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. 2022 Dec;12(12):2731-2746.
doi: 10.1007/s13555-022-00822-x. Epub 2022 Oct 21.

Dupilumab Treatment in Adults with Moderate-to-Severe Atopic Dermatitis is Efficacious Regardless of Age of Disease Onset: a Post Hoc Analysis of Two Phase 3 Clinical Trials

Jonathan I Silverberg  1 , Mark Boguniewicz  2 , Jon Hanifin  3 , Kim A Papp  4 , Haixin Zhang  5 , Ana B Rossi  6 , Noah A Levit  7
Affiliations

Dupilumab Treatment in Adults with Moderate-to-Severe Atopic Dermatitis is Efficacious Regardless of Age of Disease Onset: a Post Hoc Analysis of Two Phase 3 Clinical Trials

Jonathan I Silverberg et al. Dermatol Ther (Heidelb). 2022 Dec.

Abstract

Introduction: Adults with atopic dermatitis (AD) commonly report adult-onset disease. AD is associated with different genetics, lesion morphology and distribution, and symptoms by age of onset. Yet little is known about possible differences in treatment efficacy between adults with adult-onset or childhood-onset AD.

Methods: We evaluated the efficacy of dupilumab by age of AD onset in adults with moderate-to-severe AD, using pooled data from the LIBERTY AD SOLO 1 and 2 studies (NCT02277743, NCT02277769). Results were stratified based on self-reported age of AD onset, divided into four age subgroups: 0-4, 5-9, 10-19, and over 20 years.

Results: This analysis included 460 patients treated with placebo and 457 treated with dupilumab 300 mg every 2 weeks (q2w), with a mean patient age of 38 years. Most patients (53.2%) reported AD onset at 0-4 years, with 14% at 5-9 years, 13.4% at 10-19 years, and 18.5% at 20 years or older. Dupilumab significantly improved AD signs and symptoms over 16 weeks compared with placebo, regardless of age of onset. Dupilumab treatment resulted in a significantly greater proportion of patients achieving Eczema Area and Severity Index (EASI)-50, EASI-75, and EASI-90 (50%, 75%, and 90% improvement from baseline EASI, respectively), and clear or almost clear skin (Investigator's Global Assessment score 0 or 1) across all age-of-onset subgroups compared with placebo. In addition, EASI improvements were significant across all anatomical regions in all subgroups. Weekly average peak pruritus Numerical Rating Scale and Dermatology Life Quality Index also improved consistently and significantly with dupilumab versus placebo, regardless of age of onset.

Conclusion: Despite possible differences in presentation and progression of AD linked to age of onset, dupilumab showed similar significant and sustained improvements in AD signs, symptoms, and quality of life in adults compared with placebo, over 16 weeks of treatment.

Trial registration: LIBERTY AD SOLO 1: NCT02277743; LIBERTY AD SOLO 2: NCT02277769. Infographic available for this article.

Keywords: Age; Atopic dermatitis; Dupilumab; Treatment efficacy.

Plain language summary

Atopic dermatitis (AD, also known as eczema) is a skin disease with itchy, red rashes. AD often develops during childhood, but can also start in adulthood. Depending on the age it starts, AD may have different triggers and appearance, and might require different treatment. A medicine called dupilumab, which targets two proteins that cause inflammation, has provided benefit in children and adults with AD. We wanted to know if the age at which AD starts (during infancy, childhood, adolescence, or adulthood) impacts the improvement of dupilumab in adult patients. We looked at 917 adults, who participated in two studies taking dupilumab or a dummy treatment (placebo) every 2 weeks for 4 months. We compared four groups of patients with different ages of AD onset. The results showed that dupilumab compared with the placebo reduced skin lesions, relieved itch, and improved quality of life in a similar way in all adults, regardless of whether their disease started earlier or later in life. In the four groups, dupilumab reduced skin lesions across all areas of the body. Together with the previously reported safety data, our results support the use of dupilumab in adults with moderate-to-severe AD, irrespective of age of disease onset. INFOGRAPHIC.

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Figures

Fig. 1
Fig. 1
Age of AD onset in study patients. Left: incidence; Right: cumulative incidence. AD atopic dermatitis, q2w every 2 weeks
Fig. 2
Fig. 2
Proportion of patients achieving EASI-50, -75, or -90 or IGA 0 or 1 at 16 weeks, age of AD onset. *p < 0.0001, **p < 0.05 for dupilumab versus placebo. AD atopic dermatitis, EASI Eczema Area and Severity Index, IGA Investigator’s Global Assessment Score, q2w every 2 weeks
Fig. 3
Fig. 3
LS mean EASI scores per body regions at baseline and 16 weeks by age of AD onset. AD atopic dermatitis, EASI Eczema Area and Severity Index, LS least squares, q2w every 2 weeks
Fig. 4
Fig. 4
Weekly average peak pruritus NRS over time, by age of AD onset. *p < 0.0001 for dupilumab versus placebo. AD atopic dermatitis, LS least squares, NRS Numerical Rating Scale, PP peak pruritus, q2w every 2 weeks
Fig. 5
Fig. 5
DLQI LS mean over time, by age of AD onset. *p < 0.0001 for dupilumab versus placebo. AD atopic dermatitis, DLQI Dermatology Life Quality Index, LS least squares, q2w every 2 weeks
See this image and copyright information in PMC

References

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