2), skin-homing dominant (mean EASI score: 27.8), Th1/Th2/Th17/IL-1 dominant (mean EASI score: 10.5), and Th1/IL-1/eosinophil inferior (mean EASI score: 12.3) as the 4 distinct pediatric clusters. The clusters were influenced by disease severity and not age, with the skin-homing dominant cluster having more severe AD than other clusters (P less than .001).

Study details: Findings are from an analysis of biomarker profiles of 240 pediatric patients with AD aged 0-17 years compared with previously found profiles in adult patients with AD.

Disclosures: This study was funded by Regeneron and Sanofi-Genzyme pharmaceuticals, Inc. Dr. M de Graaf, Dr. MS de Bruin-Weller, Dr. DS Bakker, Dr. E Knol, and Dr. JL Thijs declared being speaker, principal investigator, consultant, and/or advisory board member for various sources including Sanofi-Genzyme and Regeneron.

Source: Bakker DS et al. J Allergy Clin Immun. 2021 Jul 6. doi: 10.1016/j.jaci.2021.06.029.

Key clinical point: Higher maternal serum 25-hydroxyvitamin D (25[OH]D) levels during pregnancy may be associated with increased risk for early-onset infant atopic dermatitis (AD).

Major finding: Overall, 26.5% of infants developed AD before 1 year of age. Higher maternal serum 25(OH)D levels during pregnancy were associated with increased risks for AD in infants before 1 year of age with borderline statistical significance, particularly in the first trimester (per ln unit increase, adjusted odds ratio [aOR], 1.93; 95% confidence interval [CI], 0.96-3.88) and the second trimester (per ln unit increase, aOR, 1.72; 95% CI, 0.93-3.19).

Study details: Findings are from the analysis of pregnant women from the MKFOAD birth cohort and their infants (n=456) who received routine child care visits at birth, day 42, and 6 and 12 months after birth.

Disclosures: This study was funded by Shanghai Public Health Three-Year Action Plan, National Key Research and Development Program, Canada-China Clinical Research Program, Collaboration Grant of Children’s Hospital of Fudan University, and Pigeon Maternal and Infant Skin Care Research Institute. The authors declared no conflicts of interest.

Source: Tian Y et al. Pediatr Allergy Immunol. 2021 Jun 23. doi: 10.1111/pai.13582. 

Key clinical point: Higher maternal serum 25-hydroxyvitamin D (25[OH]D) levels during pregnancy may be associated with increased risk for early-onset infant atopic dermatitis (AD).

Major finding: Overall, 26.5% of infants developed AD before 1 year of age. Higher maternal serum 25(OH)D levels during pregnancy were associated with increased risks for AD in infants before 1 year of age with borderline statistical significance, particularly in the first trimester (per ln unit increase, adjusted odds ratio [aOR], 1.93; 95% confidence interval [CI], 0.96-3.88) and the second trimester (per ln unit increase, aOR, 1.72; 95% CI, 0.93-3.19).

Study details: Findings are from the analysis of pregnant women from the MKFOAD birth cohort and their infants (n=456) who received routine child care visits at birth, day 42, and 6 and 12 months after birth.

Disclosures: This study was funded by Shanghai Public Health Three-Year Action Plan, National Key Research and Development Program, Canada-China Clinical Research Program, Collaboration Grant of Children’s Hospital of Fudan University, and Pigeon Maternal and Infant Skin Care Research Institute. The authors declared no conflicts of interest.

Source: Tian Y et al. Pediatr Allergy Immunol. 2021 Jun 23. doi: 10.1111/pai.13582. 

Key clinical point: Higher maternal serum 25-hydroxyvitamin D (25[OH]D) levels during pregnancy may be associated with increased risk for early-onset infant atopic dermatitis (AD).

Major finding: Overall, 26.5% of infants developed AD before 1 year of age. Higher maternal serum 25(OH)D levels during pregnancy were associated with increased risks for AD in infants before 1 year of age with borderline statistical significance, particularly in the first trimester (per ln unit increase, adjusted odds ratio [aOR], 1.93; 95% confidence interval [CI], 0.96-3.88) and the second trimester (per ln unit increase, aOR, 1.72; 95% CI, 0.93-3.19).

Study details: Findings are from the analysis of pregnant women from the MKFOAD birth cohort and their infants (n=456) who received routine child care visits at birth, day 42, and 6 and 12 months after birth.

Disclosures: This study was funded by Shanghai Public Health Three-Year Action Plan, National Key Research and Development Program, Canada-China Clinical Research Program, Collaboration Grant of Children’s Hospital of Fudan University, and Pigeon Maternal and Infant Skin Care Research Institute. The authors declared no conflicts of interest.

Source: Tian Y et al. Pediatr Allergy Immunol. 2021 Jun 23. doi: 10.1111/pai.13582. 

Key clinical point: Dupilumab with or without topical corticosteroids (TCS) was beneficial in adults with moderate-to-severe atopic dermatitis (AD) regardless of any prior use of systemic nonsteroidal immunosuppressants (NSISS).

Major finding: Compared with placebo with/without TCS, dupilumab with/without TCS showed significant improvement in Eczema Area and Severity Index, SCORing AD, Peak Pruritus Numerical Rating Scale, and quality of life in patients with/without prior use of NSISS (P less than .001) by week 16 which continued through week 52 of treatment.

Study details: Findings are from a post hoc analysis of 4 phase 3 clinical trials including 1553 patients with moderate-to-severe AD randomly assigned to placebo or dupilumab as monotherapy for 16 weeks or with concomitant TCS for 16/52 weeks.

Disclosures: This study was funded by Sanofi and Regeneron Pharmaceuticals, Inc. Some of the authors declared receiving grants, honoraria and serving as consultant or speaker or on advisory board for various sources. Some of the authors declared being employees and/or holding stocks/stock options at Sanofi, Regeneron Pharmaceuticals, Inc or Sanofi Genzyme.

Source: Griffiths C et al. Dermatol Ther (Heidelb). 2021 Jun 18. doi: 10.1007/s13555-021-00558-0.

Key clinical point: Dupilumab with or without topical corticosteroids (TCS) was beneficial in adults with moderate-to-severe atopic dermatitis (AD) regardless of any prior use of systemic nonsteroidal immunosuppressants (NSISS).

Major finding: Compared with placebo with/without TCS, dupilumab with/without TCS showed significant improvement in Eczema Area and Severity Index, SCORing AD, Peak Pruritus Numerical Rating Scale, and quality of life in patients with/without prior use of NSISS (P less than .001) by week 16 which continued through week 52 of treatment.

Study details: Findings are from a post hoc analysis of 4 phase 3 clinical trials including 1553 patients with moderate-to-severe AD randomly assigned to placebo or dupilumab as monotherapy for 16 weeks or with concomitant TCS for 16/52 weeks.

Disclosures: This study was funded by Sanofi and Regeneron Pharmaceuticals, Inc. Some of the authors declared receiving grants, honoraria and serving as consultant or speaker or on advisory board for various sources. Some of the authors declared being employees and/or holding stocks/stock options at Sanofi, Regeneron Pharmaceuticals, Inc or Sanofi Genzyme.

Source: Griffiths C et al. Dermatol Ther (Heidelb). 2021 Jun 18. doi: 10.1007/s13555-021-00558-0.

Key clinical point: Dupilumab with or without topical corticosteroids (TCS) was beneficial in adults with moderate-to-severe atopic dermatitis (AD) regardless of any prior use of systemic nonsteroidal immunosuppressants (NSISS).

Major finding: Compared with placebo with/without TCS, dupilumab with/without TCS showed significant improvement in Eczema Area and Severity Index, SCORing AD, Peak Pruritus Numerical Rating Scale, and quality of life in patients with/without prior use of NSISS (P less than .001) by week 16 which continued through week 52 of treatment.

Study details: Findings are from a post hoc analysis of 4 phase 3 clinical trials including 1553 patients with moderate-to-severe AD randomly assigned to placebo or dupilumab as monotherapy for 16 weeks or with concomitant TCS for 16/52 weeks.

Disclosures: This study was funded by Sanofi and Regeneron Pharmaceuticals, Inc. Some of the authors declared receiving grants, honoraria and serving as consultant or speaker or on advisory board for various sources. Some of the authors declared being employees and/or holding stocks/stock options at Sanofi, Regeneron Pharmaceuticals, Inc or Sanofi Genzyme.

Source: Griffiths C et al. Dermatol Ther (Heidelb). 2021 Jun 18. doi: 10.1007/s13555-021-00558-0.

Key clinical point: In real world clinical practice, combination of tacrolimus ointment and dupilumab was an effective and safe treatment option for facial atopic dermatitis (AD).

Major finding: On 16 weeks of treatment, a significant decrease was observed in average scores including Investigator’s Global Assessment, overall Eczema Area and Severity Index (EASI), and head/neck EASI (P less than .0001). Moreover, the rate of improvement in head/neck EASI scores significantly correlated with the rate of improvement in the overall EASI scores (Pearson’s r, 0.61; P less than .01). None of the patients developed herpes simplex, whereas 2 patients developed conjunctivitis.

Study details: Findings are from a retrospective chart review of 109 patients with moderate-to-severe AD who initiated dupilumab, of which 60 patients also used tacrolimus ointment. Of these, 20 patients used tacrolimus ointment without any topical steroids.

Disclosures: This work was supported by grants from Japan Society for the Promotion of Science. The authors did not declare any conflicts of interest.

Source: Matsutani M et al. J Dermatol. 2021 Jun 22. doi: 10.1111/1346-8138.16039.

Key clinical point: In real world clinical practice, combination of tacrolimus ointment and dupilumab was an effective and safe treatment option for facial atopic dermatitis (AD).

Major finding: On 16 weeks of treatment, a significant decrease was observed in average scores including Investigator’s Global Assessment, overall Eczema Area and Severity Index (EASI), and head/neck EASI (P less than .0001). Moreover, the rate of improvement in head/neck EASI scores significantly correlated with the rate of improvement in the overall EASI scores (Pearson’s r, 0.61; P less than .01). None of the patients developed herpes simplex, whereas 2 patients developed conjunctivitis.

Study details: Findings are from a retrospective chart review of 109 patients with moderate-to-severe AD who initiated dupilumab, of which 60 patients also used tacrolimus ointment. Of these, 20 patients used tacrolimus ointment without any topical steroids.

Disclosures: This work was supported by grants from Japan Society for the Promotion of Science. The authors did not declare any conflicts of interest.

Source: Matsutani M et al. J Dermatol. 2021 Jun 22. doi: 10.1111/1346-8138.16039.

Key clinical point: In real world clinical practice, combination of tacrolimus ointment and dupilumab was an effective and safe treatment option for facial atopic dermatitis (AD).

Major finding: On 16 weeks of treatment, a significant decrease was observed in average scores including Investigator’s Global Assessment, overall Eczema Area and Severity Index (EASI), and head/neck EASI (P less than .0001). Moreover, the rate of improvement in head/neck EASI scores significantly correlated with the rate of improvement in the overall EASI scores (Pearson’s r, 0.61; P less than .01). None of the patients developed herpes simplex, whereas 2 patients developed conjunctivitis.

Study details: Findings are from a retrospective chart review of 109 patients with moderate-to-severe AD who initiated dupilumab, of which 60 patients also used tacrolimus ointment. Of these, 20 patients used tacrolimus ointment without any topical steroids.

Disclosures: This work was supported by grants from Japan Society for the Promotion of Science. The authors did not declare any conflicts of interest.

Source: Matsutani M et al. J Dermatol. 2021 Jun 22. doi: 10.1111/1346-8138.16039.

Key clinical point: Baricitinib therapy resulted in clinically meaningful improvement in itch severity leading to significantly better quality of life (QoL) in patients with moderate-to-severe atopic dermatitis (AD).

Major finding: By week 16, higher proportion of patients receiving baricitinib 2 mg (25.2%; P less than .0001) and 1 mg (15.9%; P = .0114) vs placebo (5.7%) experienced improvements in itch severity. Higher proportion of patients with vs without itch improvement showed no impact of AD on QoL (P less than .0001).

Study details: Findings are from a post hoc analysis of phase 3 trial, BREEZE-AD5 involving 440 adults with moderate-to-severe AD who received baricitinib 1 mg, 2 mg, or placebo once daily.

Disclosures: This work was funded by Eli Lilly and Company. Some of the authors declared receiving grants, funding, consulting fees, and/or honoraria from and/or serving as board member, speaker, advisor, and/or investigator for various sources including Eli Lilly. Five of the authors declared being employees and shareholders of Eli Lilly.

Source: Lio PA et al. J Dermatolog Treat. 2021 Jun 28. doi: 10.1080/09546634.2021.1914308.

Key clinical point: Baricitinib therapy resulted in clinically meaningful improvement in itch severity leading to significantly better quality of life (QoL) in patients with moderate-to-severe atopic dermatitis (AD).

Major finding: By week 16, higher proportion of patients receiving baricitinib 2 mg (25.2%; P less than .0001) and 1 mg (15.9%; P = .0114) vs placebo (5.7%) experienced improvements in itch severity. Higher proportion of patients with vs without itch improvement showed no impact of AD on QoL (P less than .0001).

Study details: Findings are from a post hoc analysis of phase 3 trial, BREEZE-AD5 involving 440 adults with moderate-to-severe AD who received baricitinib 1 mg, 2 mg, or placebo once daily.

Disclosures: This work was funded by Eli Lilly and Company. Some of the authors declared receiving grants, funding, consulting fees, and/or honoraria from and/or serving as board member, speaker, advisor, and/or investigator for various sources including Eli Lilly. Five of the authors declared being employees and shareholders of Eli Lilly.

Source: Lio PA et al. J Dermatolog Treat. 2021 Jun 28. doi: 10.1080/09546634.2021.1914308.

Key clinical point: Baricitinib therapy resulted in clinically meaningful improvement in itch severity leading to significantly better quality of life (QoL) in patients with moderate-to-severe atopic dermatitis (AD).

Major finding: By week 16, higher proportion of patients receiving baricitinib 2 mg (25.2%; P less than .0001) and 1 mg (15.9%; P = .0114) vs placebo (5.7%) experienced improvements in itch severity. Higher proportion of patients with vs without itch improvement showed no impact of AD on QoL (P less than .0001).

Study details: Findings are from a post hoc analysis of phase 3 trial, BREEZE-AD5 involving 440 adults with moderate-to-severe AD who received baricitinib 1 mg, 2 mg, or placebo once daily.

Disclosures: This work was funded by Eli Lilly and Company. Some of the authors declared receiving grants, funding, consulting fees, and/or honoraria from and/or serving as board member, speaker, advisor, and/or investigator for various sources including Eli Lilly. Five of the authors declared being employees and shareholders of Eli Lilly.

Source: Lio PA et al. J Dermatolog Treat. 2021 Jun 28. doi: 10.1080/09546634.2021.1914308.

Key clinical point: Abrocitinib monotherapy was associated with a rapid and profound relief in atopic dermatitis (AD) itch.

Major finding: A higher proportion of patients receiving abrocitinib 200 mg and 100 mg vs placebo experienced clinically meaningful itch improvement at week 2 (44.2% and 24.9% vs 5.8%), which continued through week 12 (57.3% and 42.9% vs 16.5%; both P less than .05). Mean percentage reductions in itch scores 24 hours after the first dose were greater for abrocitinib 200 mg and 100 mg vs placebo which was maintained through week 12 (−56.1 and −42.3 vs −19.5).

Study details: Findings are from a pooled analysis of 1 phase 2b (NCT02780167) and 2 phase 3 (JADE MONO-1 and JADE MONO-2) trials including 942 patients with moderate-to-severe AD who received abrocitinib 200 mg, abrocitinib 100 mg, or placebo.

Disclosures: This study was sponsored by Pfizer, Inc. Some of the authors declared receiving grants and personal fees and/or serving as consultant, speaker, advisor, and/or principal investigator for various sources including Pfizer. Six of the authors declared being employees and shareholders of Pfizer, Inc.

Source: Kim BS et al. Dermatitis. 2021 Jul 7. doi: 10.1097/DER.0000000000000770.

Key clinical point: Abrocitinib monotherapy was associated with a rapid and profound relief in atopic dermatitis (AD) itch.

Major finding: A higher proportion of patients receiving abrocitinib 200 mg and 100 mg vs placebo experienced clinically meaningful itch improvement at week 2 (44.2% and 24.9% vs 5.8%), which continued through week 12 (57.3% and 42.9% vs 16.5%; both P less than .05). Mean percentage reductions in itch scores 24 hours after the first dose were greater for abrocitinib 200 mg and 100 mg vs placebo which was maintained through week 12 (−56.1 and −42.3 vs −19.5).

Study details: Findings are from a pooled analysis of 1 phase 2b (NCT02780167) and 2 phase 3 (JADE MONO-1 and JADE MONO-2) trials including 942 patients with moderate-to-severe AD who received abrocitinib 200 mg, abrocitinib 100 mg, or placebo.

Disclosures: This study was sponsored by Pfizer, Inc. Some of the authors declared receiving grants and personal fees and/or serving as consultant, speaker, advisor, and/or principal investigator for various sources including Pfizer. Six of the authors declared being employees and shareholders of Pfizer, Inc.

Source: Kim BS et al. Dermatitis. 2021 Jul 7. doi: 10.1097/DER.0000000000000770.

Key clinical point: Abrocitinib monotherapy was associated with a rapid and profound relief in atopic dermatitis (AD) itch.

Major finding: A higher proportion of patients receiving abrocitinib 200 mg and 100 mg vs placebo experienced clinically meaningful itch improvement at week 2 (44.2% and 24.9% vs 5.8%), which continued through week 12 (57.3% and 42.9% vs 16.5%; both P less than .05). Mean percentage reductions in itch scores 24 hours after the first dose were greater for abrocitinib 200 mg and 100 mg vs placebo which was maintained through week 12 (−56.1 and −42.3 vs −19.5).

Study details: Findings are from a pooled analysis of 1 phase 2b (NCT02780167) and 2 phase 3 (JADE MONO-1 and JADE MONO-2) trials including 942 patients with moderate-to-severe AD who received abrocitinib 200 mg, abrocitinib 100 mg, or placebo.

Disclosures: This study was sponsored by Pfizer, Inc. Some of the authors declared receiving grants and personal fees and/or serving as consultant, speaker, advisor, and/or principal investigator for various sources including Pfizer. Six of the authors declared being employees and shareholders of Pfizer, Inc.

Source: Kim BS et al. Dermatitis. 2021 Jul 7. doi: 10.1097/DER.0000000000000770.

Key clinical point: Majority of patients with atopic dermatitis (AD) who tested positive for COVID-19 experienced subclinical infection; however, extended treatment with systemic corticosteroids during the pandemic increased chances of COVID-19-associated hospitalization.

Major finding: Most (93.1%) of the COVID-19 infections in patients with AD were subclinical. COVID-19-related complications resulted in 6% hospitalizations, 0.3% mechanical ventilations, and 1.1% deaths. Intake of systemic corticosteroids for 2 or more months during the pandemic was associated with hospitalizations related to COVID-19 (adjusted odds ratio, 1.96; P = .005). However, mortality associated with COVID-19 was not predicted by AD-related variables.

Study details: Findings are from a nested case-control study including 3618 patients with AD who tested positive for COVID-19.

Disclosures: No funding source was identified. Dr. Cohen declared serving as an advisor, investigator, or speaker for various sources. The other authors had no disclosures.

Source: Kridin K et al. Dermatitis. 2021 Jun 15. doi: 10.1097/DER.0000000000000772.

Key clinical point: Majority of patients with atopic dermatitis (AD) who tested positive for COVID-19 experienced subclinical infection; however, extended treatment with systemic corticosteroids during the pandemic increased chances of COVID-19-associated hospitalization.

Major finding: Most (93.1%) of the COVID-19 infections in patients with AD were subclinical. COVID-19-related complications resulted in 6% hospitalizations, 0.3% mechanical ventilations, and 1.1% deaths. Intake of systemic corticosteroids for 2 or more months during the pandemic was associated with hospitalizations related to COVID-19 (adjusted odds ratio, 1.96; P = .005). However, mortality associated with COVID-19 was not predicted by AD-related variables.

Study details: Findings are from a nested case-control study including 3618 patients with AD who tested positive for COVID-19.

Disclosures: No funding source was identified. Dr. Cohen declared serving as an advisor, investigator, or speaker for various sources. The other authors had no disclosures.

Source: Kridin K et al. Dermatitis. 2021 Jun 15. doi: 10.1097/DER.0000000000000772.

Key clinical point: Majority of patients with atopic dermatitis (AD) who tested positive for COVID-19 experienced subclinical infection; however, extended treatment with systemic corticosteroids during the pandemic increased chances of COVID-19-associated hospitalization.

Major finding: Most (93.1%) of the COVID-19 infections in patients with AD were subclinical. COVID-19-related complications resulted in 6% hospitalizations, 0.3% mechanical ventilations, and 1.1% deaths. Intake of systemic corticosteroids for 2 or more months during the pandemic was associated with hospitalizations related to COVID-19 (adjusted odds ratio, 1.96; P = .005). However, mortality associated with COVID-19 was not predicted by AD-related variables.

Study details: Findings are from a nested case-control study including 3618 patients with AD who tested positive for COVID-19.

Disclosures: No funding source was identified. Dr. Cohen declared serving as an advisor, investigator, or speaker for various sources. The other authors had no disclosures.

Source: Kridin K et al. Dermatitis. 2021 Jun 15. doi: 10.1097/DER.0000000000000772.

Key clinical point: Delgocitinib ointment was effective and safe for up to 56 weeks in pediatric patients with atopic dermatitis (AD).

Major finding: By the end of initial 4-week treatment, least-squares mean percentage change from baseline in the modified Eczema Area and Severity Index (mEASI) score was significantly greater for delgocitinib vs vehicle (−39.3% vs +10.9%; P less than .001) groups. Improvement in mEASI score continued through the 52-week extension phase. Treatment-related mild adverse events were reported by only 9.7% of patients.

Study details: Findings are from a phase 3 study including 137 Japanese patients aged 2-15 years with mild/moderate/severe AD randomly allocated to either delgocitinib (0.25%) or vehicle ointment for 4 weeks. Eligible patients entered the 52-week extension study phase to receive 0.25% or 0.5% delgocitinib ointment.

Disclosures: This study was funded by Japan Tobacco Inc. and Torii Pharmaceutical Co, Ltd. Some of the authors declared receiving consulting fees, research grants, speaker honoraria, and/or advisory board honoraria from various sources including Japan Tobacco Inc. Two authors declared being employees of Japan Tobacco Inc.

Source: Nakagawa H et al. J Am Acad Dermatol. 2021 Jun 9. doi: 10.1016/j.jaad.2021.06.014.

Key clinical point: Delgocitinib ointment was effective and safe for up to 56 weeks in pediatric patients with atopic dermatitis (AD).

Major finding: By the end of initial 4-week treatment, least-squares mean percentage change from baseline in the modified Eczema Area and Severity Index (mEASI) score was significantly greater for delgocitinib vs vehicle (−39.3% vs +10.9%; P less than .001) groups. Improvement in mEASI score continued through the 52-week extension phase. Treatment-related mild adverse events were reported by only 9.7% of patients.

Study details: Findings are from a phase 3 study including 137 Japanese patients aged 2-15 years with mild/moderate/severe AD randomly allocated to either delgocitinib (0.25%) or vehicle ointment for 4 weeks. Eligible patients entered the 52-week extension study phase to receive 0.25% or 0.5% delgocitinib ointment.

Disclosures: This study was funded by Japan Tobacco Inc. and Torii Pharmaceutical Co, Ltd. Some of the authors declared receiving consulting fees, research grants, speaker honoraria, and/or advisory board honoraria from various sources including Japan Tobacco Inc. Two authors declared being employees of Japan Tobacco Inc.

Source: Nakagawa H et al. J Am Acad Dermatol. 2021 Jun 9. doi: 10.1016/j.jaad.2021.06.014.

Key clinical point: Delgocitinib ointment was effective and safe for up to 56 weeks in pediatric patients with atopic dermatitis (AD).

Major finding: By the end of initial 4-week treatment, least-squares mean percentage change from baseline in the modified Eczema Area and Severity Index (mEASI) score was significantly greater for delgocitinib vs vehicle (−39.3% vs +10.9%; P less than .001) groups. Improvement in mEASI score continued through the 52-week extension phase. Treatment-related mild adverse events were reported by only 9.7% of patients.

Study details: Findings are from a phase 3 study including 137 Japanese patients aged 2-15 years with mild/moderate/severe AD randomly allocated to either delgocitinib (0.25%) or vehicle ointment for 4 weeks. Eligible patients entered the 52-week extension study phase to receive 0.25% or 0.5% delgocitinib ointment.

Disclosures: This study was funded by Japan Tobacco Inc. and Torii Pharmaceutical Co, Ltd. Some of the authors declared receiving consulting fees, research grants, speaker honoraria, and/or advisory board honoraria from various sources including Japan Tobacco Inc. Two authors declared being employees of Japan Tobacco Inc.

Source: Nakagawa H et al. J Am Acad Dermatol. 2021 Jun 9. doi: 10.1016/j.jaad.2021.06.014.