Atopic Dermatitis

Key clinical point: A substantial proportion of adults with atopic dermatitis showed contact hypersensitivity to preservatives (PCHS), thus highlighting the need for patch testing in case of worsening skin symptoms because of topical medications or personal care products.

Major finding: The most common preservatives affecting patients with concomitant AD and PCHS were methylisothiazolinone (MI; 83.8%) and 3:1 ratio of methylchloroisothiazolinone/MI (Kathon CG; 36.8%), followed by methyldibromo-glutaronitrile (16.2%), paraben (11.8%), and formaldehyde (7.4%). The majority of patients (79.41%) had one PCHS, whereas 17.65% of patients had two PCHS, with MI and Kathon CG being the most common combination.

Study details: Findings are from a 15-year retrospective study including 723 adults with PCHS and 639 adults with AD, of which 68 patients had concomitant AD and PCHS.

Disclosures: This study was funded by Semmelweis 250+ PhD Excellency Scholarship, Hungary. The authors declared no conflicts of interest.

Source: Nemeth D et al. Preservative contact hypersensitivity among adult atopic dermatitis patients. Life (Basel). 2022;12(5): 715 (May 11). Doi: 10.3390/life12050715

Key clinical point: A substantial proportion of adults with atopic dermatitis showed contact hypersensitivity to preservatives (PCHS), thus highlighting the need for patch testing in case of worsening skin symptoms because of topical medications or personal care products.

Major finding: The most common preservatives affecting patients with concomitant AD and PCHS were methylisothiazolinone (MI; 83.8%) and 3:1 ratio of methylchloroisothiazolinone/MI (Kathon CG; 36.8%), followed by methyldibromo-glutaronitrile (16.2%), paraben (11.8%), and formaldehyde (7.4%). The majority of patients (79.41%) had one PCHS, whereas 17.65% of patients had two PCHS, with MI and Kathon CG being the most common combination.

Study details: Findings are from a 15-year retrospective study including 723 adults with PCHS and 639 adults with AD, of which 68 patients had concomitant AD and PCHS.

Disclosures: This study was funded by Semmelweis 250+ PhD Excellency Scholarship, Hungary. The authors declared no conflicts of interest.

Source: Nemeth D et al. Preservative contact hypersensitivity among adult atopic dermatitis patients. Life (Basel). 2022;12(5): 715 (May 11). Doi: 10.3390/life12050715

Key clinical point: A substantial proportion of adults with atopic dermatitis showed contact hypersensitivity to preservatives (PCHS), thus highlighting the need for patch testing in case of worsening skin symptoms because of topical medications or personal care products.

Major finding: The most common preservatives affecting patients with concomitant AD and PCHS were methylisothiazolinone (MI; 83.8%) and 3:1 ratio of methylchloroisothiazolinone/MI (Kathon CG; 36.8%), followed by methyldibromo-glutaronitrile (16.2%), paraben (11.8%), and formaldehyde (7.4%). The majority of patients (79.41%) had one PCHS, whereas 17.65% of patients had two PCHS, with MI and Kathon CG being the most common combination.

Study details: Findings are from a 15-year retrospective study including 723 adults with PCHS and 639 adults with AD, of which 68 patients had concomitant AD and PCHS.

Disclosures: This study was funded by Semmelweis 250+ PhD Excellency Scholarship, Hungary. The authors declared no conflicts of interest.

Source: Nemeth D et al. Preservative contact hypersensitivity among adult atopic dermatitis patients. Life (Basel). 2022;12(5): 715 (May 11). Doi: 10.3390/life12050715

Key clinical point: In a real-world setting, patients initiating dupilumab reported longstanding moderate-to-severe atopic dermatitis (AD) with frequent type 2 comorbidities and poor quality of life (QoL).

Major finding: Patients reported experiencing AD for a median duration of 17 years, with 93.3% of patients receiving treatments for AD in the previous year, 49.5% receiving systemic medications, and 65.4% reporting a history of ≥1 type 2 inflammatory comorbidities. Overall, 89.2% of patients had a disease severity score of 3/4 (moderate/severe AD) and a mean dermatology life quality index score of 12.7, indicating a severe effect of AD on QoL.

Study details: Findings are from an interim analysis of the ongoing longitudinal, prospective, observational PROSE study including 315 adults with physician-diagnosed AD who initiated dupilumab.

Disclosures: This study was sponsored by Sanofi and Regeneron Pharmaceuticals, Inc. Seven authors declared being employees and shareholders of Regeneron Pharmaceuticals or Sanofi, and the other authors reported ties with various sources, including Sanofi and Regeneron.

Source: Bagel J et al. Baseline demographics and severity and burden of atopic dermatitis in adult patients initiating dupilumab treatment in a real-world registry (PROSE). Dermatol Ther (Heidelb). 2022 (May 20). Doi: 10.1007/s13555-022-00742-w

Key clinical point: In a real-world setting, patients initiating dupilumab reported longstanding moderate-to-severe atopic dermatitis (AD) with frequent type 2 comorbidities and poor quality of life (QoL).

Major finding: Patients reported experiencing AD for a median duration of 17 years, with 93.3% of patients receiving treatments for AD in the previous year, 49.5% receiving systemic medications, and 65.4% reporting a history of ≥1 type 2 inflammatory comorbidities. Overall, 89.2% of patients had a disease severity score of 3/4 (moderate/severe AD) and a mean dermatology life quality index score of 12.7, indicating a severe effect of AD on QoL.

Study details: Findings are from an interim analysis of the ongoing longitudinal, prospective, observational PROSE study including 315 adults with physician-diagnosed AD who initiated dupilumab.

Disclosures: This study was sponsored by Sanofi and Regeneron Pharmaceuticals, Inc. Seven authors declared being employees and shareholders of Regeneron Pharmaceuticals or Sanofi, and the other authors reported ties with various sources, including Sanofi and Regeneron.

Source: Bagel J et al. Baseline demographics and severity and burden of atopic dermatitis in adult patients initiating dupilumab treatment in a real-world registry (PROSE). Dermatol Ther (Heidelb). 2022 (May 20). Doi: 10.1007/s13555-022-00742-w

Key clinical point: In a real-world setting, patients initiating dupilumab reported longstanding moderate-to-severe atopic dermatitis (AD) with frequent type 2 comorbidities and poor quality of life (QoL).

Major finding: Patients reported experiencing AD for a median duration of 17 years, with 93.3% of patients receiving treatments for AD in the previous year, 49.5% receiving systemic medications, and 65.4% reporting a history of ≥1 type 2 inflammatory comorbidities. Overall, 89.2% of patients had a disease severity score of 3/4 (moderate/severe AD) and a mean dermatology life quality index score of 12.7, indicating a severe effect of AD on QoL.

Study details: Findings are from an interim analysis of the ongoing longitudinal, prospective, observational PROSE study including 315 adults with physician-diagnosed AD who initiated dupilumab.

Disclosures: This study was sponsored by Sanofi and Regeneron Pharmaceuticals, Inc. Seven authors declared being employees and shareholders of Regeneron Pharmaceuticals or Sanofi, and the other authors reported ties with various sources, including Sanofi and Regeneron.

Source: Bagel J et al. Baseline demographics and severity and burden of atopic dermatitis in adult patients initiating dupilumab treatment in a real-world registry (PROSE). Dermatol Ther (Heidelb). 2022 (May 20). Doi: 10.1007/s13555-022-00742-w

Key clinical point: Face masks worn during the COVID-19 pandemic increased the quality of life by covering facial eczemas and increased the efficacy of dupilumab therapy by minimizing exposure to allergens and air pollution in patients with atopic dermatitis (AD).

Major finding: Although the prevalence of facial eczema was similar before and after the COVID-19 pandemic (P = .7618), patients with AD showed improved Dermatology Life Quality Index scores at baseline (13.14 vs. 23.06; P < .0001) along with a higher reduction in Eczema Area and Severity Index scores after 16 weeks of dupilumab treatment (−21.46 vs. −17.83; P = .0001) in the post- vs. pre-pandemic period.

Study details: Findings are from a retrospective study including 64 adults with moderate-to-severe AD who were assessed for facial involvement at baseline and after 16 weeks of dupilumab therapy in both the pre- and post-pandemic periods.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Vanessa M et al. Facial dermatoses and use of protective mask during Covid-19 pandemic: A clinical and psychological evaluation in patients affected by moderate–severe atopic dermatitis under treatment with dupilumab. Dermatol Ther. 2022; e15573 (May 10). Doi: 10.1111/dth.15573

Key clinical point: Face masks worn during the COVID-19 pandemic increased the quality of life by covering facial eczemas and increased the efficacy of dupilumab therapy by minimizing exposure to allergens and air pollution in patients with atopic dermatitis (AD).

Major finding: Although the prevalence of facial eczema was similar before and after the COVID-19 pandemic (P = .7618), patients with AD showed improved Dermatology Life Quality Index scores at baseline (13.14 vs. 23.06; P < .0001) along with a higher reduction in Eczema Area and Severity Index scores after 16 weeks of dupilumab treatment (−21.46 vs. −17.83; P = .0001) in the post- vs. pre-pandemic period.

Study details: Findings are from a retrospective study including 64 adults with moderate-to-severe AD who were assessed for facial involvement at baseline and after 16 weeks of dupilumab therapy in both the pre- and post-pandemic periods.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Vanessa M et al. Facial dermatoses and use of protective mask during Covid-19 pandemic: A clinical and psychological evaluation in patients affected by moderate–severe atopic dermatitis under treatment with dupilumab. Dermatol Ther. 2022; e15573 (May 10). Doi: 10.1111/dth.15573

Key clinical point: Face masks worn during the COVID-19 pandemic increased the quality of life by covering facial eczemas and increased the efficacy of dupilumab therapy by minimizing exposure to allergens and air pollution in patients with atopic dermatitis (AD).

Major finding: Although the prevalence of facial eczema was similar before and after the COVID-19 pandemic (P = .7618), patients with AD showed improved Dermatology Life Quality Index scores at baseline (13.14 vs. 23.06; P < .0001) along with a higher reduction in Eczema Area and Severity Index scores after 16 weeks of dupilumab treatment (−21.46 vs. −17.83; P = .0001) in the post- vs. pre-pandemic period.

Study details: Findings are from a retrospective study including 64 adults with moderate-to-severe AD who were assessed for facial involvement at baseline and after 16 weeks of dupilumab therapy in both the pre- and post-pandemic periods.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Vanessa M et al. Facial dermatoses and use of protective mask during Covid-19 pandemic: A clinical and psychological evaluation in patients affected by moderate–severe atopic dermatitis under treatment with dupilumab. Dermatol Ther. 2022; e15573 (May 10). Doi: 10.1111/dth.15573

Key clinical point: Probiotic supplementation reduced the clinical severity of atopic dermatitis (AD) and improved the quality of life (QoL) in adults with AD compared with control intervention.

Major finding: Probiotic vs. control intervention significantly reduced the clinical severity of AD in both the short-term (standard mean difference [SMD] 0.63; P = .04) and long-term (SMD 1.57; P < .001) and significantly improved the long-term QoL (SMD 0.74; P < .001), with a mixture of Lactobacillus salivarius and Bifidobacterium being the best supplementation for both short- and long-term outcomes (surface under the cumulative ranking 95.2%).

Study details: Finding are from a meta-analysis of nine studies including 402 adults who received probiotic supplementation (patients with AD; n = 208) or placebo or standard treatment only (control individuals; n = 194).

Disclosures: This study was supported by the Medical and Health Research Project of China Aerospace Science and Industry Corporation. The authors declared no conflicts of interest.

Source: Li Y et al. The efficacy of probiotics supplementation for the treatment of atopic dermatitis in adults: A systematic review and meta-analysis. J Dermatolog Treat. 2022 (Jun 7). Doi: 10.1080/09546634.2022.2080170

Key clinical point: Probiotic supplementation reduced the clinical severity of atopic dermatitis (AD) and improved the quality of life (QoL) in adults with AD compared with control intervention.

Major finding: Probiotic vs. control intervention significantly reduced the clinical severity of AD in both the short-term (standard mean difference [SMD] 0.63; P = .04) and long-term (SMD 1.57; P < .001) and significantly improved the long-term QoL (SMD 0.74; P < .001), with a mixture of Lactobacillus salivarius and Bifidobacterium being the best supplementation for both short- and long-term outcomes (surface under the cumulative ranking 95.2%).

Study details: Finding are from a meta-analysis of nine studies including 402 adults who received probiotic supplementation (patients with AD; n = 208) or placebo or standard treatment only (control individuals; n = 194).

Disclosures: This study was supported by the Medical and Health Research Project of China Aerospace Science and Industry Corporation. The authors declared no conflicts of interest.

Source: Li Y et al. The efficacy of probiotics supplementation for the treatment of atopic dermatitis in adults: A systematic review and meta-analysis. J Dermatolog Treat. 2022 (Jun 7). Doi: 10.1080/09546634.2022.2080170

Key clinical point: Probiotic supplementation reduced the clinical severity of atopic dermatitis (AD) and improved the quality of life (QoL) in adults with AD compared with control intervention.

Major finding: Probiotic vs. control intervention significantly reduced the clinical severity of AD in both the short-term (standard mean difference [SMD] 0.63; P = .04) and long-term (SMD 1.57; P < .001) and significantly improved the long-term QoL (SMD 0.74; P < .001), with a mixture of Lactobacillus salivarius and Bifidobacterium being the best supplementation for both short- and long-term outcomes (surface under the cumulative ranking 95.2%).

Study details: Finding are from a meta-analysis of nine studies including 402 adults who received probiotic supplementation (patients with AD; n = 208) or placebo or standard treatment only (control individuals; n = 194).

Disclosures: This study was supported by the Medical and Health Research Project of China Aerospace Science and Industry Corporation. The authors declared no conflicts of interest.

Source: Li Y et al. The efficacy of probiotics supplementation for the treatment of atopic dermatitis in adults: A systematic review and meta-analysis. J Dermatolog Treat. 2022 (Jun 7). Doi: 10.1080/09546634.2022.2080170

Key clinical point: Children born to mothers who received probiotics vs. placebo during gestation or 1 year after childbirth showed a lower risk for infantile atopic dermatitis (AD), but a similar risk for immunoglobulin E (IgE)-associated infantile AD or sensitive constitution.

Major finding: Children born to mothers in the probiotics vs. placebo group showed a lower risk for infantile AD (risk ratio [RR] 0.86; 95% CI 0.78-0.95), although the risk for IgE-associated infantile AD (RR 0.98; 95% CI 0.79-1.22) or sensitive constitution (RR 0.93; 95% CI 0.81-1.08) was similar between both the treatment groups.

Study details: Findings are from a meta-analysis of eight randomized controlled trials including 2575 infants born to mothers who received probiotics or placebo during gestation or 1 year after birth.

Disclosures: This study did not report any source of funding. The authors declared no conflicts of interest.

Source: Pan H, Su J. Association of probiotics with atopic dermatitis among infant: A meta-analysis of randomized controlled trials. Oxid Med Cell Longev. 2022;2022:5080190 (May 23). Doi: 10.1155/2022/5080190

Key clinical point: Children born to mothers who received probiotics vs. placebo during gestation or 1 year after childbirth showed a lower risk for infantile atopic dermatitis (AD), but a similar risk for immunoglobulin E (IgE)-associated infantile AD or sensitive constitution.

Major finding: Children born to mothers in the probiotics vs. placebo group showed a lower risk for infantile AD (risk ratio [RR] 0.86; 95% CI 0.78-0.95), although the risk for IgE-associated infantile AD (RR 0.98; 95% CI 0.79-1.22) or sensitive constitution (RR 0.93; 95% CI 0.81-1.08) was similar between both the treatment groups.

Study details: Findings are from a meta-analysis of eight randomized controlled trials including 2575 infants born to mothers who received probiotics or placebo during gestation or 1 year after birth.

Disclosures: This study did not report any source of funding. The authors declared no conflicts of interest.

Source: Pan H, Su J. Association of probiotics with atopic dermatitis among infant: A meta-analysis of randomized controlled trials. Oxid Med Cell Longev. 2022;2022:5080190 (May 23). Doi: 10.1155/2022/5080190

Key clinical point: Children born to mothers who received probiotics vs. placebo during gestation or 1 year after childbirth showed a lower risk for infantile atopic dermatitis (AD), but a similar risk for immunoglobulin E (IgE)-associated infantile AD or sensitive constitution.

Major finding: Children born to mothers in the probiotics vs. placebo group showed a lower risk for infantile AD (risk ratio [RR] 0.86; 95% CI 0.78-0.95), although the risk for IgE-associated infantile AD (RR 0.98; 95% CI 0.79-1.22) or sensitive constitution (RR 0.93; 95% CI 0.81-1.08) was similar between both the treatment groups.

Study details: Findings are from a meta-analysis of eight randomized controlled trials including 2575 infants born to mothers who received probiotics or placebo during gestation or 1 year after birth.

Disclosures: This study did not report any source of funding. The authors declared no conflicts of interest.

Source: Pan H, Su J. Association of probiotics with atopic dermatitis among infant: A meta-analysis of randomized controlled trials. Oxid Med Cell Longev. 2022;2022:5080190 (May 23). Doi: 10.1155/2022/5080190

Key clinical point: Dupilumab led to clinically meaningful improvements in atopic dermatitis (AD) severity, extent, and itch severity in a real-world population of adults with moderate-to-severe AD.

Major finding: At 4 months, the Investigator’s Global Assessment score reduced by ≥1 point in 81.8% of patients and by ≥2 points in 62.8% of patients. Additionally, at 4 months, the mean itch severity score and affected body surface area reduced from 7.0 to 2.8 and from 39.3% to 16.3% (both P < .0001), respectively, with improvements being significant regardless of age, sex, or treatment history (all P < .0001).

Study details: Findings are from a retrospective, observational study based on electronic medical records of adults with moderate-to-severe AD who were evaluated at 4 months after initiating dupilumab.

Disclosures: This study was funded by Regeneron Pharmaceuticals, Inc., and Sanofi. Four authors declared being current or former employees and stockholders of Sanofi or Regeneron Pharmaceuticals. The other authors declared ties with various sources, including Regeneron and Sanofi.

Source: Eichenfield LF et al. Real-world effectiveness of dupilumab in atopic dermatitis patients: Analysis of an electronic medical records dataset. Dermatol Ther (Heidelb). 2022 (May 11). Doi: 10.1007/s13555-022-00731-z

Key clinical point: Dupilumab led to clinically meaningful improvements in atopic dermatitis (AD) severity, extent, and itch severity in a real-world population of adults with moderate-to-severe AD.

Major finding: At 4 months, the Investigator’s Global Assessment score reduced by ≥1 point in 81.8% of patients and by ≥2 points in 62.8% of patients. Additionally, at 4 months, the mean itch severity score and affected body surface area reduced from 7.0 to 2.8 and from 39.3% to 16.3% (both P < .0001), respectively, with improvements being significant regardless of age, sex, or treatment history (all P < .0001).

Study details: Findings are from a retrospective, observational study based on electronic medical records of adults with moderate-to-severe AD who were evaluated at 4 months after initiating dupilumab.

Disclosures: This study was funded by Regeneron Pharmaceuticals, Inc., and Sanofi. Four authors declared being current or former employees and stockholders of Sanofi or Regeneron Pharmaceuticals. The other authors declared ties with various sources, including Regeneron and Sanofi.

Source: Eichenfield LF et al. Real-world effectiveness of dupilumab in atopic dermatitis patients: Analysis of an electronic medical records dataset. Dermatol Ther (Heidelb). 2022 (May 11). Doi: 10.1007/s13555-022-00731-z

Key clinical point: Dupilumab led to clinically meaningful improvements in atopic dermatitis (AD) severity, extent, and itch severity in a real-world population of adults with moderate-to-severe AD.

Major finding: At 4 months, the Investigator’s Global Assessment score reduced by ≥1 point in 81.8% of patients and by ≥2 points in 62.8% of patients. Additionally, at 4 months, the mean itch severity score and affected body surface area reduced from 7.0 to 2.8 and from 39.3% to 16.3% (both P < .0001), respectively, with improvements being significant regardless of age, sex, or treatment history (all P < .0001).

Study details: Findings are from a retrospective, observational study based on electronic medical records of adults with moderate-to-severe AD who were evaluated at 4 months after initiating dupilumab.

Disclosures: This study was funded by Regeneron Pharmaceuticals, Inc., and Sanofi. Four authors declared being current or former employees and stockholders of Sanofi or Regeneron Pharmaceuticals. The other authors declared ties with various sources, including Regeneron and Sanofi.

Source: Eichenfield LF et al. Real-world effectiveness of dupilumab in atopic dermatitis patients: Analysis of an electronic medical records dataset. Dermatol Ther (Heidelb). 2022 (May 11). Doi: 10.1007/s13555-022-00731-z

Key clinical point: Patients with atopic dermatitis (AD) experience a fluctuation in depression severity over time, with the likelihood of experiencing depressive symptoms being the highest in patients with severe AD.

Major finding: Among patients with ≥2 follow-up visits, most (49.46%) experienced a fluctuation in depression severity, whereas 45.65% experienced a persistent severity of depression. High Eczema Area Severity Index (adjusted odds ratio [aOR] 7.622; 95% CI 3.881-14.968) and itch (aOR 14.745; 95% CI 4.696-46.297) scores were strongly associated with difficulty in concentrating over time.

Study details: Findings are from a longitudinal, dermatology practice-based study including 695 adults with AD who were evaluated at baseline and at every 6-month follow-up visits.

Disclosures: This study was funded by the US Agency for Healthcare Research and Quality, the Dermatology Foundation, and Galderma. R Chavda and S Gabriel declared being employees of Galderma, and JI Silverberg declared serving as a consultant for Galderma.

Source: Chatrath S et al. Longitudinal course and predictors of depressive symptoms in atopic dermatitis.  J Am Acad Dermatol. 2022 (May 9). Doi: 10.1016/j.jaad.2022.04.061

Key clinical point: Patients with atopic dermatitis (AD) experience a fluctuation in depression severity over time, with the likelihood of experiencing depressive symptoms being the highest in patients with severe AD.

Major finding: Among patients with ≥2 follow-up visits, most (49.46%) experienced a fluctuation in depression severity, whereas 45.65% experienced a persistent severity of depression. High Eczema Area Severity Index (adjusted odds ratio [aOR] 7.622; 95% CI 3.881-14.968) and itch (aOR 14.745; 95% CI 4.696-46.297) scores were strongly associated with difficulty in concentrating over time.

Study details: Findings are from a longitudinal, dermatology practice-based study including 695 adults with AD who were evaluated at baseline and at every 6-month follow-up visits.

Disclosures: This study was funded by the US Agency for Healthcare Research and Quality, the Dermatology Foundation, and Galderma. R Chavda and S Gabriel declared being employees of Galderma, and JI Silverberg declared serving as a consultant for Galderma.

Source: Chatrath S et al. Longitudinal course and predictors of depressive symptoms in atopic dermatitis.  J Am Acad Dermatol. 2022 (May 9). Doi: 10.1016/j.jaad.2022.04.061

Key clinical point: Patients with atopic dermatitis (AD) experience a fluctuation in depression severity over time, with the likelihood of experiencing depressive symptoms being the highest in patients with severe AD.

Major finding: Among patients with ≥2 follow-up visits, most (49.46%) experienced a fluctuation in depression severity, whereas 45.65% experienced a persistent severity of depression. High Eczema Area Severity Index (adjusted odds ratio [aOR] 7.622; 95% CI 3.881-14.968) and itch (aOR 14.745; 95% CI 4.696-46.297) scores were strongly associated with difficulty in concentrating over time.

Study details: Findings are from a longitudinal, dermatology practice-based study including 695 adults with AD who were evaluated at baseline and at every 6-month follow-up visits.

Disclosures: This study was funded by the US Agency for Healthcare Research and Quality, the Dermatology Foundation, and Galderma. R Chavda and S Gabriel declared being employees of Galderma, and JI Silverberg declared serving as a consultant for Galderma.

Source: Chatrath S et al. Longitudinal course and predictors of depressive symptoms in atopic dermatitis.  J Am Acad Dermatol. 2022 (May 9). Doi: 10.1016/j.jaad.2022.04.061

Key clinical point: Baricitinib vs. dupilumab demonstrated similar efficacy in reducing atopic dermatitis (AD) severity and improving quality of life (QoL), with more rapid improvement in itch.

Major finding: A dose of 4 mg baricitinib vs. dupilumab as monotherapy or with topical corticosteroids (TCS) was more likely to show ≥4-point improvement in itch scores at 4 weeks among patients with inadequate response or intolerance to topical treatments (dupliumab: relative risk [RR] 2.62; P = .013; TCS: RR 2.16; P = .029). However, both drugs showed similar efficacy across Eczema Area and Severity Index 75, itch, and QoL scores at 16 weeks.

Study details: This data comes from an indirect treatment comparison analysis of nine placebo-controlled trials included 3364 adults with moderate-to-severe AD and inadequate response or intolerance to topical treatments or cyclosporine who received dupilumab ± TCS or baricitinib ± TCS.

Disclosures: This study was supported by Eli Lilly and Company. Five authors declared being employees or shareholders of Eli Lilly. The other authors reported ties with various sources, including Eli Lilly.

Source: de Bruin-Weller MS et al. Indirect treatment comparison of baricitinib versus dupilumab in adults with moderate-to-severe atopic dermatitis. Dermatol Ther (Heidelb). 2022 (May 11). Doi: 10.1007/s13555-022-00734-w

Key clinical point: Baricitinib vs. dupilumab demonstrated similar efficacy in reducing atopic dermatitis (AD) severity and improving quality of life (QoL), with more rapid improvement in itch.

Major finding: A dose of 4 mg baricitinib vs. dupilumab as monotherapy or with topical corticosteroids (TCS) was more likely to show ≥4-point improvement in itch scores at 4 weeks among patients with inadequate response or intolerance to topical treatments (dupliumab: relative risk [RR] 2.62; P = .013; TCS: RR 2.16; P = .029). However, both drugs showed similar efficacy across Eczema Area and Severity Index 75, itch, and QoL scores at 16 weeks.

Study details: This data comes from an indirect treatment comparison analysis of nine placebo-controlled trials included 3364 adults with moderate-to-severe AD and inadequate response or intolerance to topical treatments or cyclosporine who received dupilumab ± TCS or baricitinib ± TCS.

Disclosures: This study was supported by Eli Lilly and Company. Five authors declared being employees or shareholders of Eli Lilly. The other authors reported ties with various sources, including Eli Lilly.

Source: de Bruin-Weller MS et al. Indirect treatment comparison of baricitinib versus dupilumab in adults with moderate-to-severe atopic dermatitis. Dermatol Ther (Heidelb). 2022 (May 11). Doi: 10.1007/s13555-022-00734-w

Key clinical point: Baricitinib vs. dupilumab demonstrated similar efficacy in reducing atopic dermatitis (AD) severity and improving quality of life (QoL), with more rapid improvement in itch.

Major finding: A dose of 4 mg baricitinib vs. dupilumab as monotherapy or with topical corticosteroids (TCS) was more likely to show ≥4-point improvement in itch scores at 4 weeks among patients with inadequate response or intolerance to topical treatments (dupliumab: relative risk [RR] 2.62; P = .013; TCS: RR 2.16; P = .029). However, both drugs showed similar efficacy across Eczema Area and Severity Index 75, itch, and QoL scores at 16 weeks.

Study details: This data comes from an indirect treatment comparison analysis of nine placebo-controlled trials included 3364 adults with moderate-to-severe AD and inadequate response or intolerance to topical treatments or cyclosporine who received dupilumab ± TCS or baricitinib ± TCS.

Disclosures: This study was supported by Eli Lilly and Company. Five authors declared being employees or shareholders of Eli Lilly. The other authors reported ties with various sources, including Eli Lilly.

Source: de Bruin-Weller MS et al. Indirect treatment comparison of baricitinib versus dupilumab in adults with moderate-to-severe atopic dermatitis. Dermatol Ther (Heidelb). 2022 (May 11). Doi: 10.1007/s13555-022-00734-w

Key clinical point: Dupilumab showed an acceptable safety profile and sustained efficacy through 52 weeks in adolescents with inadequately controlled moderate-to-severe atopic dermatitis (AD).

Major finding: Rate of treatment emergent adverse events was 370.2 events/100 patient-years, with most being mild/moderate. At least 75% improvement in Eczema Area and Severity Index scores was achieved by 81.2% of patients receiving dupilumab at week 52 and 51.9% of patients who were uptitrated from every-4-week (q4w) to every-2-week (q2w) dosing regimen at week 48 after the first uptitration visit.

Study details: Findings are from an ongoing open-label extension study, LIBERTY AD PED-OLE, including 294 adolescents with moderate-to-severe AD who participated in previous dupilumab trials, received dupilumab q4w, and were uptitrated to the weight-tiered q2w dose regimen upon inadequate clinical response.

Disclosures: This study was funded by Sanofi and Regeneron Pharmaceuticals, Inc. Eight authors declared being employees or shareholders of Regeneron Pharmaceuticals or Sanofi, and the other authors reported ties with various sources, including Sanofi and Regeneron.

Source: Blauvelt A et al. Long-term efficacy and safety of dupilumab in adolescents with moderate-to-severe atopic dermatitis: Results through week 52 from a phase III open-label extension trial (LIBERTY AD PED-OLE). Am J Clin Dermatol. 2022;23:365–383  (May 14). Doi: 10.1007/s40257-022-00683-2

Key clinical point: Dupilumab showed an acceptable safety profile and sustained efficacy through 52 weeks in adolescents with inadequately controlled moderate-to-severe atopic dermatitis (AD).

Major finding: Rate of treatment emergent adverse events was 370.2 events/100 patient-years, with most being mild/moderate. At least 75% improvement in Eczema Area and Severity Index scores was achieved by 81.2% of patients receiving dupilumab at week 52 and 51.9% of patients who were uptitrated from every-4-week (q4w) to every-2-week (q2w) dosing regimen at week 48 after the first uptitration visit.

Study details: Findings are from an ongoing open-label extension study, LIBERTY AD PED-OLE, including 294 adolescents with moderate-to-severe AD who participated in previous dupilumab trials, received dupilumab q4w, and were uptitrated to the weight-tiered q2w dose regimen upon inadequate clinical response.

Disclosures: This study was funded by Sanofi and Regeneron Pharmaceuticals, Inc. Eight authors declared being employees or shareholders of Regeneron Pharmaceuticals or Sanofi, and the other authors reported ties with various sources, including Sanofi and Regeneron.

Source: Blauvelt A et al. Long-term efficacy and safety of dupilumab in adolescents with moderate-to-severe atopic dermatitis: Results through week 52 from a phase III open-label extension trial (LIBERTY AD PED-OLE). Am J Clin Dermatol. 2022;23:365–383  (May 14). Doi: 10.1007/s40257-022-00683-2

Key clinical point: Dupilumab showed an acceptable safety profile and sustained efficacy through 52 weeks in adolescents with inadequately controlled moderate-to-severe atopic dermatitis (AD).

Major finding: Rate of treatment emergent adverse events was 370.2 events/100 patient-years, with most being mild/moderate. At least 75% improvement in Eczema Area and Severity Index scores was achieved by 81.2% of patients receiving dupilumab at week 52 and 51.9% of patients who were uptitrated from every-4-week (q4w) to every-2-week (q2w) dosing regimen at week 48 after the first uptitration visit.

Study details: Findings are from an ongoing open-label extension study, LIBERTY AD PED-OLE, including 294 adolescents with moderate-to-severe AD who participated in previous dupilumab trials, received dupilumab q4w, and were uptitrated to the weight-tiered q2w dose regimen upon inadequate clinical response.

Disclosures: This study was funded by Sanofi and Regeneron Pharmaceuticals, Inc. Eight authors declared being employees or shareholders of Regeneron Pharmaceuticals or Sanofi, and the other authors reported ties with various sources, including Sanofi and Regeneron.

Source: Blauvelt A et al. Long-term efficacy and safety of dupilumab in adolescents with moderate-to-severe atopic dermatitis: Results through week 52 from a phase III open-label extension trial (LIBERTY AD PED-OLE). Am J Clin Dermatol. 2022;23:365–383  (May 14). Doi: 10.1007/s40257-022-00683-2

For dermatologists and others treating patients with atopic dermatitis (AD), it is “an incredible time,” Lawrence F. Eichenfield, MD, said at MedscapeLive’s Women’s & Pediatric Dermatology Seminar.

More and more treatment options are available and even more are in the pipeline, said Dr. Eichenfield, professor of dermatology and pediatrics and vice chair of dermatology at the University of California, San Diego and Rady Children’s Hospital. As he put it: “We got pills, injections, things to smear on the skin.”

Those options are welcome and needed, as AD affects up to 20% of children and up to 10% of adults. The course is variable, as is severity, and quality of life is impacted.

Besides new treatment options, there is a new understanding about comorbidities, environmental effects, and triggers, Dr. Eichenfield said. Among the potential comorbidities health care providers should be aware of are allergies, such as food allergies; asthma; rhinitis; mental health issues (depression, anxiety, ADHD, learning disabilities, or in adults, substance abuse); bone health; skin infections; immune disorders such as alopecia areata or urticaria; and cardiovascular issues that could affect adults.

Environmental effects can play a role in aggravating AD, as providers learned after visits for AD increased after Northern California wildfires and also in other areas with high air pollution, Dr. Eichenfield said. “I actually discuss this with my families,” when making them aware of factors that may affect AD, he noted.

Dr. Eichenfield provided an overview of available treatment options, and what treatments may be coming next. Among the highlights:

Topical ruxolitinib: A JAK1,2 inhibitor in a cream formulation, it is now approved for patients with mild to moderate AD aged 12 years and older in the United States. Of the two strengths studied, the higher strength, 1.5%, was approved, Dr. Eichenfield said. How well did it work? In two phase 3 studies in patients aged 12 and older, of those on 1.5%, 53% were clear or almost clear at 8 weeks, versus 11% in the control group given the vehicle; 52% had at least a 4-point reduction in itch from baseline, versus 15.4% on vehicle. Quality of life improved in up to 73.2% of those given the medication versus 19.7% of those on the vehicle. There was a marked and quick improvement in itch, as early as 12 hours, and safety measures also look good, he said.

Topical tapinarof: Approved in May 2022, for adults with plaque psoriasis, phase 3 trials began in September, 2021, for adults and children with AD, according to the manufacturer. Activation of the aryl hydrocarbon receptor mediates its anti-inflammatory properties.

Topical roflumilast: A potent PDE-4 inhibitor, phase 3 AD studies are underway. It appears to be well tolerated, Dr. Eichenfield said.

Dupilumab: An IL-4/13 blocker, this biologic produced an itch reduction of 50% and EASI of 80%, improved quality of life, and reduced anxiety and depression. The drug “led the revolution in systemic therapy for atopic dermatitis,” he said. First approved for treating AD in patients aged 18 years and up in 2017, approval for patients 12 years and up followed in March 2019, then for age 6 years and up May 2020.

At the meeting on June 3, Dr. Eichenfield said that approval in children 5 years and under was imminent, and on June 7, the FDA approved dupilumab for use in children aged 6 months to 5 years. In a phase 3, 16-week trial, 28% of children treated with dupilumab added on to low-potency topical corticosteroids met the endpoint of clear or nearly clear skin, compared with 4% of those on the corticosteroids alone (P < .0001).

Tralokinumab: There is no approved indication yet for adolescents, but the injected biologic, an interleukin-13 antagonist, is approved for adults with moderate to severe AD who are not well-controlled with topicals, or who cannot use topicals.

Oral JAK inhibitors: These include abrocitinib and upadacitinib, both approved by the FDA in January 2022 for treating moderate to severe AD, and baricitinib (the latter not in the United States). “For AD, you probably won’t see it in the U.S.,” Dr. Eichenfield said, referring to baricitinib. However, it might get approved for alopecia areata, he noted.

Upadacitinib is approved for adolescents 12 and older with AD. Abrocitinib is approved for adults 18 and older with AD.

Regarding safety and tolerance concerns with oral JAK inhibitors, Dr. Eichenfield cites headache, acne, nausea, and upper respiratory tract infections as relatively common, while herpes zoster, venous thromboembolism, and lab anomalies (neutropenia, elevated CPK) are uncommon.

As the options for AD treatments increase, and expectations by families and clinicians change, Dr. Eichenfield said he often focuses on “bucket duty” – whether a specific patient should be in the topical bucket or the systemic one. It’s a decision that will continue to be crucial, he said.

When presented with treatment options, patients – and parents – often worry about side effects, said Vivian Shi, MD, associate professor of dermatology at the University of Arkansas Medical Center, Little Rock, who also spoke at the meeting. She gently tells them: “The worst side effect you can have is probably not treating the disease itself.”

Medscape Live and this news organization are owned by the same parent company. Dr. Eichenfield is a consultant or investigator for numerous companies that manufacture treatments for AD, but based his discussion on evidence-based recommendations and public presentations or publications.

For dermatologists and others treating patients with atopic dermatitis (AD), it is “an incredible time,” Lawrence F. Eichenfield, MD, said at MedscapeLive’s Women’s & Pediatric Dermatology Seminar.

More and more treatment options are available and even more are in the pipeline, said Dr. Eichenfield, professor of dermatology and pediatrics and vice chair of dermatology at the University of California, San Diego and Rady Children’s Hospital. As he put it: “We got pills, injections, things to smear on the skin.”

Those options are welcome and needed, as AD affects up to 20% of children and up to 10% of adults. The course is variable, as is severity, and quality of life is impacted.

Besides new treatment options, there is a new understanding about comorbidities, environmental effects, and triggers, Dr. Eichenfield said. Among the potential comorbidities health care providers should be aware of are allergies, such as food allergies; asthma; rhinitis; mental health issues (depression, anxiety, ADHD, learning disabilities, or in adults, substance abuse); bone health; skin infections; immune disorders such as alopecia areata or urticaria; and cardiovascular issues that could affect adults.

Environmental effects can play a role in aggravating AD, as providers learned after visits for AD increased after Northern California wildfires and also in other areas with high air pollution, Dr. Eichenfield said. “I actually discuss this with my families,” when making them aware of factors that may affect AD, he noted.

Dr. Eichenfield provided an overview of available treatment options, and what treatments may be coming next. Among the highlights:

Topical ruxolitinib: A JAK1,2 inhibitor in a cream formulation, it is now approved for patients with mild to moderate AD aged 12 years and older in the United States. Of the two strengths studied, the higher strength, 1.5%, was approved, Dr. Eichenfield said. How well did it work? In two phase 3 studies in patients aged 12 and older, of those on 1.5%, 53% were clear or almost clear at 8 weeks, versus 11% in the control group given the vehicle; 52% had at least a 4-point reduction in itch from baseline, versus 15.4% on vehicle. Quality of life improved in up to 73.2% of those given the medication versus 19.7% of those on the vehicle. There was a marked and quick improvement in itch, as early as 12 hours, and safety measures also look good, he said.

Topical tapinarof: Approved in May 2022, for adults with plaque psoriasis, phase 3 trials began in September, 2021, for adults and children with AD, according to the manufacturer. Activation of the aryl hydrocarbon receptor mediates its anti-inflammatory properties.

Topical roflumilast: A potent PDE-4 inhibitor, phase 3 AD studies are underway. It appears to be well tolerated, Dr. Eichenfield said.

Dupilumab: An IL-4/13 blocker, this biologic produced an itch reduction of 50% and EASI of 80%, improved quality of life, and reduced anxiety and depression. The drug “led the revolution in systemic therapy for atopic dermatitis,” he said. First approved for treating AD in patients aged 18 years and up in 2017, approval for patients 12 years and up followed in March 2019, then for age 6 years and up May 2020.

At the meeting on June 3, Dr. Eichenfield said that approval in children 5 years and under was imminent, and on June 7, the FDA approved dupilumab for use in children aged 6 months to 5 years. In a phase 3, 16-week trial, 28% of children treated with dupilumab added on to low-potency topical corticosteroids met the endpoint of clear or nearly clear skin, compared with 4% of those on the corticosteroids alone (P < .0001).

Tralokinumab: There is no approved indication yet for adolescents, but the injected biologic, an interleukin-13 antagonist, is approved for adults with moderate to severe AD who are not well-controlled with topicals, or who cannot use topicals.

Oral JAK inhibitors: These include abrocitinib and upadacitinib, both approved by the FDA in January 2022 for treating moderate to severe AD, and baricitinib (the latter not in the United States). “For AD, you probably won’t see it in the U.S.,” Dr. Eichenfield said, referring to baricitinib. However, it might get approved for alopecia areata, he noted.

Upadacitinib is approved for adolescents 12 and older with AD. Abrocitinib is approved for adults 18 and older with AD.

Regarding safety and tolerance concerns with oral JAK inhibitors, Dr. Eichenfield cites headache, acne, nausea, and upper respiratory tract infections as relatively common, while herpes zoster, venous thromboembolism, and lab anomalies (neutropenia, elevated CPK) are uncommon.

As the options for AD treatments increase, and expectations by families and clinicians change, Dr. Eichenfield said he often focuses on “bucket duty” – whether a specific patient should be in the topical bucket or the systemic one. It’s a decision that will continue to be crucial, he said.

When presented with treatment options, patients – and parents – often worry about side effects, said Vivian Shi, MD, associate professor of dermatology at the University of Arkansas Medical Center, Little Rock, who also spoke at the meeting. She gently tells them: “The worst side effect you can have is probably not treating the disease itself.”

Medscape Live and this news organization are owned by the same parent company. Dr. Eichenfield is a consultant or investigator for numerous companies that manufacture treatments for AD, but based his discussion on evidence-based recommendations and public presentations or publications.

For dermatologists and others treating patients with atopic dermatitis (AD), it is “an incredible time,” Lawrence F. Eichenfield, MD, said at MedscapeLive’s Women’s & Pediatric Dermatology Seminar.

More and more treatment options are available and even more are in the pipeline, said Dr. Eichenfield, professor of dermatology and pediatrics and vice chair of dermatology at the University of California, San Diego and Rady Children’s Hospital. As he put it: “We got pills, injections, things to smear on the skin.”

Those options are welcome and needed, as AD affects up to 20% of children and up to 10% of adults. The course is variable, as is severity, and quality of life is impacted.

Besides new treatment options, there is a new understanding about comorbidities, environmental effects, and triggers, Dr. Eichenfield said. Among the potential comorbidities health care providers should be aware of are allergies, such as food allergies; asthma; rhinitis; mental health issues (depression, anxiety, ADHD, learning disabilities, or in adults, substance abuse); bone health; skin infections; immune disorders such as alopecia areata or urticaria; and cardiovascular issues that could affect adults.

Environmental effects can play a role in aggravating AD, as providers learned after visits for AD increased after Northern California wildfires and also in other areas with high air pollution, Dr. Eichenfield said. “I actually discuss this with my families,” when making them aware of factors that may affect AD, he noted.

Dr. Eichenfield provided an overview of available treatment options, and what treatments may be coming next. Among the highlights:

Topical ruxolitinib: A JAK1,2 inhibitor in a cream formulation, it is now approved for patients with mild to moderate AD aged 12 years and older in the United States. Of the two strengths studied, the higher strength, 1.5%, was approved, Dr. Eichenfield said. How well did it work? In two phase 3 studies in patients aged 12 and older, of those on 1.5%, 53% were clear or almost clear at 8 weeks, versus 11% in the control group given the vehicle; 52% had at least a 4-point reduction in itch from baseline, versus 15.4% on vehicle. Quality of life improved in up to 73.2% of those given the medication versus 19.7% of those on the vehicle. There was a marked and quick improvement in itch, as early as 12 hours, and safety measures also look good, he said.

Topical tapinarof: Approved in May 2022, for adults with plaque psoriasis, phase 3 trials began in September, 2021, for adults and children with AD, according to the manufacturer. Activation of the aryl hydrocarbon receptor mediates its anti-inflammatory properties.

Topical roflumilast: A potent PDE-4 inhibitor, phase 3 AD studies are underway. It appears to be well tolerated, Dr. Eichenfield said.

Dupilumab: An IL-4/13 blocker, this biologic produced an itch reduction of 50% and EASI of 80%, improved quality of life, and reduced anxiety and depression. The drug “led the revolution in systemic therapy for atopic dermatitis,” he said. First approved for treating AD in patients aged 18 years and up in 2017, approval for patients 12 years and up followed in March 2019, then for age 6 years and up May 2020.

At the meeting on June 3, Dr. Eichenfield said that approval in children 5 years and under was imminent, and on June 7, the FDA approved dupilumab for use in children aged 6 months to 5 years. In a phase 3, 16-week trial, 28% of children treated with dupilumab added on to low-potency topical corticosteroids met the endpoint of clear or nearly clear skin, compared with 4% of those on the corticosteroids alone (P < .0001).

Tralokinumab: There is no approved indication yet for adolescents, but the injected biologic, an interleukin-13 antagonist, is approved for adults with moderate to severe AD who are not well-controlled with topicals, or who cannot use topicals.

Oral JAK inhibitors: These include abrocitinib and upadacitinib, both approved by the FDA in January 2022 for treating moderate to severe AD, and baricitinib (the latter not in the United States). “For AD, you probably won’t see it in the U.S.,” Dr. Eichenfield said, referring to baricitinib. However, it might get approved for alopecia areata, he noted.

Upadacitinib is approved for adolescents 12 and older with AD. Abrocitinib is approved for adults 18 and older with AD.

Regarding safety and tolerance concerns with oral JAK inhibitors, Dr. Eichenfield cites headache, acne, nausea, and upper respiratory tract infections as relatively common, while herpes zoster, venous thromboembolism, and lab anomalies (neutropenia, elevated CPK) are uncommon.

As the options for AD treatments increase, and expectations by families and clinicians change, Dr. Eichenfield said he often focuses on “bucket duty” – whether a specific patient should be in the topical bucket or the systemic one. It’s a decision that will continue to be crucial, he said.

When presented with treatment options, patients – and parents – often worry about side effects, said Vivian Shi, MD, associate professor of dermatology at the University of Arkansas Medical Center, Little Rock, who also spoke at the meeting. She gently tells them: “The worst side effect you can have is probably not treating the disease itself.”

Medscape Live and this news organization are owned by the same parent company. Dr. Eichenfield is a consultant or investigator for numerous companies that manufacture treatments for AD, but based his discussion on evidence-based recommendations and public presentations or publications.