Key clinical point: Children who were hospitalized for atopic dermatitis (AD) exacerbation had significantly higher serum total IgE levels than those hospitalized for AD-associated infectious complications.

Major finding: Children with AD exacerbation vs an infectious complication had significantly higher mean serum total IgE levels (9603 ± 15,873 vs 3167 ± 5486 kU/L; P = .029). The likelihood of AD exacerbation vs an infectious complication was significantly greater in children with an age-adjusted IgE level (serum total IgE level/maximum reference IgE value for their age) of >4.

Study details: This retrospective chart review study included 68 children hospitalized for AD exacerbations (n = 34) or AD-associated infectious complications (n = 34) over a 17-year period.

Disclosures: This study did not report the source of funding. PY Ong declared serving as a consultant for and receiving research funding from various organizations.

Source: Atwal S, Ong PY. Elevated serum total IgE is associated with eczema exacerbation in children hospitalized for atopic dermatitis. Pediatr Dermatol. 2023 (Jan 19). Doi: 10.1111/pde.15245

Key clinical point: Children who were hospitalized for atopic dermatitis (AD) exacerbation had significantly higher serum total IgE levels than those hospitalized for AD-associated infectious complications.

Major finding: Children with AD exacerbation vs an infectious complication had significantly higher mean serum total IgE levels (9603 ± 15,873 vs 3167 ± 5486 kU/L; P = .029). The likelihood of AD exacerbation vs an infectious complication was significantly greater in children with an age-adjusted IgE level (serum total IgE level/maximum reference IgE value for their age) of >4.

Study details: This retrospective chart review study included 68 children hospitalized for AD exacerbations (n = 34) or AD-associated infectious complications (n = 34) over a 17-year period.

Disclosures: This study did not report the source of funding. PY Ong declared serving as a consultant for and receiving research funding from various organizations.

Source: Atwal S, Ong PY. Elevated serum total IgE is associated with eczema exacerbation in children hospitalized for atopic dermatitis. Pediatr Dermatol. 2023 (Jan 19). Doi: 10.1111/pde.15245

Key clinical point: Children who were hospitalized for atopic dermatitis (AD) exacerbation had significantly higher serum total IgE levels than those hospitalized for AD-associated infectious complications.

Major finding: Children with AD exacerbation vs an infectious complication had significantly higher mean serum total IgE levels (9603 ± 15,873 vs 3167 ± 5486 kU/L; P = .029). The likelihood of AD exacerbation vs an infectious complication was significantly greater in children with an age-adjusted IgE level (serum total IgE level/maximum reference IgE value for their age) of >4.

Study details: This retrospective chart review study included 68 children hospitalized for AD exacerbations (n = 34) or AD-associated infectious complications (n = 34) over a 17-year period.

Disclosures: This study did not report the source of funding. PY Ong declared serving as a consultant for and receiving research funding from various organizations.

Source: Atwal S, Ong PY. Elevated serum total IgE is associated with eczema exacerbation in children hospitalized for atopic dermatitis. Pediatr Dermatol. 2023 (Jan 19). Doi: 10.1111/pde.15245

Key clinical point: Dupilumab demonstrated good 4-year drug survival in patients with moderate-to-severe atopic dermatitis (AD); however, early-onset AD (at <18 years of age) was a risk factor for a shorter drug survival.

Major finding: The 1-, 2-, 3-, and 4-year overall dupilumab drug survival rates were 90.5%, 82.9%, 78.8%, and 76.4%, respectively. Early onset of AD may serve as a significant predictor of shorter overall drug survival (hazard ratio, 1.32; P = .04).

Study details: This real-world prospective cohort study included 363 patients with moderate-to-severe AD who had received dupilumab for ≥4 weeks.

Disclosures: This study did not receive any funding. Some authors declared serving as consultants and/or speakers for various organizations.

Source: Pezzolo E et al. Long-term drug survival of dupilumab and associated predictors in moderate to severe atopic dermatitis: A real-world prospective cohort study. J Eur Acad Dermatol Venereol. 2023 (Jan 20). Doi: 10.1111/jdv.18889

Key clinical point: Dupilumab demonstrated good 4-year drug survival in patients with moderate-to-severe atopic dermatitis (AD); however, early-onset AD (at <18 years of age) was a risk factor for a shorter drug survival.

Major finding: The 1-, 2-, 3-, and 4-year overall dupilumab drug survival rates were 90.5%, 82.9%, 78.8%, and 76.4%, respectively. Early onset of AD may serve as a significant predictor of shorter overall drug survival (hazard ratio, 1.32; P = .04).

Study details: This real-world prospective cohort study included 363 patients with moderate-to-severe AD who had received dupilumab for ≥4 weeks.

Disclosures: This study did not receive any funding. Some authors declared serving as consultants and/or speakers for various organizations.

Source: Pezzolo E et al. Long-term drug survival of dupilumab and associated predictors in moderate to severe atopic dermatitis: A real-world prospective cohort study. J Eur Acad Dermatol Venereol. 2023 (Jan 20). Doi: 10.1111/jdv.18889

Key clinical point: Dupilumab demonstrated good 4-year drug survival in patients with moderate-to-severe atopic dermatitis (AD); however, early-onset AD (at <18 years of age) was a risk factor for a shorter drug survival.

Major finding: The 1-, 2-, 3-, and 4-year overall dupilumab drug survival rates were 90.5%, 82.9%, 78.8%, and 76.4%, respectively. Early onset of AD may serve as a significant predictor of shorter overall drug survival (hazard ratio, 1.32; P = .04).

Study details: This real-world prospective cohort study included 363 patients with moderate-to-severe AD who had received dupilumab for ≥4 weeks.

Disclosures: This study did not receive any funding. Some authors declared serving as consultants and/or speakers for various organizations.

Source: Pezzolo E et al. Long-term drug survival of dupilumab and associated predictors in moderate to severe atopic dermatitis: A real-world prospective cohort study. J Eur Acad Dermatol Venereol. 2023 (Jan 20). Doi: 10.1111/jdv.18889

Key clinical point: Coadjuvant treatment with a specific probiotic preparation reduced disease severity in children and adolescents with atopic dermatitis (AD), as evidenced by a decrease in Scoring of Atopic Dermatitis (SCORAD) and Investigator’s Global Assessment (IGA) scores.

Major finding: At 12 weeks, patients receiving the probiotic preparation vs placebo had a significantly higher rate of achieving at least a 1-point improvement in IGA score (90.5% vs 56.7%; P < .002) and lower SCORAD score (13.52 vs 18.96; P = .041).

Study details: This study included 70 patients aged 4-17 years with AD who were randomly assigned to receive the probiotic preparation (containing Bifidobacterium lactis, Bifidobacterium longum, and Lactobacillus casei; n = 35) or placebo (n = 35) daily for 12 weeks.

Disclosures: This study was funded by Biopolis SL. The authors declared no conflicts of interest.

Source: Feíto-Rodríguez M et al. Randomised double blind placebo controlled clinical trial to evaluate the effect of a mixture of probiotic strains on symptom severity and the use of corticosteroids in children and adolescents with atopic dermatitis. Clin Exp Dermatol. 2023 (Jan 13). Doi: 10.1093/ced/llad007

Key clinical point: Coadjuvant treatment with a specific probiotic preparation reduced disease severity in children and adolescents with atopic dermatitis (AD), as evidenced by a decrease in Scoring of Atopic Dermatitis (SCORAD) and Investigator’s Global Assessment (IGA) scores.

Major finding: At 12 weeks, patients receiving the probiotic preparation vs placebo had a significantly higher rate of achieving at least a 1-point improvement in IGA score (90.5% vs 56.7%; P < .002) and lower SCORAD score (13.52 vs 18.96; P = .041).

Study details: This study included 70 patients aged 4-17 years with AD who were randomly assigned to receive the probiotic preparation (containing Bifidobacterium lactis, Bifidobacterium longum, and Lactobacillus casei; n = 35) or placebo (n = 35) daily for 12 weeks.

Disclosures: This study was funded by Biopolis SL. The authors declared no conflicts of interest.

Source: Feíto-Rodríguez M et al. Randomised double blind placebo controlled clinical trial to evaluate the effect of a mixture of probiotic strains on symptom severity and the use of corticosteroids in children and adolescents with atopic dermatitis. Clin Exp Dermatol. 2023 (Jan 13). Doi: 10.1093/ced/llad007

Key clinical point: Coadjuvant treatment with a specific probiotic preparation reduced disease severity in children and adolescents with atopic dermatitis (AD), as evidenced by a decrease in Scoring of Atopic Dermatitis (SCORAD) and Investigator’s Global Assessment (IGA) scores.

Major finding: At 12 weeks, patients receiving the probiotic preparation vs placebo had a significantly higher rate of achieving at least a 1-point improvement in IGA score (90.5% vs 56.7%; P < .002) and lower SCORAD score (13.52 vs 18.96; P = .041).

Study details: This study included 70 patients aged 4-17 years with AD who were randomly assigned to receive the probiotic preparation (containing Bifidobacterium lactis, Bifidobacterium longum, and Lactobacillus casei; n = 35) or placebo (n = 35) daily for 12 weeks.

Disclosures: This study was funded by Biopolis SL. The authors declared no conflicts of interest.

Source: Feíto-Rodríguez M et al. Randomised double blind placebo controlled clinical trial to evaluate the effect of a mixture of probiotic strains on symptom severity and the use of corticosteroids in children and adolescents with atopic dermatitis. Clin Exp Dermatol. 2023 (Jan 13). Doi: 10.1093/ced/llad007

Key clinical point: Upadacitinib can serve as an effective treatment option for atopic dermatitis (AD) and concomitant hand eczema (HE) in daily practice.

Major finding: At week 16, the mean Eczema Area and Severity Index (EASI) score decreased significantly from 17.2 (at baseline) to 4.8 (P < .001) and 50.0%, 40.6%, 59.3%, and 74.1% of patients achieved EASI-75, an Investigator’s Global Assessment score of (almost) clear, Hand Eczema Severity Index-75, and a score of (almost) clear on the photographic guide, respectively. Adverse events were generally mild in severity.

Study details: This multicenter prospective observational study included 38 patients with AD from the BioDay registry who received once-daily upadacitinib over 16 weeks, of which 32 patients had concomitant HE.

Disclosures: The BioDay registry is funded by Sanofi/Regeneron and others. Some authors declared serving as advisors, speakers, or consultants for or receiving consulting fees from various sources, including the registry funders.

Source: Kamphuis E, Loman L, et al. Experiences from daily practice of upadacitinib treatment on atopic dermatitis with a focus on hand eczema: Results from the BioDay registry. Contact Dermatitis. 2023 (Jan 9). Doi: 10.1111/cod.14276

Key clinical point: Upadacitinib can serve as an effective treatment option for atopic dermatitis (AD) and concomitant hand eczema (HE) in daily practice.

Major finding: At week 16, the mean Eczema Area and Severity Index (EASI) score decreased significantly from 17.2 (at baseline) to 4.8 (P < .001) and 50.0%, 40.6%, 59.3%, and 74.1% of patients achieved EASI-75, an Investigator’s Global Assessment score of (almost) clear, Hand Eczema Severity Index-75, and a score of (almost) clear on the photographic guide, respectively. Adverse events were generally mild in severity.

Study details: This multicenter prospective observational study included 38 patients with AD from the BioDay registry who received once-daily upadacitinib over 16 weeks, of which 32 patients had concomitant HE.

Disclosures: The BioDay registry is funded by Sanofi/Regeneron and others. Some authors declared serving as advisors, speakers, or consultants for or receiving consulting fees from various sources, including the registry funders.

Source: Kamphuis E, Loman L, et al. Experiences from daily practice of upadacitinib treatment on atopic dermatitis with a focus on hand eczema: Results from the BioDay registry. Contact Dermatitis. 2023 (Jan 9). Doi: 10.1111/cod.14276

Key clinical point: Upadacitinib can serve as an effective treatment option for atopic dermatitis (AD) and concomitant hand eczema (HE) in daily practice.

Major finding: At week 16, the mean Eczema Area and Severity Index (EASI) score decreased significantly from 17.2 (at baseline) to 4.8 (P < .001) and 50.0%, 40.6%, 59.3%, and 74.1% of patients achieved EASI-75, an Investigator’s Global Assessment score of (almost) clear, Hand Eczema Severity Index-75, and a score of (almost) clear on the photographic guide, respectively. Adverse events were generally mild in severity.

Study details: This multicenter prospective observational study included 38 patients with AD from the BioDay registry who received once-daily upadacitinib over 16 weeks, of which 32 patients had concomitant HE.

Disclosures: The BioDay registry is funded by Sanofi/Regeneron and others. Some authors declared serving as advisors, speakers, or consultants for or receiving consulting fees from various sources, including the registry funders.

Source: Kamphuis E, Loman L, et al. Experiences from daily practice of upadacitinib treatment on atopic dermatitis with a focus on hand eczema: Results from the BioDay registry. Contact Dermatitis. 2023 (Jan 9). Doi: 10.1111/cod.14276

Key clinical point: Dupilumab provides rapid improvement in atopic dermatitis (AD) signs and symptoms and is well tolerated in patients with moderate-to-severe AD in a real-world setting.

Major finding: At week 12, the percentages of patients who achieved ≥75% improvement in the Eczema Area and Severity Index, an Investigator’s Global Assessment score of 0/1 with a ≥2-point reduction from baseline, and a ≥4-point decrease in itch-numerical rating scale score were 59.4%, 33.0%, and 57.0%, respectively. Adverse event rates were lower than those reported in previous phase 3 trials.

Study details: Findings are from a 12-week analysis of the multicenter prospective real-life study PROLEAD including 828 dupilumab-naive adult patients with moderate-to-severe AD who received dupilumab.

Disclosures: This study was funded by Sanofi. Some authors reported ties with various organizations, including Sanofi. Three authors declared being employees of or holding stock or stock options in Sanofi.

Source: Augustin M et al. Dupilumab demonstrates rapid onset of action in improving signs, symptoms and quality of life in adults with atopic dermatitis. Dermatol Ther (Heidelb). 2023 (Feb 4). Doi: 10.1007/s13555-023-00894-3

Key clinical point: Dupilumab provides rapid improvement in atopic dermatitis (AD) signs and symptoms and is well tolerated in patients with moderate-to-severe AD in a real-world setting.

Major finding: At week 12, the percentages of patients who achieved ≥75% improvement in the Eczema Area and Severity Index, an Investigator’s Global Assessment score of 0/1 with a ≥2-point reduction from baseline, and a ≥4-point decrease in itch-numerical rating scale score were 59.4%, 33.0%, and 57.0%, respectively. Adverse event rates were lower than those reported in previous phase 3 trials.

Study details: Findings are from a 12-week analysis of the multicenter prospective real-life study PROLEAD including 828 dupilumab-naive adult patients with moderate-to-severe AD who received dupilumab.

Disclosures: This study was funded by Sanofi. Some authors reported ties with various organizations, including Sanofi. Three authors declared being employees of or holding stock or stock options in Sanofi.

Source: Augustin M et al. Dupilumab demonstrates rapid onset of action in improving signs, symptoms and quality of life in adults with atopic dermatitis. Dermatol Ther (Heidelb). 2023 (Feb 4). Doi: 10.1007/s13555-023-00894-3

Key clinical point: Dupilumab provides rapid improvement in atopic dermatitis (AD) signs and symptoms and is well tolerated in patients with moderate-to-severe AD in a real-world setting.

Major finding: At week 12, the percentages of patients who achieved ≥75% improvement in the Eczema Area and Severity Index, an Investigator’s Global Assessment score of 0/1 with a ≥2-point reduction from baseline, and a ≥4-point decrease in itch-numerical rating scale score were 59.4%, 33.0%, and 57.0%, respectively. Adverse event rates were lower than those reported in previous phase 3 trials.

Study details: Findings are from a 12-week analysis of the multicenter prospective real-life study PROLEAD including 828 dupilumab-naive adult patients with moderate-to-severe AD who received dupilumab.

Disclosures: This study was funded by Sanofi. Some authors reported ties with various organizations, including Sanofi. Three authors declared being employees of or holding stock or stock options in Sanofi.

Source: Augustin M et al. Dupilumab demonstrates rapid onset of action in improving signs, symptoms and quality of life in adults with atopic dermatitis. Dermatol Ther (Heidelb). 2023 (Feb 4). Doi: 10.1007/s13555-023-00894-3

Key clinical point: Tralokinumab was effective and safe in a real-world cohort of patients with moderate-to-severe atopic dermatitis (AD) who had failed prior systemic therapy.

Major finding: At last review (24 weeks of maximum follow-up), 59% of patients were still on tralokinumab therapy and showed a decrease in the median Numeric Rating Scale Peak Pruritus Score over the past 7 days (from 5 at baseline to 2) but without any change in the median Investigator Global Assessment score. Treatment-related adverse events were mostly mild in severity.

Study details: Findings are from an observational, prospective cohort study including 37 patients aged ≥15 years with moderate-to-severe AD who had failed prior therapy with immunosuppressants, biologics, or a Janus kinase inhibitor and received subcutaneous tralokinumab.

Disclosures: This study did not receive any funding. DJ Hijnen declared serving as an investigator for and receiving consulting fees from various sources.

Source: Schlösser AR et al. Tralokinumab for moderate-to-severe atopic dermatitis patients: First daily practice results. Clin Exp Dermatol. 2023 (Jan 26). Doi: 10.1093/ced/llad038

Key clinical point: Tralokinumab was effective and safe in a real-world cohort of patients with moderate-to-severe atopic dermatitis (AD) who had failed prior systemic therapy.

Major finding: At last review (24 weeks of maximum follow-up), 59% of patients were still on tralokinumab therapy and showed a decrease in the median Numeric Rating Scale Peak Pruritus Score over the past 7 days (from 5 at baseline to 2) but without any change in the median Investigator Global Assessment score. Treatment-related adverse events were mostly mild in severity.

Study details: Findings are from an observational, prospective cohort study including 37 patients aged ≥15 years with moderate-to-severe AD who had failed prior therapy with immunosuppressants, biologics, or a Janus kinase inhibitor and received subcutaneous tralokinumab.

Disclosures: This study did not receive any funding. DJ Hijnen declared serving as an investigator for and receiving consulting fees from various sources.

Source: Schlösser AR et al. Tralokinumab for moderate-to-severe atopic dermatitis patients: First daily practice results. Clin Exp Dermatol. 2023 (Jan 26). Doi: 10.1093/ced/llad038

Key clinical point: Tralokinumab was effective and safe in a real-world cohort of patients with moderate-to-severe atopic dermatitis (AD) who had failed prior systemic therapy.

Major finding: At last review (24 weeks of maximum follow-up), 59% of patients were still on tralokinumab therapy and showed a decrease in the median Numeric Rating Scale Peak Pruritus Score over the past 7 days (from 5 at baseline to 2) but without any change in the median Investigator Global Assessment score. Treatment-related adverse events were mostly mild in severity.

Study details: Findings are from an observational, prospective cohort study including 37 patients aged ≥15 years with moderate-to-severe AD who had failed prior therapy with immunosuppressants, biologics, or a Janus kinase inhibitor and received subcutaneous tralokinumab.

Disclosures: This study did not receive any funding. DJ Hijnen declared serving as an investigator for and receiving consulting fees from various sources.

Source: Schlösser AR et al. Tralokinumab for moderate-to-severe atopic dermatitis patients: First daily practice results. Clin Exp Dermatol. 2023 (Jan 26). Doi: 10.1093/ced/llad038

Key clinical point: Tralokinumab was effective and safe in a real-world cohort of patients with moderate-to-severe atopic dermatitis (AD) who had failed prior systemic therapy.

Major finding: At last review (24 weeks of maximum follow-up), 59% of patients were still on tralokinumab therapy and showed a decrease in the median Numeric Rating Scale Peak Pruritus Score over the past 7 days (from 5 at baseline to 2) but without any change in the median Investigator Global Assessment score. Treatment-related adverse events were mostly mild in severity.

Study details: Findings are from an observational, prospective cohort study including 37 patients aged ≥15 years with moderate-to-severe AD who had failed prior therapy with immunosuppressants, biologics, or a Janus kinase inhibitor and received subcutaneous tralokinumab.

Disclosures: This study did not receive any funding. DJ Hijnen declared serving as an investigator for and receiving consulting fees from various sources.

Source: Schlösser AR et al. Tralokinumab for moderate-to-severe atopic dermatitis patients: First daily practice results. Clin Exp Dermatol. 2023 (Jan 26). Doi: 10.1093/ced/llad038

Key clinical point: Tralokinumab was effective and safe in a real-world cohort of patients with moderate-to-severe atopic dermatitis (AD) who had failed prior systemic therapy.

Major finding: At last review (24 weeks of maximum follow-up), 59% of patients were still on tralokinumab therapy and showed a decrease in the median Numeric Rating Scale Peak Pruritus Score over the past 7 days (from 5 at baseline to 2) but without any change in the median Investigator Global Assessment score. Treatment-related adverse events were mostly mild in severity.

Study details: Findings are from an observational, prospective cohort study including 37 patients aged ≥15 years with moderate-to-severe AD who had failed prior therapy with immunosuppressants, biologics, or a Janus kinase inhibitor and received subcutaneous tralokinumab.

Disclosures: This study did not receive any funding. DJ Hijnen declared serving as an investigator for and receiving consulting fees from various sources.

Source: Schlösser AR et al. Tralokinumab for moderate-to-severe atopic dermatitis patients: First daily practice results. Clin Exp Dermatol. 2023 (Jan 26). Doi: 10.1093/ced/llad038

Key clinical point: Tralokinumab was effective and safe in a real-world cohort of patients with moderate-to-severe atopic dermatitis (AD) who had failed prior systemic therapy.

Major finding: At last review (24 weeks of maximum follow-up), 59% of patients were still on tralokinumab therapy and showed a decrease in the median Numeric Rating Scale Peak Pruritus Score over the past 7 days (from 5 at baseline to 2) but without any change in the median Investigator Global Assessment score. Treatment-related adverse events were mostly mild in severity.

Study details: Findings are from an observational, prospective cohort study including 37 patients aged ≥15 years with moderate-to-severe AD who had failed prior therapy with immunosuppressants, biologics, or a Janus kinase inhibitor and received subcutaneous tralokinumab.

Disclosures: This study did not receive any funding. DJ Hijnen declared serving as an investigator for and receiving consulting fees from various sources.

Source: Schlösser AR et al. Tralokinumab for moderate-to-severe atopic dermatitis patients: First daily practice results. Clin Exp Dermatol. 2023 (Jan 26). Doi: 10.1093/ced/llad038

Key clinical point: Children born by cesarean section or instrumental vaginal delivery are at a greater risk of developing atopic dermatitis (AD) compared with those born by uncomplicated vaginal delivery.

Major finding: Children aged <1 year born by instrumental vaginal delivery (adjusted hazard ratio [aHR] 1.10; 95% CI 1.07-1.13), emergency cesarean section (aHR 1.12; 95% CI 1.10-1.15), and elective caesarean section (aHR 1.13; 95% CI 1.10-1.16) were at a higher risk for AD compared with those born by uncomplicated vaginal delivery, with the risk being similar in children aged ≥1 year.

Study details: This prospective population-based study included 1,399,406 children aged ≤5 years with available information on the mode of delivery and mother's identity.

Disclosures: This study was supported by the Swedish Research Council, Swedish Heart-Lung Foundation, and Stiftelsen Frimurare Barnhuset i Stockholm. The authors declared no conflicts of interest.

Source: Mubanga M et al. Mode of delivery and offspring atopic dermatitis in a Swedish nationwide study. Pediatr Allergy Immunol. 2023;34(1):e13904 (Jan 11). Doi: 10.1111/pai.13904

Key clinical point: Children born by cesarean section or instrumental vaginal delivery are at a greater risk of developing atopic dermatitis (AD) compared with those born by uncomplicated vaginal delivery.

Major finding: Children aged <1 year born by instrumental vaginal delivery (adjusted hazard ratio [aHR] 1.10; 95% CI 1.07-1.13), emergency cesarean section (aHR 1.12; 95% CI 1.10-1.15), and elective caesarean section (aHR 1.13; 95% CI 1.10-1.16) were at a higher risk for AD compared with those born by uncomplicated vaginal delivery, with the risk being similar in children aged ≥1 year.

Study details: This prospective population-based study included 1,399,406 children aged ≤5 years with available information on the mode of delivery and mother's identity.

Disclosures: This study was supported by the Swedish Research Council, Swedish Heart-Lung Foundation, and Stiftelsen Frimurare Barnhuset i Stockholm. The authors declared no conflicts of interest.

Source: Mubanga M et al. Mode of delivery and offspring atopic dermatitis in a Swedish nationwide study. Pediatr Allergy Immunol. 2023;34(1):e13904 (Jan 11). Doi: 10.1111/pai.13904

Key clinical point: Children born by cesarean section or instrumental vaginal delivery are at a greater risk of developing atopic dermatitis (AD) compared with those born by uncomplicated vaginal delivery.

Major finding: Children aged <1 year born by instrumental vaginal delivery (adjusted hazard ratio [aHR] 1.10; 95% CI 1.07-1.13), emergency cesarean section (aHR 1.12; 95% CI 1.10-1.15), and elective caesarean section (aHR 1.13; 95% CI 1.10-1.16) were at a higher risk for AD compared with those born by uncomplicated vaginal delivery, with the risk being similar in children aged ≥1 year.

Study details: This prospective population-based study included 1,399,406 children aged ≤5 years with available information on the mode of delivery and mother's identity.

Disclosures: This study was supported by the Swedish Research Council, Swedish Heart-Lung Foundation, and Stiftelsen Frimurare Barnhuset i Stockholm. The authors declared no conflicts of interest.

Source: Mubanga M et al. Mode of delivery and offspring atopic dermatitis in a Swedish nationwide study. Pediatr Allergy Immunol. 2023;34(1):e13904 (Jan 11). Doi: 10.1111/pai.13904

Key clinical point: Dupilumab with or without concomitant topical corticosteroids (TCS) was safe and provided rapid and sustained improvements in atopic dermatitis (AD) signs and symptoms in patients with erythrodermic AD.

Major finding: At week 16, dupilumab without and with concomitant TCS vs placebo provided significant improvements in the percentage of AD-affected body surface area (P = .02 and P < .001, respectively), Eczema Area and Severity Index score (P = .002 and P < .001, respectively), and Peak Pruritus Numerical Rating Scale score (P < .001 and P = .002, respectively), with improvements observed from week 1. Most treatment-emergent adverse events were mild or moderate in severity.

Study details: This post hoc analysis of six multicenter randomized trials included 209 patients with erythrodermic AD who were randomly assigned to receive dupilumab or placebo (both with or without concomitant TCS).

Disclosures: This study was funded by Sanofi-Regeneron Pharmaceuticals Inc. Some authors reported ties with various organizations, including Sanofi/Regeneron. Four authors declared being employees of or holding stock or stock options in Sanofi/Regeneron.

Source: Paller AS et al. Efficacy and safety of dupilumab in patients with erythrodermic atopic dermatitis: A post hoc analysis of 6 randomized clinical trials. JAMA Dermatol. 2023 (Feb 1). Doi: 10.1001/jamadermatol.2022.6192

Key clinical point: Dupilumab with or without concomitant topical corticosteroids (TCS) was safe and provided rapid and sustained improvements in atopic dermatitis (AD) signs and symptoms in patients with erythrodermic AD.

Major finding: At week 16, dupilumab without and with concomitant TCS vs placebo provided significant improvements in the percentage of AD-affected body surface area (P = .02 and P < .001, respectively), Eczema Area and Severity Index score (P = .002 and P < .001, respectively), and Peak Pruritus Numerical Rating Scale score (P < .001 and P = .002, respectively), with improvements observed from week 1. Most treatment-emergent adverse events were mild or moderate in severity.

Study details: This post hoc analysis of six multicenter randomized trials included 209 patients with erythrodermic AD who were randomly assigned to receive dupilumab or placebo (both with or without concomitant TCS).

Disclosures: This study was funded by Sanofi-Regeneron Pharmaceuticals Inc. Some authors reported ties with various organizations, including Sanofi/Regeneron. Four authors declared being employees of or holding stock or stock options in Sanofi/Regeneron.

Source: Paller AS et al. Efficacy and safety of dupilumab in patients with erythrodermic atopic dermatitis: A post hoc analysis of 6 randomized clinical trials. JAMA Dermatol. 2023 (Feb 1). Doi: 10.1001/jamadermatol.2022.6192

Key clinical point: Dupilumab with or without concomitant topical corticosteroids (TCS) was safe and provided rapid and sustained improvements in atopic dermatitis (AD) signs and symptoms in patients with erythrodermic AD.

Major finding: At week 16, dupilumab without and with concomitant TCS vs placebo provided significant improvements in the percentage of AD-affected body surface area (P = .02 and P < .001, respectively), Eczema Area and Severity Index score (P = .002 and P < .001, respectively), and Peak Pruritus Numerical Rating Scale score (P < .001 and P = .002, respectively), with improvements observed from week 1. Most treatment-emergent adverse events were mild or moderate in severity.

Study details: This post hoc analysis of six multicenter randomized trials included 209 patients with erythrodermic AD who were randomly assigned to receive dupilumab or placebo (both with or without concomitant TCS).

Disclosures: This study was funded by Sanofi-Regeneron Pharmaceuticals Inc. Some authors reported ties with various organizations, including Sanofi/Regeneron. Four authors declared being employees of or holding stock or stock options in Sanofi/Regeneron.

Source: Paller AS et al. Efficacy and safety of dupilumab in patients with erythrodermic atopic dermatitis: A post hoc analysis of 6 randomized clinical trials. JAMA Dermatol. 2023 (Feb 1). Doi: 10.1001/jamadermatol.2022.6192

People at high risk for nonalcoholic fatty liver disease (NAFLD), such as those with type 2 diabetes or medically complicated obesity, should be screened for advanced fibrosis, says new guidance from the American Association for the Study of Liver Diseases.

The guidance, published online in Hepatology, also reflects recent advances in the diagnosis and management of NAFLD, particularly noninvasive testing, lead author Mary E. Rinella, MD, University of Chicago, told this news organization.

The “biggest change” from the previous guidance, published 5 years ago, is “that we are explicitly recommending that people in high-risk categories get screened in primary care,” she said.

NAFLD is “a silent disease ... you could easily have somebody develop cirrhosis,” Dr. Rinella said. By identifying patients earlier, physicians would be able to “prevent or reduce the number of people turning up decompensated or at an advanced stage,” she added.

The other message that Dr. Rinella wants clinicians to take away from the guidance is that “something can be done” for patients with NAFLD. “It’s very common, and the often-cited reason why patients aren’t referred to specialty care is that there’s ‘nothing that can be done.’ ”

Although there is no U.S. Food and Drug Administration–approved drug for NAFLD, clinicians can still support their patients and suggest lifestyle changes, she added.

The guidelines also are designed to prepare the groundwork for novel drugs in the pipeline, as well as discuss those that are already available for conditions such as obesity and diabetes and that benefit people with liver disease, Dr. Rinella said.
 

Screening and evaluation

The guidance covers all aspects of NAFLD, including the latest developments in understanding of the epidemiology and natural history of the disease, and its molecular and cellular pathogenesis.

The guidance continues to recommend against population-based screening for NAFLD. In addition to the aforementioned screening for advanced fibrosis in high-risk individuals, it calls for a primary risk assessment with FIB-4 to be performed every 1-2 years in patients with pre-diabetes, type 2 diabetes, two or more metabolic risk factors, or imaging evidence of hepatic steatosis.

Patients with nonalcoholic steatohepatitis (NASH) cirrhosis require routine monitoring, as they are at the highest risk for liver-related outcomes, the guidance adds. Those with suspected NASH should be referred for evaluation by a specialist.

In assessments of liver fibrosis in patients, findings such as highly elevated liver stiffness, FIB-4, and enhanced liver fibrosis scores can predict an increased risk for hepatic decompensation and mortality, the authors write.
 

Intervention guidance

Patients with NAFLD who are overweight or obese should be prescribed a reduced calorie diet in a multidisciplinary setting because weight loss “improves hepatic steatosis, NASH, and hepatic fibrosis in a dose-dependent manner,” the guidance states.

Bariatric surgery should be considered in appropriate patients because of its effectiveness in resolving NAFLD and NASH in most patients without cirrhosis, the guidance says. However, in patients with well-compensated NASH cirrhosis, the type, safety, and efficacy of bariatric surgery is not established, so a “careful benefit-risk assessment by a multidisciplinary team of experts that includes a hepatologist” is needed, the authors note.

The guidance discusses alcohol consumption’s role in the progression of fatty liver disease and recommends that intake be assessed on a regular basis in patients with NAFLD. Patients with clinically significant hepatic fibrosis should abstain completely, it adds. Abstinence, particularly for patients with moderate to heavy alcohol intake, may lower the risk of fibrosis progression and hepatic and extrahepatic malignancies, the authors note.

Additionally, drinking at least three cups of coffee, caffeinated or not, per day is “associated with less-advanced liver disease,” they write.

The guidance also sets out key considerations for people with comorbid conditions. It states that patients with NAFLD should be screened for type 2 diabetes and that statins can be safely used for cardiovascular risk reduction “across the disease spectrum, including compensated cirrhosis.”

While noting the lack of approved medications for NAFLD, the guidance states that some drugs prescribed for comorbidities also benefit patients with NASH. These are glucagon-like peptide 1 agonist semaglutide, pioglitazone, and vitamin E supplementation in select patients.

Available data on these same drugs, however, do not show an antifibrotic benefit and haven’t been studied in patients with cirrhosis, the guidance states.

Additionally, metformin, ursodeoxycholic acid, dipeptidyl peptidase-4 inhibitors, silymarin, and statins do not offer meaningful histologic benefit and shouldn’t be used as a treatment for NASH.
 

Help against an ‘evolving epidemic’

The guidance is “timely and long awaited,” Jamile Wakim-Fleming, MD, director of the fatty liver disease program at the Cleveland Clinic, said in an interview. NAFLD is an “evolving epidemic,” she added.

Numerous recent studies have “led to new modalities for diagnosis and therapy, and a better understanding” of the epidemiology and pathophysiology of NAFLD, she said. “More specifically, advancements in noninvasive testing, risk stratifications, and therapeutic modalities are now available and worth disseminating.”

NAFLD’s complexity and the lack of an FDA-approved therapy specifically targeting the liver means that managing the disease “requires expertise in multiple disciplines and knowledge of the latest developments,” Dr. Wakim-Fleming noted.

“This guidance describes preventive and treatment strategies for the metabolic conditions associated with NAFLD and is very useful for physicians in different specialties who treat individuals with these conditions,” she said.

No funding was declared. Dr. Rinella and Dr. Wakim-Fleming have disclosed no relevant financial relationships.

A version of this article originally appeared on Medscape.com.


The AGA’s Clinical Practice Update on the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Lean Individuals is available online.

People at high risk for nonalcoholic fatty liver disease (NAFLD), such as those with type 2 diabetes or medically complicated obesity, should be screened for advanced fibrosis, says new guidance from the American Association for the Study of Liver Diseases.

The guidance, published online in Hepatology, also reflects recent advances in the diagnosis and management of NAFLD, particularly noninvasive testing, lead author Mary E. Rinella, MD, University of Chicago, told this news organization.

The “biggest change” from the previous guidance, published 5 years ago, is “that we are explicitly recommending that people in high-risk categories get screened in primary care,” she said.

NAFLD is “a silent disease ... you could easily have somebody develop cirrhosis,” Dr. Rinella said. By identifying patients earlier, physicians would be able to “prevent or reduce the number of people turning up decompensated or at an advanced stage,” she added.

The other message that Dr. Rinella wants clinicians to take away from the guidance is that “something can be done” for patients with NAFLD. “It’s very common, and the often-cited reason why patients aren’t referred to specialty care is that there’s ‘nothing that can be done.’ ”

Although there is no U.S. Food and Drug Administration–approved drug for NAFLD, clinicians can still support their patients and suggest lifestyle changes, she added.

The guidelines also are designed to prepare the groundwork for novel drugs in the pipeline, as well as discuss those that are already available for conditions such as obesity and diabetes and that benefit people with liver disease, Dr. Rinella said.
 

Screening and evaluation

The guidance covers all aspects of NAFLD, including the latest developments in understanding of the epidemiology and natural history of the disease, and its molecular and cellular pathogenesis.

The guidance continues to recommend against population-based screening for NAFLD. In addition to the aforementioned screening for advanced fibrosis in high-risk individuals, it calls for a primary risk assessment with FIB-4 to be performed every 1-2 years in patients with pre-diabetes, type 2 diabetes, two or more metabolic risk factors, or imaging evidence of hepatic steatosis.

Patients with nonalcoholic steatohepatitis (NASH) cirrhosis require routine monitoring, as they are at the highest risk for liver-related outcomes, the guidance adds. Those with suspected NASH should be referred for evaluation by a specialist.

In assessments of liver fibrosis in patients, findings such as highly elevated liver stiffness, FIB-4, and enhanced liver fibrosis scores can predict an increased risk for hepatic decompensation and mortality, the authors write.
 

Intervention guidance

Patients with NAFLD who are overweight or obese should be prescribed a reduced calorie diet in a multidisciplinary setting because weight loss “improves hepatic steatosis, NASH, and hepatic fibrosis in a dose-dependent manner,” the guidance states.

Bariatric surgery should be considered in appropriate patients because of its effectiveness in resolving NAFLD and NASH in most patients without cirrhosis, the guidance says. However, in patients with well-compensated NASH cirrhosis, the type, safety, and efficacy of bariatric surgery is not established, so a “careful benefit-risk assessment by a multidisciplinary team of experts that includes a hepatologist” is needed, the authors note.

The guidance discusses alcohol consumption’s role in the progression of fatty liver disease and recommends that intake be assessed on a regular basis in patients with NAFLD. Patients with clinically significant hepatic fibrosis should abstain completely, it adds. Abstinence, particularly for patients with moderate to heavy alcohol intake, may lower the risk of fibrosis progression and hepatic and extrahepatic malignancies, the authors note.

Additionally, drinking at least three cups of coffee, caffeinated or not, per day is “associated with less-advanced liver disease,” they write.

The guidance also sets out key considerations for people with comorbid conditions. It states that patients with NAFLD should be screened for type 2 diabetes and that statins can be safely used for cardiovascular risk reduction “across the disease spectrum, including compensated cirrhosis.”

While noting the lack of approved medications for NAFLD, the guidance states that some drugs prescribed for comorbidities also benefit patients with NASH. These are glucagon-like peptide 1 agonist semaglutide, pioglitazone, and vitamin E supplementation in select patients.

Available data on these same drugs, however, do not show an antifibrotic benefit and haven’t been studied in patients with cirrhosis, the guidance states.

Additionally, metformin, ursodeoxycholic acid, dipeptidyl peptidase-4 inhibitors, silymarin, and statins do not offer meaningful histologic benefit and shouldn’t be used as a treatment for NASH.
 

Help against an ‘evolving epidemic’

The guidance is “timely and long awaited,” Jamile Wakim-Fleming, MD, director of the fatty liver disease program at the Cleveland Clinic, said in an interview. NAFLD is an “evolving epidemic,” she added.

Numerous recent studies have “led to new modalities for diagnosis and therapy, and a better understanding” of the epidemiology and pathophysiology of NAFLD, she said. “More specifically, advancements in noninvasive testing, risk stratifications, and therapeutic modalities are now available and worth disseminating.”

NAFLD’s complexity and the lack of an FDA-approved therapy specifically targeting the liver means that managing the disease “requires expertise in multiple disciplines and knowledge of the latest developments,” Dr. Wakim-Fleming noted.

“This guidance describes preventive and treatment strategies for the metabolic conditions associated with NAFLD and is very useful for physicians in different specialties who treat individuals with these conditions,” she said.

No funding was declared. Dr. Rinella and Dr. Wakim-Fleming have disclosed no relevant financial relationships.

A version of this article originally appeared on Medscape.com.


The AGA’s Clinical Practice Update on the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Lean Individuals is available online.

People at high risk for nonalcoholic fatty liver disease (NAFLD), such as those with type 2 diabetes or medically complicated obesity, should be screened for advanced fibrosis, says new guidance from the American Association for the Study of Liver Diseases.

The guidance, published online in Hepatology, also reflects recent advances in the diagnosis and management of NAFLD, particularly noninvasive testing, lead author Mary E. Rinella, MD, University of Chicago, told this news organization.

The “biggest change” from the previous guidance, published 5 years ago, is “that we are explicitly recommending that people in high-risk categories get screened in primary care,” she said.

NAFLD is “a silent disease ... you could easily have somebody develop cirrhosis,” Dr. Rinella said. By identifying patients earlier, physicians would be able to “prevent or reduce the number of people turning up decompensated or at an advanced stage,” she added.

The other message that Dr. Rinella wants clinicians to take away from the guidance is that “something can be done” for patients with NAFLD. “It’s very common, and the often-cited reason why patients aren’t referred to specialty care is that there’s ‘nothing that can be done.’ ”

Although there is no U.S. Food and Drug Administration–approved drug for NAFLD, clinicians can still support their patients and suggest lifestyle changes, she added.

The guidelines also are designed to prepare the groundwork for novel drugs in the pipeline, as well as discuss those that are already available for conditions such as obesity and diabetes and that benefit people with liver disease, Dr. Rinella said.
 

Screening and evaluation

The guidance covers all aspects of NAFLD, including the latest developments in understanding of the epidemiology and natural history of the disease, and its molecular and cellular pathogenesis.

The guidance continues to recommend against population-based screening for NAFLD. In addition to the aforementioned screening for advanced fibrosis in high-risk individuals, it calls for a primary risk assessment with FIB-4 to be performed every 1-2 years in patients with pre-diabetes, type 2 diabetes, two or more metabolic risk factors, or imaging evidence of hepatic steatosis.

Patients with nonalcoholic steatohepatitis (NASH) cirrhosis require routine monitoring, as they are at the highest risk for liver-related outcomes, the guidance adds. Those with suspected NASH should be referred for evaluation by a specialist.

In assessments of liver fibrosis in patients, findings such as highly elevated liver stiffness, FIB-4, and enhanced liver fibrosis scores can predict an increased risk for hepatic decompensation and mortality, the authors write.
 

Intervention guidance

Patients with NAFLD who are overweight or obese should be prescribed a reduced calorie diet in a multidisciplinary setting because weight loss “improves hepatic steatosis, NASH, and hepatic fibrosis in a dose-dependent manner,” the guidance states.

Bariatric surgery should be considered in appropriate patients because of its effectiveness in resolving NAFLD and NASH in most patients without cirrhosis, the guidance says. However, in patients with well-compensated NASH cirrhosis, the type, safety, and efficacy of bariatric surgery is not established, so a “careful benefit-risk assessment by a multidisciplinary team of experts that includes a hepatologist” is needed, the authors note.

The guidance discusses alcohol consumption’s role in the progression of fatty liver disease and recommends that intake be assessed on a regular basis in patients with NAFLD. Patients with clinically significant hepatic fibrosis should abstain completely, it adds. Abstinence, particularly for patients with moderate to heavy alcohol intake, may lower the risk of fibrosis progression and hepatic and extrahepatic malignancies, the authors note.

Additionally, drinking at least three cups of coffee, caffeinated or not, per day is “associated with less-advanced liver disease,” they write.

The guidance also sets out key considerations for people with comorbid conditions. It states that patients with NAFLD should be screened for type 2 diabetes and that statins can be safely used for cardiovascular risk reduction “across the disease spectrum, including compensated cirrhosis.”

While noting the lack of approved medications for NAFLD, the guidance states that some drugs prescribed for comorbidities also benefit patients with NASH. These are glucagon-like peptide 1 agonist semaglutide, pioglitazone, and vitamin E supplementation in select patients.

Available data on these same drugs, however, do not show an antifibrotic benefit and haven’t been studied in patients with cirrhosis, the guidance states.

Additionally, metformin, ursodeoxycholic acid, dipeptidyl peptidase-4 inhibitors, silymarin, and statins do not offer meaningful histologic benefit and shouldn’t be used as a treatment for NASH.
 

Help against an ‘evolving epidemic’

The guidance is “timely and long awaited,” Jamile Wakim-Fleming, MD, director of the fatty liver disease program at the Cleveland Clinic, said in an interview. NAFLD is an “evolving epidemic,” she added.

Numerous recent studies have “led to new modalities for diagnosis and therapy, and a better understanding” of the epidemiology and pathophysiology of NAFLD, she said. “More specifically, advancements in noninvasive testing, risk stratifications, and therapeutic modalities are now available and worth disseminating.”

NAFLD’s complexity and the lack of an FDA-approved therapy specifically targeting the liver means that managing the disease “requires expertise in multiple disciplines and knowledge of the latest developments,” Dr. Wakim-Fleming noted.

“This guidance describes preventive and treatment strategies for the metabolic conditions associated with NAFLD and is very useful for physicians in different specialties who treat individuals with these conditions,” she said.

No funding was declared. Dr. Rinella and Dr. Wakim-Fleming have disclosed no relevant financial relationships.

A version of this article originally appeared on Medscape.com.


The AGA’s Clinical Practice Update on the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Lean Individuals is available online.