From the Dermatology Department, Virgen de las Nieves University Hospital, Granada, Spain.
Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
Dermatitis. 2024 May-Jun;35(3):250-257. doi: 10.1089/derm.2023.0176. Epub 2023 Sep 11.
Dupilumab is an effective treatment for atopic Dermatitis® (AD) and it also restores skin barrier function. Nevertheless, early changes in epidermal barrier parameters related to sustained treatment response or treatment failure are not known. So, the objective of this study is to evaluate whether changes in skin barrier function after 16 weeks dupilumab treatment could predict sustained treatment response or treatment failure. A prospective observational study was conducted that included patients with AD starting dupilumab. Clinical scores, patient-reported outcome measures (PROMs), and skin barrier function parameters were assessed at baseline and after 16 weeks treatment. Patients were followed until they failed to dupilumab or until the end of the study period. Participants were divided into 2 groups: patients with treatment failure and those with sustained treatment response. In total, 32 patients with AD were included in the study, with a mean age of 28.03 years (standard deviation 10.65), being 20 (60.6%) females. In total, 22 (66.7%) patients sustained dupilumab response during the study period and only 10 (33.3%) failed to treatment. After 16 weeks treatment, clinical scores were improved in both groups. Patients with sustained treatment response increased stratum corneum hydration (SCH) on noninvolved skin (34.25 arbitrary units [AU] vs 44.90AU, = 0.001) and on eczematous lesions (20.71 AU vs 40.94 AU, < 0.001) and also decreased transepidermal water loss (TEWL) on eczematous lesions (28.22 g/[m·h] vs 14.83 g/[m·h], = 0.002). Patients with treatment failure did not change TEWL or SCH. SCH after 16 weeks treatment on noninvolved skin (odds ratio [OR] = 0.83, = 0.018) and SCH after 16 weeks treatment on eczematous lesions (OR = 0.86, = 0.028) were related to dupilumab failure. SCH could be used as a predictive biomarker of dupilumab response in patients with AD.
度普利尤单抗是一种有效的特应性皮炎（AD）治疗药物，它还能恢复皮肤屏障功能。然而，与持续治疗反应或治疗失败相关的表皮屏障参数的早期变化尚不清楚。因此，本研究的目的是评估 16 周度普利尤单抗治疗后皮肤屏障功能的变化是否可以预测持续的治疗反应或治疗失败。这是一项前瞻性观察性研究，纳入了开始接受度普利尤单抗治疗的 AD 患者。在基线和治疗 16 周后评估临床评分、患者报告的结局测量（PROM）和皮肤屏障功能参数。患者随访至度普利尤单抗治疗失败或研究结束。参与者分为两组：治疗失败组和持续治疗反应组。共有 32 例 AD 患者纳入本研究，平均年龄 28.03 岁（标准差 10.65），其中女性 20 例（60.6%）。在研究期间，共有 22 例（66.7%）患者持续对度普利尤单抗有反应，仅 10 例（33.3%）治疗失败。治疗 16 周后，两组的临床评分均有所改善。持续治疗反应组的患者非受累皮肤的角质层水分含量（SCH）增加（34.25 个任意单位 [AU] 比 44.90AU， = 0.001），湿疹病变的 SCH 增加（20.71 AU 比 40.94 AU， < 0.001），湿疹病变的经皮水分丢失（TEWL）也减少（28.22 g/[m·h] 比 14.83 g/[m·h]， = 0.002）。治疗失败组的 TEWL 或 SCH 无变化。治疗 16 周后非受累皮肤的 SCH（比值比 [OR] = 0.83， = 0.018）和治疗 16 周后湿疹病变的 SCH（OR = 0.86， = 0.028）与度普利尤单抗治疗失败相关。SCH 可作为 AD 患者度普利尤单抗反应的预测生物标志物。
