Dupilumab improves lichenification in atopic dermatitis across age, racial groups

Key takeaways:

• Dupilumab was able to improve lichenification among patients aged 6 to 88 years with atopic dermatitis.
• Patients of different races including Asian, Black and white also all benefited equally.

Dupilumab rapidly treated and maintained improvements in lichenification, a type of skin thickening from repetitive scratching, among patients of varying ages and races with atopic dermatitis, according to a study.

Most prevalent in patients with South-Eastern Asian or African racial backgrounds, lichenification is sometimes considered a cosmetic issue, according to study author Jared Jagdeo, MD, MS, associate professor of dermatology and director of the center for photomedicine at SUNY Downstate Health Sciences University and a part of the dermatology service at the Veterans Affairs New York Harbor Healthcare System.

“Clinicians should recognize that persistent lichenification is not merely a cosmetic concern but a sign of ongoing inflammation that can be effectively treated with targeted systemic therapy,” Jagdeo told Healio, arguing that dupilumab (Dupixent; Sanofi, Regeneron) may be one such effective therapy.

“Previous studies have established the efficacy of dupilumab in reducing AD severity, pruritus and skin barrier dysfunction,” he continued, “but this study provides specific evidence on its impact on lichenification.”

In the post hoc analysis of pooled data from five clinical trials, 1,997 patients aged 6 to 88 years of varying races with moderate to severe AD were treated either with dupilumab or placebo.

The patient groups were subcategorized by age (n = 1,535) and race (n = 1,902). Among those analyzed by age, 123 children, 85 adolescents and 460 adults were treated with placebo and 244, 166 and 457, respectively, were treated with dupilumab. Among those analyzed by race, 132 Asian, 74 Black and 427 white patients were treated with placebo. The remaining 234, 112 and 923 received dupilumab.

According to week 16 scores on the Global Individual Signs Scores (GISS) scale, which measures the severity of certain AD signs:

• Children aged 6 to 11 years treated with dupilumab and topical corticosteroids (TCS) achieved a higher least square mean severity score reduction from baseline vs. children treated with placebo and TCS (1.3 vs. 1.9; P < .0001).
• Adolescents aged 12 to 17 years treated with dupilumab vs. placebo achieved a higher least square mean severity score reduction from baseline (1.5 vs. 2; P < .0001).
• Adults aged 18 years and older treated with dupilumab 300 mg once every 2 weeks vs. placebo achieved a higher least square mean severity score reduction from baseline (1.1 vs. 1.7; P < .0001).

Results from the GISS were confirmed by similar results on the SCORing Atopic Dermatitis scale, which measures the severity of psoriasis based on the extent of skin affected and the intensity of the symptoms.

Improvements in lichenification were observed as early as week 1 in adults and week 2 in children. Jagdeo explained that “given lichenification often persists despite traditional therapies,” the fact that dupilumab was able to incite improvements “highlights the potential of dupilumab to rapidly disrupt the itch-scratch cycle and modify chronic disease pathology.”

The ability of dupilumab to improve lichenifications also applied across racial groups according to GISS scores at 16 weeks, with:

• Asian patients treated with dupilumab and TCS achieving a 45.5% reduction vs. a 15.1% reduction in the placebo group (P < .0001).
• Black and African American patients treated with dupilumab and TCS achieving a 41.6% reduction vs. a 19.9% reduction in the placebo group (P = .0021).
• White patients treated with dupilumab and TCS achieving a 47.7% reduction vs. a 22.6% reduction in the placebo group (P < .0001).

“While Black and African American patients had higher baseline lichenification scores, the extent of improvement was comparable across all racial groups,” Jagdeo said. “Which is reassuring given historical disparities in AD treatment outcomes.”

According to Jagdeo, these results reinforce the effectiveness of dupilumab as a treatment for this typically “difficult to treat” sign of AD.

“These findings suggest that targeting interleukin-4 and -13 with dupilumab may offer an effective treatment option for patients with longstanding, recalcitrant AD lesions,” he said. “The results also reinforce the role of type 2 inflammation in epidermal hyperplasia and chronic itch-scratch cycles, supporting the use of systemic biologic therapy to modify disease pathology rather than relying solely on topical treatments.”

References:

• Fishbein AB, et al. J Allergy Clin Immunol Pract. 2019;doi:10.1016/j.jaip.2019.06.044.
• Siegfried EC, et al. Am J Clin Dermatol. 2023;doi:10.1007/s40257-023-00791-7.