To the Editor: In a recent article by Reefer et al,1 the occurrence of antimicrobial IgE in adult patients with atopic eczema was linked to high total IgE levels and a more severe disease pattern. ......in contrast to previous reports,2,3 the authors did not find an overrepresentation of antimicrobial IgE antibodies in patients with "intrinsic" atopic eczema.
Das atopische Ekzem zählt mit einer Prävalenz von ca. 2–3% bei Erwachsenen und 10–15% bei Kindern zu den häufigsten chronischen Erkrankungen 1. Im Gegensatz zu den Erwachsenen leidet die Mehrheit der ...Kinder an leichten bis mittelschweren Formen, die in der Regel gut behandelbar sind. Bei schweren Manifestationsformen, insbesondere im Erwachsenenalter, ist häufig zusätzlich eine systemische Behandlung notwendig, die dann von entsprechenden Spezialisten begleitet werden sollte.
Zusammenfassung
Das atopische Ekzem zählt mit einer Prävalenz von ca. 2–3% bei Erwachsenen und 10–15% bei Kindern zu den häufigsten chronischen Erkrankungen
1
. Im Gegensatz zu den Erwachsenen ...leidet die Mehrheit der Kinder an leichten bis mittelschweren Formen, die in der Regel gut behandelbar sind. Bei schweren Manifestationsformen, insbesondere im Erwachsenenalter, ist häufig zusätzlich eine systemische Behandlung notwendig, die dann von entsprechenden Spezialisten begleitet werden sollte.
Abstract
There are limited approved systemic treatment options for children with atopic dermatitis (AD). Dupilumab is now approved in the United States for patients 6 months and older with ...moderate-to-severe atopic dermatitis whose disease is not adequately controlled with topical prescription therapies. European Medicines Agency is evaluating the use of dupilumab in children aged 6 months through 5 years with severe AD only. To report the efficacy and safety of dupilumab in the subgroup of children aged 6 months to 5 years with severe AD (IGA score = 4) at baseline in the LIBERTY AD PRESCHOOL trial (NCT03346434 part B). Patients aged 6 months to 5 years with inadequately controlled moderate-to-severe AD were enrolled in LIBERTY AD PRESCHOOL (part B), a randomized, double-blind placebo-controlled phase 3 study. Patients were randomized to either dupilumab 200/300 mg every 4 weeks (200 mg if baseline weight 5 to <15 kg, 300 mg if 15 to <30 kg) or placebo for 16 weeks. All patients initiated standardized treatment with low-potency topical corticosteroids (TCS) from day –14. This analysis reports efficacy and quality-of-life endpoints including a 75% reduction from baseline in the Eczema Area and Severity Index (EASI-75), Peak-Pruritus Numerical Rating Scale (PP-NRS), Children’s Dermatology Life Quality Index (CDLQI, for children aged 4 to <6 years), and Infant’s Dermatitis Quality Of Life (IDQOL, for children <4 years) in children with severe AD. Of the total trial population of 162 patients with moderate-to-severe AD, 125 patients with severe AD at baseline were randomized: 63 to the dupilumab + TCS treatment group and 62 to the placebo + TCS treatment group. Baseline demographics were similar. Mean (SD) baseline disease characteristics were also similar between the dupilumab and placebo groups: EASI (38.8 13.7 vs. 35.4 12), body surface area (63.1% 21 vs. 58.9% 21.4), weekly average PP-NRS (7.6 1.4 vs. 7.6 1.6), CDLQI (17.5 5.5 vs. 17.8 6.4) and IDQOL (18.4 5.1 vs. 17.4 5.4). Dupilumab treatment resulted in a rapid and significant increase in the proportion of patients achieving EASI-75 compared with placebo treatment by week 4 (27% vs. 4.8%; P = 0.0009). By week 16, this improvement was further increased compared with the placebo group (46% vs. 7%; P < 0.0001). At week 16, dupilumab-treated patients had a significantly greater percent reduction from baseline in PP-NRS compared with the placebo group (LS mean (SE)–41.8 5.4 vs. 0.5 5.4; P < 0.0001). Dupilumab also resulted in significant improvement in quality-of-life outcomes compared with placebo (LS mean SE) change from baseline to week 16 in CDLQI (−9.1 1.1 vs. −2.6 1.2; P < 0.0001); IDQOL (−9.1 1.3 vs. −0.6 1.1; P < 0.0001). Treatment-emergent adverse events (TEAEs) were reported in 42 (66.7%) patients in the dupilumab group and 45 (73.8%) patients in the placebo group. Most TEAEs were mild to moderate and deemed unrelated to the study drug by the investigator. The most common TEAE was atopic dermatitis in both the dupilumab group (10 15.9%) and placebo group (16 26.2%). Additionally, TEAEs in the conjunctivitis cluster were reported by 4 (6.4%) patients in the dupilumab group and none in the placebo group. In the placebo group, 3 (4.9%) serious adverse events were reported. No dupilumab-related adverse events were serious or led to treatment discontinuation. Dupilumab significantly improved AD signs, symptoms, and quality of life in children aged 6 months to 5 years with severe AD. The safety profile was consistent with that previously seen in adults, adolescents, and children aged > 6 years of age.
Zusammenfassung
Die Basistherapie stellt eine tragende Säule in der Behandlung der atopischen Dermatitis dar. Sie ist unabhängig vom Schweregrad der Erkrankung in allen Stadien indiziert. Eine ...konsequente Basistherapie trägt entscheidend zur Wiederherstellung der gestörten Barrierefunktion, zur Reduktion der Xerosis und des Juckreizes bei. Überdies konnte eine Einsparung von topischen Steroiden durch eine gleichzeitig durchgeführte Basistherapie bei akuter atopischer Dermatitis gezeigt werden. Im Langzeitmanagement der Erkrankung führt sie zu einem verlängerten rezidivfreien Intervall. Neuere Studien zeigen einen protektiven Effekt einer früh begonnenen Basistherapie hinsichtlich der Entwicklung einer atopischen Dermatitis. Im folgenden Review sollen diese Aspekte unter Berücksichtigung klassischer Basistherapeutika und neuerer Entwicklungen aufgezeigt werden.
