Tavecchio Simona, Angileri Luisa, Pozzo Giuffrida Francesco, Germiniasi Francesca, Marzano Angelo Valerio, Ferrucci Silvia
Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122 Milan, Italy.
Department of Physiopathology and Transplantation, Università degli Studi di Milano, Via Pace 9, 20122 Milan, Italy.
J Clin Med. 2020 Aug 19;9(9):2684. doi: 10.3390/jcm9092684.
The clinical features of adult-onset atopic dermatitis (AD) are heterogeneous and the diagnosis can be a challenge. A new biologic drug (dupilumab) has been approved for moderate to severe AD in adult patients. The efficacy and safety have been demonstrated in clinical trials, but these studies do not reflect conditions in daily practice and do not consider the different clinical manifestations of AD.
Analyzing the dupilumab activity in a real-world setting and comparing its efficacy on different AD phenotypes.
We retrospectively evaluated 221 AD patients treated with dupilumab, stratified into six clinical phenotypes: classic, generalized eczema inflammatory and lichenoid patterns, prurigo, nummular eczema, and erythroderma. At baseline and at weeks 4, 16, and 52, the disease severity was assessed through the Eczema Area and Severity Index (EASI) and the quality of life was assessed through the Dermatology Life Quality Index (DLQI) questionnaire, Peak Pruritus Numerical Rating Scale (itch NRS), and Peak Sleep NRS.
We found a significant improvement after 16 weeks of treatment ( < 0.0001) in all six phenotypes for all the assessed scores mentioned above, persisting up to week 52. The best improvement was seen in the more severe phenotypes, particularly the erythrodermic one.
The present study confirmed the efficacy and safety of dupilumab in the treatment of severe AD. Its strength was in the stratification of AD patients in six different phenotypes based on their clinical presentation, all of whom markedly improved in terms of both clinically evident and reported symptoms, as well as their quality of life.
成人起病的特应性皮炎（AD）临床特征具有异质性，诊断可能具有挑战性。一种新型生物药物（度普利尤单抗）已被批准用于治疗成年患者的中度至重度AD。其疗效和安全性已在临床试验中得到证实，但这些研究并未反映日常实践中的情况，也未考虑AD的不同临床表现。
分析度普利尤单抗在真实世界中的活性，并比较其对不同AD表型的疗效。
我们回顾性评估了221例接受度普利尤单抗治疗的AD患者，将其分为六种临床表型：经典型、泛发性湿疹炎症和苔藓样型、痒疹型、钱币状湿疹型和红皮病型。在基线以及第4、16和52周时，通过湿疹面积和严重程度指数（EASI）评估疾病严重程度，并通过皮肤病生活质量指数（DLQI）问卷、瘙痒峰值数字评定量表（瘙痒NRS）和睡眠峰值NRS评估生活质量。
我们发现，在上述所有评估分数方面，治疗16周后（<0.0001）所有六种表型均有显著改善，且持续至第52周。在更严重的表型中，尤其是红皮病型，改善最为明显。
本研究证实了度普利尤单抗治疗重度AD的疗效和安全性。其优势在于根据临床表现将AD患者分为六种不同表型，所有患者在临床明显症状、报告症状以及生活质量方面均有显著改善。
