Atopic Dermatitis

BOSTON – Among atopic dermatitis (AD) patients infected with COVID-19, those who received topical treatments were nearly five times more likely to be hospitalized compared with those on dupilumab monotherapy, results from a global registry demonstrated.

Moreover, combination systemic treatment, especially those that included systemic corticosteroids, was associated with the highest risk of COVID-19–related hospitalization.

“Patients with inflammatory skin diseases such as AD may be at higher risk of COVID-19,” Annelie H. Musters, MD, said during a late-breaking abstract session at the annual meeting of the American Academy of Dermatology. “Another factor to consider is that AD patients are often treated with systemic immunomodulatory therapy, including systemic corticosteroids and nonsteroidal immunosuppressants such as methotrexate, cyclosporin, biologics, and Janus kinase inhibitors. Different mechanisms of action and levels of immunosuppression may impart variable risks of serious infections.”

On the other hand, some degree of immunomodulation may have beneficial effects on the course of COVID-19 in AD patients, said Dr. Musters, of the department of dermatology at Academic Medical Center, University of Amsterdam. Targeting of specific immune pathways could reduce the development of a hyperinflammatory state in severe COVID-19. Dual blockade of interleukin (IL)-4 and IL-13 with dupilumab may have a protective effect in the context of COVID-19 infection, because expression of Th2 cytokines, including IL-4 and IL-13, may be increased during COVID-19.

“At the start of the pandemic, many of us were faced with important questions, like do systemic immunomodulatory treatments influence outcomes of COVID-19 in patients with AD?” she said. “Do patients on dupilumab or other novel systemics fare better than those on conventional systemic treatment?”

To answer these questions, she and her colleagues launched a web-based registry in April 2020 to investigate COVID-19 outcomes in patients with AD treated with or without systemic immunomodulatory treatments. For the registry, known as Surveillance Epidemiology of Coronavirus Under Research Exclusion for Atopic Dermatitis (SECURE-AD), clinicians in 27 countries used a web-based form to enter anonymized data after patients had fully recovered from COVID-19. Eligibility criteria included having proven or highly suspected COVID-19, and there were no restrictions on age nor the type of AD treatment they were receiving.

Dr. Musters reported results from 442 patients who were recruited between April 2, 2020, and Oct. 31, 2021. Their mean age was 35.6 years, their median body mass index was 23.7 kg/m², and there was an even sex distribution. Most patients were White and were recruited from Italy. Of the 442 patients, 216 (48.8%) received dupilumab monotherapy, 131 (29.6%) received topical treatments, and 14 (3.16%) received combination systemic treatments, including systemic corticosteroids. About 12% presented to the emergency department and 6% were hospitalized. Of those hospitalized, 2% required intensive care and/or ventilation, and no deaths have occurred in the registry to date.

By treatment group, hospitalization rates were highest among those on combination treatments (35.7%), followed by systemic corticosteroids (14.3%), topical treatments only (9.9%), other conventional systemics (3.6%), methotrexate (3.3%), and dupilumab (2.3%).

To further explore the differences between hospitalization rates in treatment groups, the researchers performed a multivariable logistic regression analysis, adjusted for age, sex, ethnicity, and comorbidity score. Compared with those who received dupilumab, the adjusted odds ratios (ORs) for hospitalization were highest among those who received topical treatments (OR, 4.95), followed by those who received systemic corticosteroids (OR, 2.81), and those who received other conventional systemic treatments (OR, 2.36).

Dr. Musters and colleagues also found that compared with patients on nonsteroidal immunosuppressive therapy, patients on combination systemic therapy had a significantly higher odds of hospitalization, specifically an OR of 45.75 for those on combination treatment including corticosteroids, an OR of 37.57 for those on combination treatment not including steroids, and an OR of 1.87 for those on systemic corticosteroids as monotherapy.

“Overall, the risk of COVID-19 complications appears to be low in patients with AD, even when treated with systemic immunomodulatory agents,” Dr. Musters concluded. “Dupilumab monotherapy was associated with lower odds of hospitalizations compared with other therapies. Moreover, combination systemic treatment, especially combinations including systemic corticosteroids, was associated with the highest risk of severe COVID-19.”

She added that other population-based study designs are more suitable to answer other important questions, such as whether the overall risk of COVID-19 in patients with AD is higher or lower compared to healthy controls.

Amy S. Paller, MD, professor and chair of the department of dermatology at Northwestern University, Chicago, who was asked to comment on the study, characterized the results as reassuring. In this patient population, “we expected that dupilumab would not cause any problems,” she said. “We wouldn’t necessarily expect it to [confer] a benefit, but I think it’s because the patients who need a systemic medication are going on something that’s very targeted (dupilumab) rather than something that has a broader immunosuppressing function. It was interesting but not surprising that those on systemic steroids had more of a problem. Get them on something that’s very targeted if you can and don’t suppress the immune systems that might be handling COVID-19.”

Dr. Musters reported having no disclosures. Dr. Paller disclosed that she is consultant to and/or an investigator for many pharmaceutical companies.

BOSTON – Among atopic dermatitis (AD) patients infected with COVID-19, those who received topical treatments were nearly five times more likely to be hospitalized compared with those on dupilumab monotherapy, results from a global registry demonstrated.

Moreover, combination systemic treatment, especially those that included systemic corticosteroids, was associated with the highest risk of COVID-19–related hospitalization.

“Patients with inflammatory skin diseases such as AD may be at higher risk of COVID-19,” Annelie H. Musters, MD, said during a late-breaking abstract session at the annual meeting of the American Academy of Dermatology. “Another factor to consider is that AD patients are often treated with systemic immunomodulatory therapy, including systemic corticosteroids and nonsteroidal immunosuppressants such as methotrexate, cyclosporin, biologics, and Janus kinase inhibitors. Different mechanisms of action and levels of immunosuppression may impart variable risks of serious infections.”

On the other hand, some degree of immunomodulation may have beneficial effects on the course of COVID-19 in AD patients, said Dr. Musters, of the department of dermatology at Academic Medical Center, University of Amsterdam. Targeting of specific immune pathways could reduce the development of a hyperinflammatory state in severe COVID-19. Dual blockade of interleukin (IL)-4 and IL-13 with dupilumab may have a protective effect in the context of COVID-19 infection, because expression of Th2 cytokines, including IL-4 and IL-13, may be increased during COVID-19.

“At the start of the pandemic, many of us were faced with important questions, like do systemic immunomodulatory treatments influence outcomes of COVID-19 in patients with AD?” she said. “Do patients on dupilumab or other novel systemics fare better than those on conventional systemic treatment?”

To answer these questions, she and her colleagues launched a web-based registry in April 2020 to investigate COVID-19 outcomes in patients with AD treated with or without systemic immunomodulatory treatments. For the registry, known as Surveillance Epidemiology of Coronavirus Under Research Exclusion for Atopic Dermatitis (SECURE-AD), clinicians in 27 countries used a web-based form to enter anonymized data after patients had fully recovered from COVID-19. Eligibility criteria included having proven or highly suspected COVID-19, and there were no restrictions on age nor the type of AD treatment they were receiving.

Dr. Musters reported results from 442 patients who were recruited between April 2, 2020, and Oct. 31, 2021. Their mean age was 35.6 years, their median body mass index was 23.7 kg/m², and there was an even sex distribution. Most patients were White and were recruited from Italy. Of the 442 patients, 216 (48.8%) received dupilumab monotherapy, 131 (29.6%) received topical treatments, and 14 (3.16%) received combination systemic treatments, including systemic corticosteroids. About 12% presented to the emergency department and 6% were hospitalized. Of those hospitalized, 2% required intensive care and/or ventilation, and no deaths have occurred in the registry to date.

By treatment group, hospitalization rates were highest among those on combination treatments (35.7%), followed by systemic corticosteroids (14.3%), topical treatments only (9.9%), other conventional systemics (3.6%), methotrexate (3.3%), and dupilumab (2.3%).

To further explore the differences between hospitalization rates in treatment groups, the researchers performed a multivariable logistic regression analysis, adjusted for age, sex, ethnicity, and comorbidity score. Compared with those who received dupilumab, the adjusted odds ratios (ORs) for hospitalization were highest among those who received topical treatments (OR, 4.95), followed by those who received systemic corticosteroids (OR, 2.81), and those who received other conventional systemic treatments (OR, 2.36).

Dr. Musters and colleagues also found that compared with patients on nonsteroidal immunosuppressive therapy, patients on combination systemic therapy had a significantly higher odds of hospitalization, specifically an OR of 45.75 for those on combination treatment including corticosteroids, an OR of 37.57 for those on combination treatment not including steroids, and an OR of 1.87 for those on systemic corticosteroids as monotherapy.

“Overall, the risk of COVID-19 complications appears to be low in patients with AD, even when treated with systemic immunomodulatory agents,” Dr. Musters concluded. “Dupilumab monotherapy was associated with lower odds of hospitalizations compared with other therapies. Moreover, combination systemic treatment, especially combinations including systemic corticosteroids, was associated with the highest risk of severe COVID-19.”

She added that other population-based study designs are more suitable to answer other important questions, such as whether the overall risk of COVID-19 in patients with AD is higher or lower compared to healthy controls.

Amy S. Paller, MD, professor and chair of the department of dermatology at Northwestern University, Chicago, who was asked to comment on the study, characterized the results as reassuring. In this patient population, “we expected that dupilumab would not cause any problems,” she said. “We wouldn’t necessarily expect it to [confer] a benefit, but I think it’s because the patients who need a systemic medication are going on something that’s very targeted (dupilumab) rather than something that has a broader immunosuppressing function. It was interesting but not surprising that those on systemic steroids had more of a problem. Get them on something that’s very targeted if you can and don’t suppress the immune systems that might be handling COVID-19.”

Dr. Musters reported having no disclosures. Dr. Paller disclosed that she is consultant to and/or an investigator for many pharmaceutical companies.

BOSTON – Among atopic dermatitis (AD) patients infected with COVID-19, those who received topical treatments were nearly five times more likely to be hospitalized compared with those on dupilumab monotherapy, results from a global registry demonstrated.

Moreover, combination systemic treatment, especially those that included systemic corticosteroids, was associated with the highest risk of COVID-19–related hospitalization.

“Patients with inflammatory skin diseases such as AD may be at higher risk of COVID-19,” Annelie H. Musters, MD, said during a late-breaking abstract session at the annual meeting of the American Academy of Dermatology. “Another factor to consider is that AD patients are often treated with systemic immunomodulatory therapy, including systemic corticosteroids and nonsteroidal immunosuppressants such as methotrexate, cyclosporin, biologics, and Janus kinase inhibitors. Different mechanisms of action and levels of immunosuppression may impart variable risks of serious infections.”

On the other hand, some degree of immunomodulation may have beneficial effects on the course of COVID-19 in AD patients, said Dr. Musters, of the department of dermatology at Academic Medical Center, University of Amsterdam. Targeting of specific immune pathways could reduce the development of a hyperinflammatory state in severe COVID-19. Dual blockade of interleukin (IL)-4 and IL-13 with dupilumab may have a protective effect in the context of COVID-19 infection, because expression of Th2 cytokines, including IL-4 and IL-13, may be increased during COVID-19.

“At the start of the pandemic, many of us were faced with important questions, like do systemic immunomodulatory treatments influence outcomes of COVID-19 in patients with AD?” she said. “Do patients on dupilumab or other novel systemics fare better than those on conventional systemic treatment?”

To answer these questions, she and her colleagues launched a web-based registry in April 2020 to investigate COVID-19 outcomes in patients with AD treated with or without systemic immunomodulatory treatments. For the registry, known as Surveillance Epidemiology of Coronavirus Under Research Exclusion for Atopic Dermatitis (SECURE-AD), clinicians in 27 countries used a web-based form to enter anonymized data after patients had fully recovered from COVID-19. Eligibility criteria included having proven or highly suspected COVID-19, and there were no restrictions on age nor the type of AD treatment they were receiving.

Dr. Musters reported results from 442 patients who were recruited between April 2, 2020, and Oct. 31, 2021. Their mean age was 35.6 years, their median body mass index was 23.7 kg/m², and there was an even sex distribution. Most patients were White and were recruited from Italy. Of the 442 patients, 216 (48.8%) received dupilumab monotherapy, 131 (29.6%) received topical treatments, and 14 (3.16%) received combination systemic treatments, including systemic corticosteroids. About 12% presented to the emergency department and 6% were hospitalized. Of those hospitalized, 2% required intensive care and/or ventilation, and no deaths have occurred in the registry to date.

By treatment group, hospitalization rates were highest among those on combination treatments (35.7%), followed by systemic corticosteroids (14.3%), topical treatments only (9.9%), other conventional systemics (3.6%), methotrexate (3.3%), and dupilumab (2.3%).

To further explore the differences between hospitalization rates in treatment groups, the researchers performed a multivariable logistic regression analysis, adjusted for age, sex, ethnicity, and comorbidity score. Compared with those who received dupilumab, the adjusted odds ratios (ORs) for hospitalization were highest among those who received topical treatments (OR, 4.95), followed by those who received systemic corticosteroids (OR, 2.81), and those who received other conventional systemic treatments (OR, 2.36).

Dr. Musters and colleagues also found that compared with patients on nonsteroidal immunosuppressive therapy, patients on combination systemic therapy had a significantly higher odds of hospitalization, specifically an OR of 45.75 for those on combination treatment including corticosteroids, an OR of 37.57 for those on combination treatment not including steroids, and an OR of 1.87 for those on systemic corticosteroids as monotherapy.

“Overall, the risk of COVID-19 complications appears to be low in patients with AD, even when treated with systemic immunomodulatory agents,” Dr. Musters concluded. “Dupilumab monotherapy was associated with lower odds of hospitalizations compared with other therapies. Moreover, combination systemic treatment, especially combinations including systemic corticosteroids, was associated with the highest risk of severe COVID-19.”

She added that other population-based study designs are more suitable to answer other important questions, such as whether the overall risk of COVID-19 in patients with AD is higher or lower compared to healthy controls.

Amy S. Paller, MD, professor and chair of the department of dermatology at Northwestern University, Chicago, who was asked to comment on the study, characterized the results as reassuring. In this patient population, “we expected that dupilumab would not cause any problems,” she said. “We wouldn’t necessarily expect it to [confer] a benefit, but I think it’s because the patients who need a systemic medication are going on something that’s very targeted (dupilumab) rather than something that has a broader immunosuppressing function. It was interesting but not surprising that those on systemic steroids had more of a problem. Get them on something that’s very targeted if you can and don’t suppress the immune systems that might be handling COVID-19.”

Dr. Musters reported having no disclosures. Dr. Paller disclosed that she is consultant to and/or an investigator for many pharmaceutical companies.

Key clinical point: Patients with atopic dermatitis (AD) vs. healthy controls had significantly lower levels of serum 25-hydroxyvitamin D (25[OH]D), with the levels even lower in patients with severe vs. mild/moderate AD. Supplementation with vitamin D helped improve AD symptoms.

Major finding: The mean serum 25(OH)D level was significantly lower by 7.42 ng/mL in patients with AD vs. healthy controls and by an average of 7.99 ng/mL and 2.95 ng/mL in patients with severe vs. mild and moderate AD, respectively (all P < .001). Over a weighted mean of 2.88 months, patients receiving vitamin D supplementation at a weighted mean dose of 1,721 IU/day reported improvement in AD symptoms (P < .001).

Study details: Findings are from a meta-analysis of 20 studies with 1,882 cases of AD.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Ng JC and Yew YW. Effect of vitamin D serum levels and supplementation on atopic dermatitis: A systematic review and meta-analysis. Am J Clin Dermatol. 2022 (Mar 5). Doi: 10.1007/s40257-022-00677-0

Key clinical point: Patients with atopic dermatitis (AD) vs. healthy controls had significantly lower levels of serum 25-hydroxyvitamin D (25[OH]D), with the levels even lower in patients with severe vs. mild/moderate AD. Supplementation with vitamin D helped improve AD symptoms.

Major finding: The mean serum 25(OH)D level was significantly lower by 7.42 ng/mL in patients with AD vs. healthy controls and by an average of 7.99 ng/mL and 2.95 ng/mL in patients with severe vs. mild and moderate AD, respectively (all P < .001). Over a weighted mean of 2.88 months, patients receiving vitamin D supplementation at a weighted mean dose of 1,721 IU/day reported improvement in AD symptoms (P < .001).

Study details: Findings are from a meta-analysis of 20 studies with 1,882 cases of AD.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Ng JC and Yew YW. Effect of vitamin D serum levels and supplementation on atopic dermatitis: A systematic review and meta-analysis. Am J Clin Dermatol. 2022 (Mar 5). Doi: 10.1007/s40257-022-00677-0

Key clinical point: Patients with atopic dermatitis (AD) vs. healthy controls had significantly lower levels of serum 25-hydroxyvitamin D (25[OH]D), with the levels even lower in patients with severe vs. mild/moderate AD. Supplementation with vitamin D helped improve AD symptoms.

Major finding: The mean serum 25(OH)D level was significantly lower by 7.42 ng/mL in patients with AD vs. healthy controls and by an average of 7.99 ng/mL and 2.95 ng/mL in patients with severe vs. mild and moderate AD, respectively (all P < .001). Over a weighted mean of 2.88 months, patients receiving vitamin D supplementation at a weighted mean dose of 1,721 IU/day reported improvement in AD symptoms (P < .001).

Study details: Findings are from a meta-analysis of 20 studies with 1,882 cases of AD.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Ng JC and Yew YW. Effect of vitamin D serum levels and supplementation on atopic dermatitis: A systematic review and meta-analysis. Am J Clin Dermatol. 2022 (Mar 5). Doi: 10.1007/s40257-022-00677-0

Key clinical point: Cimetidine at a dose of 25-40 mg/kg along with standard treatment reduced severity of acute extrinsic atopic dermatitis (AD) without any serious adverse events.

Major finding: The SCORing Atopic Dermatitis (SCORAD) and objective SCORAD scores improved significantly in the cimetidine vs. placebo group at week 2 (both P = .004) and continued to improve further at weeks 4 (both P = .001), 6 (both P < .001), and 8 (both P < .001) after treatment. At week 2, gastric discomfort was reported by 1 patient receiving cimetidine, which improved after treatment discontinuation.

Study details: Findings are from a phase 3 study including 26 patients aged 12-60 years with AD who had acute lesions and were randomly assigned to receive 25-40 mg/kg cimetidine daily or placebo, both in conjunction with standard AD treatment.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Novianto E et al. Effectiveness of cimetidine as adjuvant therapy in the treatment of acute-extrinsic atopic dermatitis: A double-blind randomized controlled trial. Dermatol Ther (Heidelb). 2022 (Feb 17). Doi: 10.1007/s13555-022-00688-z

Key clinical point: Cimetidine at a dose of 25-40 mg/kg along with standard treatment reduced severity of acute extrinsic atopic dermatitis (AD) without any serious adverse events.

Major finding: The SCORing Atopic Dermatitis (SCORAD) and objective SCORAD scores improved significantly in the cimetidine vs. placebo group at week 2 (both P = .004) and continued to improve further at weeks 4 (both P = .001), 6 (both P < .001), and 8 (both P < .001) after treatment. At week 2, gastric discomfort was reported by 1 patient receiving cimetidine, which improved after treatment discontinuation.

Study details: Findings are from a phase 3 study including 26 patients aged 12-60 years with AD who had acute lesions and were randomly assigned to receive 25-40 mg/kg cimetidine daily or placebo, both in conjunction with standard AD treatment.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Novianto E et al. Effectiveness of cimetidine as adjuvant therapy in the treatment of acute-extrinsic atopic dermatitis: A double-blind randomized controlled trial. Dermatol Ther (Heidelb). 2022 (Feb 17). Doi: 10.1007/s13555-022-00688-z

Key clinical point: Cimetidine at a dose of 25-40 mg/kg along with standard treatment reduced severity of acute extrinsic atopic dermatitis (AD) without any serious adverse events.

Major finding: The SCORing Atopic Dermatitis (SCORAD) and objective SCORAD scores improved significantly in the cimetidine vs. placebo group at week 2 (both P = .004) and continued to improve further at weeks 4 (both P = .001), 6 (both P < .001), and 8 (both P < .001) after treatment. At week 2, gastric discomfort was reported by 1 patient receiving cimetidine, which improved after treatment discontinuation.

Study details: Findings are from a phase 3 study including 26 patients aged 12-60 years with AD who had acute lesions and were randomly assigned to receive 25-40 mg/kg cimetidine daily or placebo, both in conjunction with standard AD treatment.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Novianto E et al. Effectiveness of cimetidine as adjuvant therapy in the treatment of acute-extrinsic atopic dermatitis: A double-blind randomized controlled trial. Dermatol Ther (Heidelb). 2022 (Feb 17). Doi: 10.1007/s13555-022-00688-z

Key clinical point: Lower levels of caprylate and acetate in breast milk could be risk factors for infantile atopic dermatitis (AD) in exclusively breastfed infants.

Major finding: Caprylate (P = .034) and acetate (P = .002) levels were significantly lower in breast milk for infants with vs. without AD, with caprylate (P = .021) and acetate (P = .015) levels in breast milk being the factors significantly associated with the presence of infantile AD.

Study details: This prospective, observational study included 94 2- to 4-month-old exclusively breastfed infants. In this group 47 infants were diagnosed with mild (n = 17), moderate (n = 25), or severe (n = 5) AD and 47 infants without AD formed the control group.

Disclosures: This study was supported by National Taiwan University Hospital, Taipei, Taiwan. The authors declared no conflict of interests.

Source: Wang LC et al. Lower caprylate and acetate levels in the breast milk is associated with atopic dermatitis in infancy. Pediatr Allergy Immunol. 2022;33(2) e13744 (Feb 21). Doi:  10.1111/pai.13744

Key clinical point: Lower levels of caprylate and acetate in breast milk could be risk factors for infantile atopic dermatitis (AD) in exclusively breastfed infants.

Major finding: Caprylate (P = .034) and acetate (P = .002) levels were significantly lower in breast milk for infants with vs. without AD, with caprylate (P = .021) and acetate (P = .015) levels in breast milk being the factors significantly associated with the presence of infantile AD.

Study details: This prospective, observational study included 94 2- to 4-month-old exclusively breastfed infants. In this group 47 infants were diagnosed with mild (n = 17), moderate (n = 25), or severe (n = 5) AD and 47 infants without AD formed the control group.

Disclosures: This study was supported by National Taiwan University Hospital, Taipei, Taiwan. The authors declared no conflict of interests.

Source: Wang LC et al. Lower caprylate and acetate levels in the breast milk is associated with atopic dermatitis in infancy. Pediatr Allergy Immunol. 2022;33(2) e13744 (Feb 21). Doi:  10.1111/pai.13744

Key clinical point: Lower levels of caprylate and acetate in breast milk could be risk factors for infantile atopic dermatitis (AD) in exclusively breastfed infants.

Major finding: Caprylate (P = .034) and acetate (P = .002) levels were significantly lower in breast milk for infants with vs. without AD, with caprylate (P = .021) and acetate (P = .015) levels in breast milk being the factors significantly associated with the presence of infantile AD.

Study details: This prospective, observational study included 94 2- to 4-month-old exclusively breastfed infants. In this group 47 infants were diagnosed with mild (n = 17), moderate (n = 25), or severe (n = 5) AD and 47 infants without AD formed the control group.

Disclosures: This study was supported by National Taiwan University Hospital, Taipei, Taiwan. The authors declared no conflict of interests.

Source: Wang LC et al. Lower caprylate and acetate levels in the breast milk is associated with atopic dermatitis in infancy. Pediatr Allergy Immunol. 2022;33(2) e13744 (Feb 21). Doi:  10.1111/pai.13744

Key clinical point: Patients with atopic dermatitis (AD) who initiated dupilumab were at a 2-fold higher risk of developing conjunctivitis within 6 months of treatment initiation vs. those who initiated other systemic therapies, with comorbid asthma further increasing the risk.

Major finding: The risk of developing conjunctivitis within 6 months of treatment initiation was higher with dupilumab vs. methotrexate (relative risk [RR] 2.12; 95% CI 1.56-2.91), mycophenolate (RR 2.43; 95% CI 1.32-4.47), or cyclosporine (RR 1.83; 95% CI 1.05-3.20). Comorbid asthma could be a risk factor for conjunctivitis in dupilumab initiators (RR 2.86; 95% CI 1.24-6.60).

Study details: This population-based longitudinal study included 5,004,117 patients with AD who newly initiated dupilumab or methotrexate (cohort 1, n = 5,770), dupilumab or mycophenolate (cohort 2, n = 4,402), and dupilumab or cyclosporine (cohort 3, n = 4,238).

Disclosures: This study was supported by the Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA. The authors declared serving as advisors, speakers, consultants, or principal investigators or receiving funding and grants from several sources.

Source: Schneeweiss MC et al. Incidence of bacterial and nonbacterial conjunctivitis in patients with atopic dermatitis treated with dupilumab: A US multidatabase cohort study. Dermatitis. 2022 (Feb 15). Doi: 10.1097/DER.0000000000000843

Key clinical point: Patients with atopic dermatitis (AD) who initiated dupilumab were at a 2-fold higher risk of developing conjunctivitis within 6 months of treatment initiation vs. those who initiated other systemic therapies, with comorbid asthma further increasing the risk.

Major finding: The risk of developing conjunctivitis within 6 months of treatment initiation was higher with dupilumab vs. methotrexate (relative risk [RR] 2.12; 95% CI 1.56-2.91), mycophenolate (RR 2.43; 95% CI 1.32-4.47), or cyclosporine (RR 1.83; 95% CI 1.05-3.20). Comorbid asthma could be a risk factor for conjunctivitis in dupilumab initiators (RR 2.86; 95% CI 1.24-6.60).

Study details: This population-based longitudinal study included 5,004,117 patients with AD who newly initiated dupilumab or methotrexate (cohort 1, n = 5,770), dupilumab or mycophenolate (cohort 2, n = 4,402), and dupilumab or cyclosporine (cohort 3, n = 4,238).

Disclosures: This study was supported by the Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA. The authors declared serving as advisors, speakers, consultants, or principal investigators or receiving funding and grants from several sources.

Source: Schneeweiss MC et al. Incidence of bacterial and nonbacterial conjunctivitis in patients with atopic dermatitis treated with dupilumab: A US multidatabase cohort study. Dermatitis. 2022 (Feb 15). Doi: 10.1097/DER.0000000000000843

Key clinical point: Patients with atopic dermatitis (AD) who initiated dupilumab were at a 2-fold higher risk of developing conjunctivitis within 6 months of treatment initiation vs. those who initiated other systemic therapies, with comorbid asthma further increasing the risk.

Major finding: The risk of developing conjunctivitis within 6 months of treatment initiation was higher with dupilumab vs. methotrexate (relative risk [RR] 2.12; 95% CI 1.56-2.91), mycophenolate (RR 2.43; 95% CI 1.32-4.47), or cyclosporine (RR 1.83; 95% CI 1.05-3.20). Comorbid asthma could be a risk factor for conjunctivitis in dupilumab initiators (RR 2.86; 95% CI 1.24-6.60).

Study details: This population-based longitudinal study included 5,004,117 patients with AD who newly initiated dupilumab or methotrexate (cohort 1, n = 5,770), dupilumab or mycophenolate (cohort 2, n = 4,402), and dupilumab or cyclosporine (cohort 3, n = 4,238).

Disclosures: This study was supported by the Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA. The authors declared serving as advisors, speakers, consultants, or principal investigators or receiving funding and grants from several sources.

Source: Schneeweiss MC et al. Incidence of bacterial and nonbacterial conjunctivitis in patients with atopic dermatitis treated with dupilumab: A US multidatabase cohort study. Dermatitis. 2022 (Feb 15). Doi: 10.1097/DER.0000000000000843

Key clinical point: Dupilumab effectively reduced signs and symptoms of atopic dermatitis (AD) along with a tolerable safety profile in a real-world setting during the COVID-19 pandemic.

Major finding: At least 75% improvement in the Eczema Area and Severity Index was achieved by 66.6%, 89.5%, and 95.8% patients at 16 weeks, 1 year, and 2 years of dupilumab therapy, respectively, with persistence rates being >90% throughout the 2 years of therapy. The most reported adverse events were infections, with a mild course of COVID-19 being the most reported (4.7%), followed by ocular complications (2.5%).

Study details: Findings are from a retrospective, multicenter study including 360 adults with severe AD who received ≥1 dose of dupilumab.

Disclosures: This study did not receive any funding. Some authors declared serving as a consultant, speaker, or investigator for several sources.

Source: Kojanova M et al. Dupilumab for the treatment of atopic dermatitis: real-world data from the Czech Republic BIOREP registry. J Dermatolog Treat. 2022 (Feb 21). Doi: 10.1080/09546634.2022.2043545

Key clinical point: Dupilumab effectively reduced signs and symptoms of atopic dermatitis (AD) along with a tolerable safety profile in a real-world setting during the COVID-19 pandemic.

Major finding: At least 75% improvement in the Eczema Area and Severity Index was achieved by 66.6%, 89.5%, and 95.8% patients at 16 weeks, 1 year, and 2 years of dupilumab therapy, respectively, with persistence rates being >90% throughout the 2 years of therapy. The most reported adverse events were infections, with a mild course of COVID-19 being the most reported (4.7%), followed by ocular complications (2.5%).

Study details: Findings are from a retrospective, multicenter study including 360 adults with severe AD who received ≥1 dose of dupilumab.

Disclosures: This study did not receive any funding. Some authors declared serving as a consultant, speaker, or investigator for several sources.

Source: Kojanova M et al. Dupilumab for the treatment of atopic dermatitis: real-world data from the Czech Republic BIOREP registry. J Dermatolog Treat. 2022 (Feb 21). Doi: 10.1080/09546634.2022.2043545

Key clinical point: Dupilumab effectively reduced signs and symptoms of atopic dermatitis (AD) along with a tolerable safety profile in a real-world setting during the COVID-19 pandemic.

Major finding: At least 75% improvement in the Eczema Area and Severity Index was achieved by 66.6%, 89.5%, and 95.8% patients at 16 weeks, 1 year, and 2 years of dupilumab therapy, respectively, with persistence rates being >90% throughout the 2 years of therapy. The most reported adverse events were infections, with a mild course of COVID-19 being the most reported (4.7%), followed by ocular complications (2.5%).

Study details: Findings are from a retrospective, multicenter study including 360 adults with severe AD who received ≥1 dose of dupilumab.

Disclosures: This study did not receive any funding. Some authors declared serving as a consultant, speaker, or investigator for several sources.

Source: Kojanova M et al. Dupilumab for the treatment of atopic dermatitis: real-world data from the Czech Republic BIOREP registry. J Dermatolog Treat. 2022 (Feb 21). Doi: 10.1080/09546634.2022.2043545

Key clinical point: Risk for acne was comparable in adolescents and adults with atopic dermatitis (AD) and matched reference individuals from the general population; however, the risk varied with age and sex, with males and older patients appearing to be at higher risk.

Major finding: Although the overall risk for acne was similar among patients with AD vs. reference individuals (hazard ratio [HR] 0.96; P = .4623), the risk was significantly higher in males with AD (HR 1.22; P = .0234) and in patients aged 30-39 (HR 1.41; P = .0156) and ≥40 (HR 2.07; P = .0002) years.

Study details: Findings are from a prospective cohort study including 6,600 adults and adolescents with AD matched with 66,000 reference individuals without AD.

Disclosures: This study did not receive any funding. The authors declared serving as an advisory board member, investigator, speaker, consultant, or receiving honoraria, fees, research funding, and research support from several sources.

Source: Thyssen JP et al. Incidence, prevalence and risk of acne in adolescent and adult patients with atopic dermatitis: a matched cohort study. J Eur Acad Dermatol Venereol. 2022 (Feb 26). Doi: 10.1111/jdv.18027

Key clinical point: Risk for acne was comparable in adolescents and adults with atopic dermatitis (AD) and matched reference individuals from the general population; however, the risk varied with age and sex, with males and older patients appearing to be at higher risk.

Major finding: Although the overall risk for acne was similar among patients with AD vs. reference individuals (hazard ratio [HR] 0.96; P = .4623), the risk was significantly higher in males with AD (HR 1.22; P = .0234) and in patients aged 30-39 (HR 1.41; P = .0156) and ≥40 (HR 2.07; P = .0002) years.

Study details: Findings are from a prospective cohort study including 6,600 adults and adolescents with AD matched with 66,000 reference individuals without AD.

Disclosures: This study did not receive any funding. The authors declared serving as an advisory board member, investigator, speaker, consultant, or receiving honoraria, fees, research funding, and research support from several sources.

Source: Thyssen JP et al. Incidence, prevalence and risk of acne in adolescent and adult patients with atopic dermatitis: a matched cohort study. J Eur Acad Dermatol Venereol. 2022 (Feb 26). Doi: 10.1111/jdv.18027

Key clinical point: Risk for acne was comparable in adolescents and adults with atopic dermatitis (AD) and matched reference individuals from the general population; however, the risk varied with age and sex, with males and older patients appearing to be at higher risk.

Major finding: Although the overall risk for acne was similar among patients with AD vs. reference individuals (hazard ratio [HR] 0.96; P = .4623), the risk was significantly higher in males with AD (HR 1.22; P = .0234) and in patients aged 30-39 (HR 1.41; P = .0156) and ≥40 (HR 2.07; P = .0002) years.

Study details: Findings are from a prospective cohort study including 6,600 adults and adolescents with AD matched with 66,000 reference individuals without AD.

Disclosures: This study did not receive any funding. The authors declared serving as an advisory board member, investigator, speaker, consultant, or receiving honoraria, fees, research funding, and research support from several sources.

Source: Thyssen JP et al. Incidence, prevalence and risk of acne in adolescent and adult patients with atopic dermatitis: a matched cohort study. J Eur Acad Dermatol Venereol. 2022 (Feb 26). Doi: 10.1111/jdv.18027

Key clinical point: A significant proportion of patients with atopic dermatitis (AD) experience sleep disturbance (SD), which usually improves overtime; however, patients with moderate-to-severe AD are more likely to experience a persistent SD course.

Major finding: At least 3 nights of SD were reported by 34.2% of patients at baseline; however only 12.3% of patients reported persistent SD at the first and second follow-ups, and only 11.5% of patients with severe SD at baseline experienced persistent SD scores at the second follow-up. Severe/very severe AD vs. mild AD was a significant predictor of increased nights of SD by eczema (adjusted odds ratio 16.20; P < .0001).

Study details: This prospective, dermatology practice-based study included 1,295 patients with mild (40.5%), moderate (35.1%), or severe/very severe (24.4%) AD.

Disclosures: This study was supported by the Agency for Healthcare Research and Quality, the Dermatology Foundation, and an unrestricted research grant from Galderma. R Chavda and S Gabriel declared being employees of and JI Silverberg declared being a consultant for Galderma.

Source: Manjunath J et al. longitudinal course of sleep disturbance and relationship with itch in adult atopic dermatitis in clinical practice. Dermatitis. 2022 (Mar 3). Doi: 10.1097/DER.0000000000000859

Key clinical point: A significant proportion of patients with atopic dermatitis (AD) experience sleep disturbance (SD), which usually improves overtime; however, patients with moderate-to-severe AD are more likely to experience a persistent SD course.

Major finding: At least 3 nights of SD were reported by 34.2% of patients at baseline; however only 12.3% of patients reported persistent SD at the first and second follow-ups, and only 11.5% of patients with severe SD at baseline experienced persistent SD scores at the second follow-up. Severe/very severe AD vs. mild AD was a significant predictor of increased nights of SD by eczema (adjusted odds ratio 16.20; P < .0001).

Study details: This prospective, dermatology practice-based study included 1,295 patients with mild (40.5%), moderate (35.1%), or severe/very severe (24.4%) AD.

Disclosures: This study was supported by the Agency for Healthcare Research and Quality, the Dermatology Foundation, and an unrestricted research grant from Galderma. R Chavda and S Gabriel declared being employees of and JI Silverberg declared being a consultant for Galderma.

Source: Manjunath J et al. longitudinal course of sleep disturbance and relationship with itch in adult atopic dermatitis in clinical practice. Dermatitis. 2022 (Mar 3). Doi: 10.1097/DER.0000000000000859

Key clinical point: A significant proportion of patients with atopic dermatitis (AD) experience sleep disturbance (SD), which usually improves overtime; however, patients with moderate-to-severe AD are more likely to experience a persistent SD course.

Major finding: At least 3 nights of SD were reported by 34.2% of patients at baseline; however only 12.3% of patients reported persistent SD at the first and second follow-ups, and only 11.5% of patients with severe SD at baseline experienced persistent SD scores at the second follow-up. Severe/very severe AD vs. mild AD was a significant predictor of increased nights of SD by eczema (adjusted odds ratio 16.20; P < .0001).

Study details: This prospective, dermatology practice-based study included 1,295 patients with mild (40.5%), moderate (35.1%), or severe/very severe (24.4%) AD.

Disclosures: This study was supported by the Agency for Healthcare Research and Quality, the Dermatology Foundation, and an unrestricted research grant from Galderma. R Chavda and S Gabriel declared being employees of and JI Silverberg declared being a consultant for Galderma.

Source: Manjunath J et al. longitudinal course of sleep disturbance and relationship with itch in adult atopic dermatitis in clinical practice. Dermatitis. 2022 (Mar 3). Doi: 10.1097/DER.0000000000000859

Key clinical point: Atopic dermatitis (AD) was negatively associated with some serum lipids, indicating AD being intrinsically protective for dyslipidemia.

Major finding: AD was significantly associated with lower levels of total cholesterol (β −0.004; P < .001), triglycerides (β −0.006; P = .006), and low-density lipoprotein (β −0.004; P < .001) but not with high-density lipoprotein (P = .794).

Study details: The data come from a large-scale, cross-sectional study including 13,822 patients with AD and 67,896 patients with asthma.

Disclosures: This study was supported by the National Key Research and Development Project of China Precision Medicine Initiative and the Program of Introducing Talents of Discipline to Universities. The authors declared no conflict of interests.

Source: Tang Z et al. Association between atopic dermatitis, asthma, and serum lipids: A UK Biobank based observational study and Mendelian randomization analysis. Front Med. 2022 (Feb 21). Doi: 10.3389/fmed.2022.810092

Key clinical point: Atopic dermatitis (AD) was negatively associated with some serum lipids, indicating AD being intrinsically protective for dyslipidemia.

Major finding: AD was significantly associated with lower levels of total cholesterol (β −0.004; P < .001), triglycerides (β −0.006; P = .006), and low-density lipoprotein (β −0.004; P < .001) but not with high-density lipoprotein (P = .794).

Study details: The data come from a large-scale, cross-sectional study including 13,822 patients with AD and 67,896 patients with asthma.

Disclosures: This study was supported by the National Key Research and Development Project of China Precision Medicine Initiative and the Program of Introducing Talents of Discipline to Universities. The authors declared no conflict of interests.

Source: Tang Z et al. Association between atopic dermatitis, asthma, and serum lipids: A UK Biobank based observational study and Mendelian randomization analysis. Front Med. 2022 (Feb 21). Doi: 10.3389/fmed.2022.810092

Key clinical point: Atopic dermatitis (AD) was negatively associated with some serum lipids, indicating AD being intrinsically protective for dyslipidemia.

Major finding: AD was significantly associated with lower levels of total cholesterol (β −0.004; P < .001), triglycerides (β −0.006; P = .006), and low-density lipoprotein (β −0.004; P < .001) but not with high-density lipoprotein (P = .794).

Study details: The data come from a large-scale, cross-sectional study including 13,822 patients with AD and 67,896 patients with asthma.

Disclosures: This study was supported by the National Key Research and Development Project of China Precision Medicine Initiative and the Program of Introducing Talents of Discipline to Universities. The authors declared no conflict of interests.

Source: Tang Z et al. Association between atopic dermatitis, asthma, and serum lipids: A UK Biobank based observational study and Mendelian randomization analysis. Front Med. 2022 (Feb 21). Doi: 10.3389/fmed.2022.810092

Key clinical point: A 4-week treatment with a test cream (TC) containing only 2% urea and 20% glycerol significantly reduced sodium lauryl sulphate-induced skin irritation in patients with atopic dermatitis (AD) compared with a no treatment control (NTC) and two reference creams.

Major finding: After 28 days, there was a significant reduction in transepidermal water loss with TC vs. NTC (P < .001), paraffin cream (P < .001), and glycerol cream (P = .021); objective redness was lower with TC vs. NTC (P = .002) and paraffin cream (P < .001). The TC was well tolerated with no evidence of stinging or redness.

Study details: Findings are from a phase 2 trial including 49 adults with AD who were randomly assigned to receive either a TC containing urea and glycerol, a glycerol-containing moisturizer, a simple paraffin cream containing no humectant, or NTC.

Disclosures: This study was funded by Perrigo Nordic. The authors declared serving as consultants, investigators, or advisory board members for and receiving research grants from several sources. Three authors declared being employees of Perrigo Nordic.

Source: Danby SG et al. Different types of emollient cream exhibit diverse physiological effects on the skin barrier in adults with atopic dermatitis. Clin Exp Dermatol. 2022 (Feb 15). Doi:  10.1111/ced.15141

Key clinical point: A 4-week treatment with a test cream (TC) containing only 2% urea and 20% glycerol significantly reduced sodium lauryl sulphate-induced skin irritation in patients with atopic dermatitis (AD) compared with a no treatment control (NTC) and two reference creams.

Major finding: After 28 days, there was a significant reduction in transepidermal water loss with TC vs. NTC (P < .001), paraffin cream (P < .001), and glycerol cream (P = .021); objective redness was lower with TC vs. NTC (P = .002) and paraffin cream (P < .001). The TC was well tolerated with no evidence of stinging or redness.

Study details: Findings are from a phase 2 trial including 49 adults with AD who were randomly assigned to receive either a TC containing urea and glycerol, a glycerol-containing moisturizer, a simple paraffin cream containing no humectant, or NTC.

Disclosures: This study was funded by Perrigo Nordic. The authors declared serving as consultants, investigators, or advisory board members for and receiving research grants from several sources. Three authors declared being employees of Perrigo Nordic.

Source: Danby SG et al. Different types of emollient cream exhibit diverse physiological effects on the skin barrier in adults with atopic dermatitis. Clin Exp Dermatol. 2022 (Feb 15). Doi:  10.1111/ced.15141

Key clinical point: A 4-week treatment with a test cream (TC) containing only 2% urea and 20% glycerol significantly reduced sodium lauryl sulphate-induced skin irritation in patients with atopic dermatitis (AD) compared with a no treatment control (NTC) and two reference creams.

Major finding: After 28 days, there was a significant reduction in transepidermal water loss with TC vs. NTC (P < .001), paraffin cream (P < .001), and glycerol cream (P = .021); objective redness was lower with TC vs. NTC (P = .002) and paraffin cream (P < .001). The TC was well tolerated with no evidence of stinging or redness.

Study details: Findings are from a phase 2 trial including 49 adults with AD who were randomly assigned to receive either a TC containing urea and glycerol, a glycerol-containing moisturizer, a simple paraffin cream containing no humectant, or NTC.

Disclosures: This study was funded by Perrigo Nordic. The authors declared serving as consultants, investigators, or advisory board members for and receiving research grants from several sources. Three authors declared being employees of Perrigo Nordic.

Source: Danby SG et al. Different types of emollient cream exhibit diverse physiological effects on the skin barrier in adults with atopic dermatitis. Clin Exp Dermatol. 2022 (Feb 15). Doi:  10.1111/ced.15141