Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Oct;38(10):1939-1946.
doi: 10.1111/jdv.20053. Epub 2024 Apr 30.

Detecting T-cell receptor clonality in patients with severe atopic dermatitis refractory to dupilumab

Hyungdon Kook  1 , Ho Eun Gwag  1 , So Yun Park  1 , Narang Hong  1 , Jung-Ho Lee  2 , Hye Jung Jung  1 , Mi Youn Park  1 , Yu Sung Choi  3 , Hyun Je Kim  2   4 , Stephan Weidinger  5 , Jiyoung Ahn  1
Affiliations

Detecting T-cell receptor clonality in patients with severe atopic dermatitis refractory to dupilumab

Hyungdon Kook et al. J Eur Acad Dermatol Venereol. 2024 Oct.

Abstract

Background: Trials and real-life studies demonstrated clinically meaningful improvements of disease activity in the majority of patients with moderate to severe atopic dermatitis (AD) treated with the anti-IL-4RA-antibody dupilumab. However, misdiagnosis or confounding skin diseases in particular cutaneous T-cell lymphoma (CTCL) may lead to inadequate response.

Objective: To investigate the clinical and pathological features of patients with AD who showed insufficient response to dupilumab.

Methods: We reviewed the medical records of 371 patients treated with dupilumab for severe AD. Insufficient response was defined as failure to achieve an improvement of the eczema area severity index (EASI) of at least 50% (EASI-50) at Week 16 and of 75% (EASI-75) at Week 52. Among 46 patients with insufficient response, 35 patients consented to a re-evaluation including a full physical exam, biopsies and laboratory assessments including immunohistochemistry and T-cell receptor gene rearrangement analysis to differentiate CTCL.

Results: Of the 371 patients treated with dupilumab, 46 (12.3%) patients showed insufficient response to dupilumab. Of these, 35 underwent further evaluation, and 19 (54.2% of inadequate responders) were finally diagnosed with mycosis fungoides (MF). In these patients, transition to or addition of conventional MF treatment led to clinical improvements.

Conclusions: Insufficient response to dupilumab treatment may help uncover early MF on an existing AD background.

PubMed Disclaimer

References

REFERENCES

    1. Huang J, Choo YJ, Smith HE, Apfelbacher C. Quality of life in atopic dermatitis in Asian countries: a systematic review. Arch Dermatol Res. 2022;314(5):445–462.
    1. Fishbein AB, Silverberg JI, Wilson EJ, Ong PY. Update on atopic dermatitis: diagnosis, severity assessment, and treatment selection. J Allergy Clin Immunol Pract. 2020;8(1):91–101.
    1. Ahn J, Choi Y, Simpson EL. Therapeutic new era for atopic dermatitis: part 2. Small molecules. Ann Dermatol. 2021;33(2):101–107.
    1. Drucker AM, Morra DE, Prieto‐Merino D, Ellis AG, Yiu ZZN, Rochwerg B, et al. Systemic immunomodulatory treatments for atopic dermatitis: update of a living systematic review and network meta‐analysis. JAMA Dermatol. 2022;158(5):523–532.
    1. Deleuran M, Thaçi D, Beck LA, de Bruin‐Weller M, Blauvelt A, Forman S, et al. Dupilumab shows long‐term safety and efficacy in patients with moderate to severe atopic dermatitis enrolled in a phase 3 open‐label extension study. J Am Acad Dermatol. 2020;82(2):377–388.

Substances

LinkOut - more resources