Dupilumab reduces hospitalizations in adults with moderate/severe atopic dermatitis (eczema)
Published: January 11, 2022
Atopic dermatitis (AD) – also known as eczema – results in itchy, cracked, sore skin. This damage increases the risk of skin infections, which occasionally require hospitalization. Patients with AD may also require hospital treatment during a flare (a sudden worsening of symptoms) or if they have severe side effects from medications. As AD is thought to occur due to an overreactive immune system, one of the treatment options for patients with moderate or severe AD is immunosuppressants. Although these calm down the itching and irritation, they can also increase the risk of infection because they reduce the body’s defenses against microbes. Another treatment option for moderate or severe AD is a drug called dupilumab, which controls two inflammatory proteins that are overactive in AD, called interleukin 4 and interleukin 13. Dupilumab does not suppress the immune system, so does not increase the risk of infections.
In a recent article in The Journal of Allergy and Clinical Immunology: In Practice, Silverberg et al. compared the rates of hospitalizations among adults with moderate or severe AD who were treated with dupilumab or placebo (dummy treatment). They included data from 7 trials (2,932 patients), in which patients either received dupilumab 300 mg every week or placebo (2 studies) or dupilumab 300 mg every week or every 2 weeks or placebo (5 studies) for between 4 months and 1 year. In 2 of the 7 studies, all patients also received steroid cream, which is commonly prescribed for patients with AD.
Among the 1,091 patients who received placebo, there were 46 hospitalizations. For those who received dupilumab every 2 weeks (which is the approved regimen), the rate of hospitalization was reduced by 49%; for patients who received dupilumab every week, it was reduced by 71%. Some of the hospitalizations were judged to be specifically related to AD, and dupilumab use reduced the rate of AD-related hospitalizations by 60% (when given every 2 weeks) and 91% (when given every week). The duration of AD-related hospitalizations also decreased with dupilumab. Per 100 patients with AD followed for 1 year (i.e. 100-patient-year as a unit), the total length of hospital stays was 39 days with placebo, but only 11 days with dupilumab every 2 weeks and 7 days with dupilumab every week.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.