Caiazzo Giuseppina, Napolitano Maddalena, Quaranta Maria, Picone Vincenzo, Fabbrocini Gabriella, Patruno Cataldo
Department of Advanced Biomedical Sciences, University of Naples Federico II, Napoli, Italy.
Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
Arch Dermatol Res. 2025 Mar 17;317(1):575. doi: 10.1007/s00403-025-04090-5.
Atopic dermatitis is a chronic inflammatory systemic disease that can persist or start in adulthood, even in elderly age, with several clinical phenotypes. The aim of this study was to evaluate the relationship between phenotype and endotype in elderly patients, and the long-term effects of dupilumab on molecular signature in these patients. A total of 50 elderly patients had been treated with dupilumab during the follow up period. Regarding effectiveness parameters, mean EASI score at Week 0 was 25.12 ± 4.23 and significantly reduced to 2.42 ± 3.15 at Week 52 (p < 0.05). Regarding safety, none of the registered adverse events led to the discontinuation of dupilumab therapy. Moreover, after 52 weeks of dupilumab treatment, Th2 cytokines expression was decreased, with IL-13 and IL-31 downregulated in both patient groups at Week 52, at both gene and protein levels when compared with Week 0. Our data also revealed a significant increase in both IL-4 gene expression and protein production at Week 52 when compared with Week 0. Unexpectedly, our results also revealed that IL-22 cutaneous expression was significantly increased, while circulating levels were decreased at Week 52 when compared to Week 0. In conclusion, our results highlight the effectiveness of dupilumab at a late time point as Week 52. Of note, a dumping of the Th2- and Th17- immune response at both systemic and in situ level and a possible remodelling role of IL-22 in the skin is suggested.
特应性皮炎是一种慢性炎症性全身性疾病，可在成年期甚至老年期持续存在或发病，具有多种临床表型。本研究的目的是评估老年患者表型与内型之间的关系，以及度普利尤单抗对这些患者分子特征的长期影响。在随访期间，共有50名老年患者接受了度普利尤单抗治疗。关于有效性参数，第0周时平均EASI评分是25.12±4.23，在第52周时显著降至2.42±3.15（p<0.05）。关于安全性，登记的不良事件均未导致度普利尤单抗治疗中断。此外，度普利尤单抗治疗52周后，Th2细胞因子表达降低，与第0周相比，在第52周时两个患者组的IL-13和IL-31在基因和蛋白水平均下调。我们的数据还显示，与第0周相比，第52周时IL-4基因表达和蛋白产生均显著增加。出乎意料的是，我们的结果还显示，与第0周相比，第52周时IL-22的皮肤表达显著增加，而循环水平降低。总之，我们的结果突出了度普利尤单抗在第52周这一较晚时间点的有效性。值得注意的是，提示在全身和原位水平上Th2和Th17免疫反应均有减弱，且IL-22在皮肤中可能具有重塑作用。
