Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Dermatologia, Rome, Italy.
Università Cattolica del Sacro Cuore, Rome, Italy.
Dermatology. 2021;237(4):535-541. doi: 10.1159/000512890. Epub 2021 Jan 21.
Dupilumab, a monoclonal antibody inhibiting the signaling pathway of IL-4/IL-13, was shown to be safe and effective in the treatment of moderate/severe atopic dermatitis (AD) in several clinical trials and real-life experiences, with only a small percentage of patients showing to be resistant or to lose disease control.
In this study, we investigated the effectiveness and safety in combining dupilumab with systemic agents or phototherapy in patients experiencing an inadequate response to dupilumab.
This retrospective, monocentric, observational study consecutively included patients aged >18 years, with moderate-severe AD, under treatment with dupilumab. In this cohort of patients, we analyzed data of subjects who experienced an inadequate response to dupilumab, even when combined with topical corticosteroids, and for whom an additional systemic treatment or phototherapy was combined to dupilumab.
In this study, we included a total population of 69 patients treated with dupilumab. In 12/69 patients (17.4%) showing an inadequate response to dupilumab, a combined treatment consisting of dupilumab plus methylprednisolone (n = 5), cyclosporine (n = 4), methotrexate (n = 2), or narrow band-UVB (n = 1) was administered. Overall, after 8 weeks of combined therapy, the majority of patients (11 of 12) obtained an improvement of signs and symptoms of AD. Patients treated with combined therapy did not experience any adverse events, neither did they withdraw treatment because of the occurrence of adverse events.
This study suggests that the combination of dupilumab with a conventional drug or phototherapy may represent a valid therapeutic choice, maintaining a good safety profile in AD patients recalcitrant to dupilumab monotherapy.
白细胞介素 4/13 信号通路抑制剂度普利尤单抗在多项临床试验和真实世界研究中已被证实可安全有效地治疗中重度特应性皮炎（AD），仅有小部分患者表现出耐药或疾病控制丢失。
本研究旨在评估在接受度普利尤单抗治疗但应答不足的患者中联合使用度普利尤单抗与系统药物或光疗的疗效和安全性。
本回顾性、单中心、观察性研究连续纳入了接受度普利尤单抗治疗的年龄＞18 岁的中重度 AD 患者。在该患者队列中，我们分析了对度普利尤单抗应答不足（即使联合局部皮质类固醇治疗）且联合度普利尤单抗时加用其他系统治疗或光疗的患者的数据。
本研究共纳入 69 例接受度普利尤单抗治疗的患者。在 12/69 例（17.4%）对度普利尤单抗应答不足的患者中，给予联合治疗，方案为度普利尤单抗联合甲泼尼龙（n=5）、环孢素（n=4）、甲氨蝶呤（n=2）或窄谱 UVB（n=1）。总体而言，联合治疗 8 周后，大多数患者（11/12）的 AD 体征和症状得到改善。接受联合治疗的患者未发生任何不良事件，也未因不良事件而停药。
本研究提示，在对度普利尤单抗单药治疗应答不足的 AD 患者中，联合度普利尤单抗与常规药物或光疗可能是一种有效的治疗选择，且具有良好的安全性。
