Introduction
Dupilumab has recently been approved for the treatment of moderate to severe atopic dermatitis (AD) in adults. Daily practice data on dupilumab treatment are scarce.
Objective
To study ...the effect of 16‐week treatment with dupilumab on clinical response and serum biomarkers in adult patients with moderate‐severe AD in daily practice.
Methods
Data were extracted from the BioDay registry, a prospective multicenter registry. Sixteen‐week clinical effectiveness of dupilumab was expressed as number of patients achieving EASI‐50 (Eczema Area and Severity Index) or EASI‐75, as well as patient‐reported outcomes measures (Patient‐Oriented Eczema Measure, Dermatology Life Quality Index, Numeric Rating Scale pruritus). Twenty‐one biomarkers were measured in patients treated with dupilumab without concomitant use of oral immunosuppressive drugs at five different time points (baseline, 4, 8, 12, and 16 weeks).
Results
In total, 138 patients treated with dupilumab in daily practice were included. This cohort consisted of patients with very difficult‐to‐treat AD, including 84 (61%) patients who failed treatment on ≥2 immunosuppressive drugs. At week 16, the mean percent change in EASI score was 73%. The EASI‐50 and EASI‐75 were achieved by 114 (86%) and 82 (62%) patients after 16 weeks of treatment. The most reported side effect was conjunctivitis, occurring in 47 (34%) patients. During dupilumab treatment, disease severity‐related serum biomarkers (TARC, PARC, periostin, and IL‐22), eotaxin‐1, and eotaxin‐3 significantly decreased.
Conclusion
Treatment with dupilumab significantly improved disease severity and decreased severity‐related serum biomarkers in patients with very difficult‐to‐treat AD in a daily practice setting.
This study evaluated the clinical effectiveness and safety of 16‐weeks of dupilumab treatment in adults with AD. Dupilumab treatment significantly suppressed disease severity‐related serum biomarkers and eosinophil chemokines. By the end of the treatment, the EASI‐50 and EASI‐75 was achieved by 86% and 62% of patients, respectively.
Abbreviations: AD: Atopic dermatitis; DLQI: Dermatology life quality index; EASI: Eczema area and severity index; IGA: Investigators global assessment; NRS: Numeric rating scale; PARC: Pulmonary and activation‐regulated chemokine; POEM: Patient‐oriented eczema measure; TARC: Thymus‐ and activation‐regulated chemokine
This article reviews the use of optical and microwave remote sensing data for soil and terrain mapping with emphasis on applications at regional and coarser scales. Remote sensing is expected to ...offer possibilities for improving incomplete spatial and thematic coverage of current regional and global soil databases. Traditionally, remotely sensed imagery have been used to support segmentation of the landscape into rather homogeneous soil–landscape units for which soil composition can be established by sampling. Soil properties have also been inferred from optical and microwave data using physically-based and empirical methods. Used as a secondary data source, remotely sensed imagery may support spatial interpolation of sparsely sampled soil property data. Soil properties that have been measured using remote or proximal sensing approaches include mineralogy, texture, soil iron, soil moisture, soil organic carbon, soil salinity and carbonate content. In sparsely vegetated areas, successful use of space borne, airborne, and in situ measurements using optical, passive and active microwave instruments has been reported. On the other hand, in densely vegetated areas, soil data acquisition typically relied on indirect retrievals using soil indicators, such as plant functional groups, productivity changes, and Ellenberg indicator values. Several forms of kriging, classification and regression tree analyses have been used jointly with remotely sensed data to predict soil properties at unvisited locations aiming at obtaining continuous area coverage. We expect that remotely sensed data from existing platforms and planned missions can provide an important data source supporting digital soil mapping. Yet, most studies so far have been performed on a local scale and only few on regional or smaller map scale. Although progress has been made, current methods and techniques still bear potential to further explore the full range of spectral, spatial and temporal properties of existing data sources. For example, space borne spectroscopy has been of limited use in retrieving soil data when compared to laboratory or field spectroscopy. To date, there is no coherent methodology established, where approaches of spatial segmentation, measurements of soil properties and interpolation using remotely sensed data are integrated in a holistic fashion to achieve complete area coverage. Such approaches will enhance the perspectives of using remotely sensed data for digital soil mapping.
► Remote sensing offers possibilities for improving current soil databases. ► Soil attribute retrievals from remote sensing should be used as covariates in DSM. ► The gap between proximal and remote sensing has to be bridged. ► We will be seeing future instruments launched soon enhancing the perspectives of DSM. ► A coherent multidisciplinary method for soil and terrain mapping should be developed.
Background
The hands are a common predilection site of atopic dermatitis (AD). Dupilumab is licensed for the treatment of AD but not for chronic hand eczema (CHE), while CHE is challenging to treat.
...Objectives
To evaluate the long‐term effect of dupilumab on hand eczema (HE) in patients with AD from the BioDay Registry.
Methods
A prospective observational study of adult patients with HE, treated for AD with dupilumab. Patients with a HE severity of at least moderate at baseline were considered for analysis. Patients with other concomitantly systemic immunosuppressive treatments were excluded. Clinical effectiveness on HE severity, using the Hand Eczema Severity Index (HECSI) and photographic guide, and health‐related quality of life, using the Quality of Life in Hand Eczema Questionnaire (QOLHEQ), were evaluated.
Results
A total of 72 patients were included. HECSI‐75 was achieved by 54/62 patients (87.1%) and HECSI‐90 by 39/72 (62.9%) at 52 weeks. Based on the photographic guide, 56/62 patients (90.3%) achieved the endpoint of ‘clear’ or ‘almost clear’. Mean QOLHEQ reduction was −63.5% (95% confidence interval −38.23 to −27.41). There was no difference in response between HE subtypes.
Conclusions
The results from this study hold promise for dupilumab to be a suitable treatment option for isolated CHE.
Dupilumab for atopic hand eczema.
Dupilumab is licensed for the treatment of atopic dermatitis (AD) but not for chronic hand eczema (CHE), while CHE is challenging to treat.
Dupilumab gave long‐term reduction of hand eczema severity and long‐term improvement of hand eczema‐related quality of life in patients with AD and concomitant moderate to very severe hand eczema.
The results from this study hold promise for dupilumab to be a suitable treatment option for isolated CHE.
Annual global land cover maps (GLC) are being provided by several operational monitoring efforts. However, map validation is lagging, in the sense that the annual land cover maps are often not ...validated. Concurrently, users such as the climate and land management community require information on the temporal consistency of multi-date GLC maps and stability in their accuracy. In this study, we propose a framework for operational validation of annual global land cover maps using efficient means for updating validation datasets that allow timely map validation according to recommendations in the CEOS Stage-4 validation guidelines. The framework includes a regular update of a validation dataset and continuous map validation. For the regular update of a validation dataset, a partial revision of the validation dataset based on random and targeted rechecking (areas with a high probability of change) is proposed followed by additional validation data collection. For continuous map validation, an accuracy assessment of each map release is proposed including an assessment of stability in map accuracy addressing the user needs on the temporal consistency information of GLC map and map quality. This validation approach was applied to the validation of the Copernicus Global Land Service GLC product (CGLS-LC100). The CGLS-LC100 global validation dataset was updated from 2015 to 2019. The update was done through a partial revision of the validation dataset and an additional collection of sample validation sites. From the global validation dataset, a total of 40% (10% for each update year) was revisited, supplemented by a targeted revision focusing on validation sample locations that were identified as possibly changed using the BFAST time series algorithm. Additionally, 6720 sample sites were collected to represent possible land cover change areas within 2015 and 2019. Through this updating mechanism, we increased the sampling intensity of validation sample sites in possible land cover change areas within the period. Next, the dataset was used to validate the annual GLC maps of the CGLS-LC100 product for 2015–2019. The results showed that the CGLS-LC100 annual GLC maps have about 80% overall accuracy showing high temporal consistency in general. In terms of stability in class accuracy, herbaceous wetland class showed to be the least stable over the period. As more operational land cover monitoring efforts are upcoming, we emphasize the importance of updated map validation and recommend improving the current validation practices and guidelines towards operational map validation so that long-term land cover maps and their uncertainty information are well understood and properly used.
•We present a framework for operational validation of global land cover maps.•Random and targeted reviews of the validation dataset are proposed.•Collecting extra validation sample sites in possible change areas is suggested.•Stability assessment in map accuracy over longer-term is conducted.•The framework is applied to validating the annual maps of CGLS-LC100 (2015–2019).
Global land cover (GLC) maps and assessments of their accuracy provide important information for different user communities. To date, there are several GLC reference datasets which are used for ...assessing the accuracy of specific maps. Despite significant efforts put into generating them, their availability and role in applications outside their intended use have been very limited. This study analyses metadata information from 12 existing and forthcoming GLC reference datasets and assesses their characteristics and potential uses in the context of 4 GLC user groups, i.e., climate modellers requiring data on Essential Climate Variables (ECV), global forest change analysts, the GEO Community of Practice for Global Agricultural Monitoring and GLC map producers. We assessed user requirements with respect to the sampling scheme, thematic coverage, spatial and temporal detail and quality control of the GLC reference datasets. Suitability of the datasets is highly dependent upon specific applications by the user communities considered. The LC-CCI, GOFC-GOLD, FAO-FRA and Geo-Wiki datasets had the broadest applicability for multiple uses. The re-usability of the GLC reference datasets would be greatly enhanced by making them publicly available in an expert framework that guides users on how to use them for specific applications.
Background
At present, no real‐world studies are available on different dupilumab dosing regimens in controlled atopic dermatitis (AD). The aim of this study was to clinically evaluate a ...patient‐centered dupilumab dosing regimen in patients with controlled AD and to relate this to serum drug levels and serum biomarkers.
Methods
Ninety adult AD patients from the prospective BioDay registry were included based on their dupilumab administration interval according to a predefined patient‐centered dosing regimen. Group A (n = 30) did not fulfill the criteria for interval prolongation and continued using the standard dupilumab dosage (300 mg/2 weeks), group B (n = 30) prolonged dupilumab interval with 50% (300 mg/4 weeks), and group C (n = 30) prolonged dupilumab interval with 66%–75% (300 mg/6–8 weeks). AD severity score, patient‐reported outcomes, serum dupilumab levels, and serum biomarkers were analyzed over time.
Results
Disease severity scores did not significantly change over time during the tapering period in any of the groups. In groups B and C, the Numeric Rating Scale (NRS)‐pruritus temporarily significantly increased after interval prolongation but remained low (median NRS‐pruritus≤4). Median dupilumab levels remained stable in group A (standard dosage), but significantly decreased in groups B and C (24.1 mg/L (IQR = 17.1–45.6); 12.5 mg/L (IQR = 1.7–22.3)) compared with the levels during the standard dosage (88.2 mg/L IQR = 67.1–123.0, p < .001). Disease severity biomarker levels (CCL17/CCL18) remained low in all study groups during the whole observation period.
Conclusions
This study showed that dose reduction was successful in a subgroup of patients with controlled AD by using a patient‐centered dosing regimen. These patients showed stable low disease activity and low severity biomarkers over time.
Dose reduction was successful in a subgroup of controlled AD patients by using a patient‐centered dupilumab dosing regimen. Despite significantly lower dupilumab levels, the EASI‐score and disease severity biomarkers (TARC/CCL17 and PARC/CCL18) in groups B (Q4W) and C (Q6W/Q8W) remained low and stable. These findings are the first step toward personalized dupilumab treatment for controlled AD patients in clinical practice.Abbreviations: AD, atopic dermatitis; EASI, eczema area and severity index; PARC (CCL18), pulmonary and activation‐regulated chemokine; PROMs, patient‐reported outcome measures; Q2W, every two weeks; Q4W, every four weeks; Q6W, every six weeks; Q8W, every eight weeks; TARC (CCL17), thymus and activation‐regulated chemokine
Background
Criteria for bariatric weight loss success are numerous. Most of them are arbitrary. None of them is evidence-based. Our objective was to determine their sensitivity and specificity.
...Methods
Thirteen common bariatric weight loss criteria were compared to a benchmark reflecting the gold standard in bariatric surgery. We used an elaborate baseline BMI-independent weight loss percentile chart, based on retrospective data after laparoscopic Roux-en-Y gastric bypass (LRYGB), performed between 2007 and 2017. Percentile curves p31.6 (patients’ expectation), p25 (interquartile range), p15.9 (1 standard deviation (SD) below median), and p10.9 (surgeons’ goal) were used as possible cutoff for success to determine true or false positive and negative results beyond 1 year.
Results
We operated 4497 primary LRYGB patients, with mean follow-up 22 (± 1 SD 19; range 0–109) months, 3031 patients with last result ≥ 1 year, 518 ≥ 5 years. For all four cutoff percentile curves for success, specificities were low (2–72%) for criteria < 35 body mass index (BMI), ≥ 25percentage excess BMI loss (%EBMIL), ≥ 50%EBMIL, ≥ 15 percentage total weight loss (%TWL), ≥ 20%TWL, ≥ 25 percentage excess weight loss (%EWL), and high (83–96%) for < 30 BMI. No criterion had > 80% specificity and sensitivity for a cutoff above p15.9. For p15.9, they were both > 80% for criteria ≥ 10 BMI reduction and ≥ 50%EWL, both > 90% for ≥ 25%TWL and ≥ 35 percentage alterable weight loss (%AWL). All criteria had high sensitivities for all cutoff percentile curves (87–100%), except < 30 BMI (65–78%).
Conclusions
For the first time, common bariatric criteria for weight loss success were systematically validated. Most criteria recognized success very well (high sensitivities), but ≥ 15%TWL, ≥ 20%TWL, < 35BMI, ≥ 25%EWL, ≥ 25%EBMIL, and ≥ 50%EBMIL left too many poor responders unnoticed (low specificities). Bariatric weight loss success is best assessed by comparing results to percentile curve 1 SD below median (p15.9) in a bariatric baseline BMI-independent weight loss percentile chart. Criteria ≥ 35%AWL and ≥ 25%TWL came close to that curve, both with > 90% sensitivity and specificity. Among others, criterion ≥ 50%EBMIL did not.
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