Kido-Nakahara Makiko, Onozuka Daisuke, Izuhara Kenji, Saeki Hidehisa, Nunomura Satoshi, Takenaka Motoi, Matsumoto Mai, Kataoka Yoko, Fujimoto Rai, Kaneko Sakae, Morita Eishin, Tanaka Akio, Hide Michihiro, Okano Tatsuro, Miyagaki Tomomitsu, Aoki Natsuko, Nakajima Kimiko, Ichiyama Susumu, Tonomura Kyoko, Nakagawa Yukinobu, Tamagawa-Mineoka Risa, Masuda Koji, Takeichi Takuya, Akiyama Masashi, Ishiuji Yozo, Katsuta Michie, Kinoshita Yuki, Tateishi Chiharu, Yamamoto Aya, Morita Akimichi, Matsuda-Hirose Haruna, Hatano Yutaka, Kawasaki Hiroshi, Tanese Keiji, Ohtsuki Mamitaro, Kamiya Koji, Kabata Yudai, Abe Riichiro, Mitsui Hiroshi, Kawamura Tatsuyoshi, Tsuji Gaku, Furue Masutaka, Katoh Norito, Nakahara Takeshi
Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Oral Microbe Control, Graduate School of Medicine, Osaka University, Osaka, Japan.
J Allergy Clin Immunol Glob. 2024 Jul 31;3(4):100317. doi: 10.1016/j.jacig.2024.100317. eCollection 2024 Nov.
Atopic dermatitis (AD) is a common chronic eczematous skin disease with severe pruritus. Several new therapeutic agents for AD such as dupilumab, an anti-IL-4Rα antibody, have been developed in recent years. We need to predict which agent is the best choice for each patient, but this remains difficult.
Our aim was to examine clinical background factors and baseline biomarkers that could predict the achievement of improved clinical outcomes in patients with AD treated with dupilumab.
A multicenter, prospective observational study was conducted on 110 patients with AD. The Eczema Area and Severity Index was used as an objective assessment, and the Patient-Oriented Eczema Measure and Numerical Rating Scale for Pruritus were used as patient-reported outcomes. In addition, some clinical background factors were evaluated.
The achievement of an absolute Eczema Area and Severity Index of 7 or less was negatively associated with current comorbidity of food allergy and baseline serum lactate dehydrogenase (LDH) levels. There were negative associations between achievement of a Patient-Oriented Eczema Measure score of 7 or less and duration of severe AD and between achievement of an itching Numerical Rating Scale for Pruritus score of 1 or less and current comorbidity of allergic conjunctivitis or baseline serum periostin level. Furthermore, signal detection analysis showed that a baseline serum LDH level less than 328 U/L could potentially be used as a cutoff value for predicting the efficacy of dupilumab.
Baseline biomarkers such as LDH and periostin and clinical background factors such as current comorbidity of food allergy and a long period of severe disease may be useful indicators when choosing dupilumab for systemic treatment for AD, as they can predict the efficacy of dupilumab.
特应性皮炎（AD）是一种常见的慢性湿疹性皮肤病，伴有严重瘙痒。近年来已研发出几种用于治疗AD的新型治疗药物，如抗IL-4Rα抗体度普利尤单抗。我们需要预测哪种药物对每位患者是最佳选择，但这仍然很困难。
我们的目的是研究临床背景因素和基线生物标志物，这些因素和标志物可预测接受度普利尤单抗治疗的AD患者能否取得改善的临床结局。
对110例AD患者进行了一项多中心前瞻性观察研究。采用湿疹面积和严重程度指数作为客观评估指标，采用患者导向性湿疹评估量表和瘙痒数字评定量表作为患者报告的结局指标。此外，还评估了一些临床背景因素。
湿疹面积和严重程度指数绝对值达到7或更低与目前食物过敏合并症及基线血清乳酸脱氢酶（LDH）水平呈负相关。患者导向性湿疹评估量表评分达到7或更低与重度AD病程之间以及瘙痒数字评定量表评分达到1或更低与目前过敏性结膜炎合并症或基线血清骨膜蛋白水平之间均呈负相关。此外，信号检测分析表明，基线血清LDH水平低于328 U/L可能可用作预测度普利尤单抗疗效的临界值。
当选择度普利尤单抗用于AD的全身治疗时，LDH和骨膜蛋白等基线生物标志物以及目前食物过敏合并症和长期重度疾病等临床背景因素可能是有用的指标，因为它们可以预测度普利尤单抗的疗效。
