Biologicals bij constitutioneel eczeem

Abstract

In the past decennia systemic immunosuppressive treatment options in moderate to severe atopic dermatitis (AD) were limited. Oral immunosuppressive drugs, such as cyclosporine A (CsA), azathioprine, methotrexate and mycophenolic acid are used regularly, however a high a percentage of patients discontinue treatment due to inefficacy and/or side effects. In 2014 the first results of a phase 1 trial with dupilumab, a fully-human monoclonal antibody directed against the interleukin-4 receptor, in the treatment moderate to severe AD, were published. Dupilumab resulted in a rapid and a strong reduction of eczema an pruritus. An extensive phase 2 /3 dupilumab study was conducted, involving more than 2500 patients with moderate to severe AD. In 2 randomized, double-blind, placebo-controlled phase 3 trials including 1379 patients with moderate-to-severe AD and inadequate response to topical medications, dupilumab monotherapy resulted in a 50[%] reduction of EASI score in 61-69[%] of the patients (placebo groups 22-25[%]); EASI 75 was reached in 44-52[%] in the dupilumab groups compared to 12-15[%] in the placebo groups. The results of long-term treatment with dupilumab (52 weeks, concomitant treatment with topical steroids) show a consistent significant effect on all outcome measures. The results of a study including patients with a history of failure of CsA treatment (side effects or inefficacy) or with contra-indication to CsA treatment are expected shortly. Recently phase 1 and 2 studies with monoclonal antibodies directed against IL-13 and IL-31 were performed. The first results of IL-31 treatment are published and show a significant effect on pruritus and sleep disturbances in AD patients.