Portuguese immunoallergology clinical experience in patients with severe atopic dermatitis under dupilumab treatment

ABSTRACT

Background: Dupilumab has been recently approved for treatment in patients with severe AD in Portugal-until now there is no published data regarding Portuguese experience in Allergy centers. Method: Cross sectional clinical and laboratory assessment of 33 patients (pts) with moderate to severe AD treated with dupilumab (dupi) for at least 16 weeks (W) prospective evaluation of severity scores (SCORAD-Scoring Atopic Dermatitis, EASI-Eczema Area and Severity Index, P-VAS-Pruritus Visual Analogic Scale), report of adverse events up to 52 weeks of treatment. SCORAD and EASI were assessed in 23 pts at W52, P-VAS in 21 pts at W52. Results: Of the 33 pts, 18 were female (55%) with a mean age (SD, range) of 35.3 years (13.2, 15-60). In 16 pts the age of onset was before 2 years old, mean (SD) disease duration 28.1 years (12);94% patients had a diffuse pattern of skin lesions;97% of pts had allergic rhinitis, 82% asthma, 52% conjunctivitis and 30% food allergy. Median total IgE at baseline was of 6313 U/ml (P25-P75 2842-12491) with a 76% reduction at W52 in 16 pts. Median eosinophil count at baseline was 520 eosinophils/mm3 (P25-P75 270-740). Before starting dupi 29 pts had been treated with cyclosporine. At the beginning, 15 pts were under oral corticosteroids, 14 under oral systemic immunosuppressive drugs (all pts but two stopped both until W12 of dupi) and 5 switched from omalizumab. At baseline, median SCORAD and EASI were 69.3 and 24.2 points. At W16, W36 and W52, median SCORAD was 27.4, 22.3 and 21.5, and median EASI 5.3, 4.1 and 2.1. At W16, the EASI-50, EASI-75 and EASI-90 were achieved by 91%, 61% and 18% pts, and at W52, by 87%, 70% and 52% pts. The mean percentage of SCORAD reduction at W16 and W52 was 55% and 73%;and of EASI was 76% and 82%. At W16 and W52, an improvement of ≥4 points in P-VAS was achieved by 77% and 95% pts. There was a mean reduction of P-VAS at W2, W4, W16 and W52 of 2.6;3.6;4.7 and 6.3 points, respectively. Conjunctivitis was reported in 10 (30%) pts, two of them with keratoconjunctivitis and blepharitis, without needing to interrupt treatment;two pts also had facial erythema. One patient had COVID, and dupilumab scheme treatment was maintained. Conclusion: The majority of AD patients had a significant and consistent improvement in all the severity scores, after one year of treatment with dupilumab. No relevant adverse events were reported.