Does Age of Disease Onset Affect Atopic Dermatitis Treatment Efficacy?

Dupilumab was efficacious in adults with moderate to severe atopic dermatitis (AD) regardless of age of disease onset, according to new findings published in Dermatology and Therapy.

While childhood-onset AD is most common, a growing body of evidence suggests AD develops in adulthood more frequently than previously thought, researchers said.

“Adult-onset AD is estimated to account for approximately one-quarter of AD cases among adult patients, and studies have shown that it has distinct clinical characteristics, including localized hand, head, and neck lesions,” said Jonathan I Silverberg, MD, PhD, MPH, associate professor of dermatology, George Washington University School of Medicine and Health Sciences, and coauthors.

To understand whether age of onset affected the efficacy of dupilumab, researchers conducted a post hoc analysis of 2 phase 3 clinical trials, LIBERTY AD SOLO 1 and LIBERTY AD SOLO 2. Included in the analysis were 460 patients who received placebo and 457 patients treated with dupilumab, which was administered at a dose of 300 mg every 2 weeks.

Over half (53.2%) of patients reported their AD developed when they were 4 years of age or younger. Some 14% were between 5 and 9 years of age; 13.4% were between 10 and 19 years; and 18.5% were at least 20 years of age.

Over 16 weeks, dupilumab significantly improved AD symptoms and skin clearance regardless of age of onset, as compared to placebo. More patients receiving dupilumab achieved Eczema Area and Severity Index (EASI)-50, EASI-75, and EASI-90 scores, as well as Investigator’s Global Assessment scores of 0 or 1.

“EASI improvements were significant across all anatomical regions in all subgroups,” Dr Silverberg and coauthors noted.

Similarly, regardless of age of onset, patients receiving dupilumab saw consistent improvements in weekly average Peak Pruritus Numerical Rating Scale and Dermatology Life Quality Index scores.

“Despite possible endophenotypic differences linked to age of onset and differences in AD duration at baseline, dupilumab showed similar improvements in AD signs, symptoms, and [quality of life] in adults during 16 weeks of treatment. These findings support targeting of both IL-4 and IL-13 as an effective treatment strategy for AD across all ages of onset,” researchers concluded.

Reference:
Silverberg JI, Boguniewicz M, Hanifin J, et al. Dupilumab treatment in adults with moderate-to-severe atopic dermatitis is efficacious regardless of age of disease onset: a post hoc analysis of two phase 3 clinical trials. Dermatol Ther (Heidelb). Published online October 21, 2022. doi:10.1007/s13555-022-00822-x