Higher baseline serum lactate dehydrogenase level is associated with poor effectiveness of dupilumab in the long term in patients with atopic dermatitis.

Dupilumab shows high efficacy and tolerable safety for the treatment of atopic dermatitis (AD). However, the extent of its effectiveness varies in individual patients. To date, practical predictors of later effectiveness of dupilumab in AD patients have not been reported. To explore practical predictors of later effectiveness of dupilumab in AD, we retrospectively investigated the correlation of baseline demographics and baseline laboratory results with the percentage reduction in Eczema Area and Severity Index (EASI) scores at 1, 3, 6 and 12 months after initiating dupilumab. Furthermore, multiple regression analyses were conducted. Data were collected from patients' charts. Data on 54 Japanese adult patients (43 men and 11 women) with moderate to severe AD were analyzed. Baseline serum lactate dehydrogenase (LDH) level was negatively correlated with the percentage reduction in EASI score at 3, 6 and 12 months after initiating dupilumab but not at 1 month. Multiple regression analyses also revealed that effectiveness of dupilumab at 3 and 6 months was associated with lower baseline serum LDH level. AD patients with allergic diseases tended to have lower percentage reduction in EASI at 1 month, but had higher percentage reduction in EASI in the long term than patients without allergic diseases. In conclusion, higher baseline serum LDH level was associated with poor effectiveness of dupilumab in the long term in patients with AD. Furthermore, it tended to take a longer time for AD patients with allergic diseases to respond to dupilumab, and these patients responded better to dupilumab in the long term than patients without allergic diseases.

[Case of chronic pigeon breeder's disease accompanied by pulmonary cysts].

We treated a case of chronic pigeon breeder's disease with pulmonary cysts. The patient was a 49-year-old woman whose husband had started to breed pigeons 23 years earlier. She was given a diagnosis of hypersensitivity pneumonitis due to pigeons 1 year previously, but since her husband refused to stop keeping the birds, she could not stay out of contact with them. A chest CT scan showed bilateral multiple pulmonary cysts and a diffuse groundglass appearance. The transbronchial lung biopsy (TBLB) specimens showed bronchioloalveolitis characterized by infiltration of lymphocytes and plasma cells into the walls of the bronchioles and the surrounding alveolar walls. Tests for antibodies to extracts of both pigeon droppings and budgerigar droppings were positive. After admission to our hospital and avoidance of contact with birds, the groundglass changes, dyspnea, and hypoxemia ameliorated. Multiple pulmonary cysts in a non-smoker is a rare manifestation of chronic pigeon breeder's disease.