Dupilumab: an evidence-based review of its potential in the treatment of atopic dermatitis
Received 10 September 2017
Accepted for publication 15 January 2018
Published 23 February 2018 Volume 2018:13 Pages 13—20
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 2
Editor who approved publication: Professor Garry Walsh
Panteha Eshtiaghi,1 Melinda J Gooderham2–4
1Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; 2SKiN Centre for Dermatology, Peterborough, ON, Canada; 3Probity Medical Research, Waterloo, ON, Canada; 4Queen’s University, Kingston, ON, Canada
Introduction: Atopic dermatitis (AD) is a recurrent, pruritic inflammatory skin disease with complex immunopathogenesis characterized by a dominant TH2 response. Dupilumab is an interleukin (IL)-4 receptor alpha antagonist that subsequently blocks IL-4 and IL-13 signaling. It has recently been approved for the treatment of adult patients with moderate-to-severe AD whose current treatment options are limited.
Aim: This article reviews the evidence of clinical efficacy, safety, and patient-reported outcome (PRO) measures from Phase I–III trials of dupilumab in adult patients with moderate-to-severe AD.
Evidence review: Results from clinical trials of dupilumab in adults with moderate-to-severe AD have shown that weekly or biweekly dupilumab injections significantly improve clinical and PROs. Transcriptome and serum analyses also found that dupilumab significantly modulates the AD molecular signature and other TH2-associated biomarkers, compared with placebo. Additionally, concomitant use of dupilumab with topical corticosteroids (TCS) results in a greater improvement in signs and symptoms of AD than with dupilumab use alone. Throughout the trials, common adverse events were headaches, conjunctivitis, and injection site reactions. These were consistently mild–moderate and occurred with similar frequency between the treatment and placebo groups.
Place in therapy: In adult patients with moderate-to-severe refractory AD, monotherapy or concomitant use of dupilumab with TCS holds great promise to significantly improve clinical outcomes and quality of life of the patient. Ongoing studies of dupilumab will help determine the clinical efficacy and safety profile of its long-term use. Finally, further economic evidence is warranted to compare the long-term costs and benefits of dupilumab with other currently available treatments for moderate-to-severe AD.
Keywords: moderate-to-severe atopic dermatitis, biologics, systemic therapy, interleukin-4, interleukin-13, dupilumab
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