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Dupilumab: A review of its use in the treatment of atopic dermatitis - 21/02/18

Doi : 10.1016/j.jaad.2017.12.022 
Melinda J. Gooderham, MD, MSc, FRCPC a, b, c, , H. Chih-ho Hong, MD, FRCPC b, d, Panteha Eshtiaghi, HBSc e, Kim A. Papp, MD, PhD, FRCPC b
a Skin Centre for Dermatology, Peterborough, Ontario, Canada 
b Probity Medical Research, Waterloo, Ontario, Canada 
c Queen's University, Kingston, Ontario, Canada 
d Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada 
e Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada 

Correspondence to: Melinda J. Gooderham, MD, MSc, FRCPC, Skin Centre for Dermatology, 775 Monaghan Road, Peterborough, ON K9J 5K2, Canada.Skin Centre for Dermatology775 Monaghan RoadPeterboroughONK9J 5K2Canada

Abstract

Atopic dermatitis (AD) is a chronic, pruritic immune-mediated inflammatory dermatosis characterized by a T helper 2 (Th2) immune response phenotype and may be associated with systemic inflammation. Dupilumab is an interleukin 4 (IL-4) receptor α-antagonist that inhibits IL-4 and IL-13 signaling through blockade of the shared IL-4α subunit. Blockade of IL-4/13 is effective in reducing Th2 response. Dupilumab has recently been approved in the United States and Europe for the treatment of adult patients with moderate-to-severe AD. Clinical trials have shown that adults with moderate-to-severe AD who receive weekly or biweekly dupilumab injections have significantly improved clinical and patient-reported outcomes, including Eczema Area Severity Index, SCORing Atopic Dermatitis, Dermatology Life Quality Index, and itch Numeric Rating Scale scores. Concomitant use of topical corticosteroids along with dupilumab results in a greater improvement in signs and symptoms of AD than with use of dupilumab alone. Biomarker analyses show that dupilumab modulates the AD molecular signature and other Th2-associated biomarkers. Common adverse events reported in the clinical trials were nasopharyngitis, upper respiratory tract infection, injection site reactions, skin infections, and conjunctivitis. These were mild-to-moderate in nature, and overall rates of adverse events occurred with similar frequency between the treatment and placebo groups. There were no significant serious safety concerns identified in phase III clinical trials. Dupilumab, as monotherapy or with concomitant use of topical corticosteroids, can significantly improve clinical outcomes and quality of life in patients suffering from moderate-to-severe AD. Ongoing studies of dupilumab will help determine the clinical efficacy and safety profile of its long-term use.

Le texte complet de cet article est disponible en PDF.

Key words : biologics, dupilumab, IL-4, IL-13, IL-4Rα, moderate-to-severe atopic dermatitis, systemic therapy

Abbreviations used : AD, ADA, CCL, CYP450, DLQI, EASI, IGA, IL, NRS, TCS, Th2


Plan


 Publication of this article was supported by Leo Pharma, Bayer, and Sanofi/Regeneron.
 Funding sources: Supported by Bayer, LEO Pharma, and Sanofi.
 Disclosure: Dr Gooderham has served as an investigator, speaker, consultant and advisory board member for AbbVie, Actelion, Akros, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Dermira, Eli Lilly, Galderma, GSK, Incyte, Janssen, Leo Pharma, Medimmune, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, UCB, and Valeant. Dr Hong has served as an investigator, speaker, consultant, and advisory board member for Abbvie, Amgen, Boehringer Ingelheim, Celgene, Dermavant, Dermira, Eli Lilly, Galderma, GSK, Incyte, Leo Pharma, Medimmune, Novartis, Pfizer, Roche, Regeneron, Sanofi Genzyme, and Valeant. Dr Papp has served as an investigator, speaker, consultant, and advisory board member for AbbVie, Akros, Allergan, Amgen, Anacor, Astellas, AstraZeneca, Baxalta, Baxter, Boehringer Ingelheim, Bristol-Myers Squibb, CanFile, Celgene, Dermavant, Dermira, Eli Lilly, Forward Pharma, Galderma, Genentech, GSK, Incyte, Janssen, Kyowa Hakko Kirin, LEO Pharma, Medimmune, Meiji Seika Pharma, Merck, Merck Serono, Mitsubishi Pharma, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Takeda, UCB, and Valeant. Ms Eshtiaghi disclosed no conflicts of interest.
 Reprints not available from the authors.


© 2017  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 78 - N° 3S1

P. S28-S36 - mars 2018 Retour au numéro
Article précédent Article précédent
  • The future is finally here: Advances in the treatment of atopic dermatitis
  • Matthew J. Zirwas
| Article suivant Article suivant
  • Monoclonal antibodies against interleukin 13 and interleukin 31RA in development for atopic dermatitis
  • Carsten R. Hamann, Jacob P. Thyssen

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