Dupilumab Is Safe, Effective Among Elderly Patients With AD

A new study of dupilumab (Dupixent) indicates that the drug is a safe and effective treatment for atopic dermatitis (AD) in individuals aged 65 and older.

A significant improvement and a good safety profile were observed in 253 of the 276 patients over a 16-week period of treatment, as shown by sharp decreases in disease severity scores, according to the results published in Journal of the European Academy of Dermatology and Venereology. Participants for the study were recruited from centers across Italy.

The study saw a 69% percent reduction of the mean Eczema Area and Severity Index score, higher than those reported in registration studies. Only 6.5% dropped out due to inefficacy before week 16, and they usually left around week 12.

Furthermore, effectiveness in the elderly population was found to be comparable to that seen in the younger population in the same geographic region.

The most common phenotype was flexural dermatitis (45%; eczema at the knees, elbows, wrists, etc). Additionally, 23% were found to have more than 1 phenotype, with head/neck or hand eczema being the most frequent kind.

Results also indicated that significant percentages of elderly patients stopped using topical corticosteroids and topical immunomodulators. The decreases in usage were 58% and 13.6% of patients, respectively.

The drug’s safety profile also held up in testing among elderly patients. Conjunctivitis was the most frequent adverse event among elderly patients, even coming in at a lower compared with the 18- to 64-year-old population: 4% vs 8.6%. The percentage was also less than has been observed in clinical trials.

The clinical presentation of AD has been explored extensively for the general adult population, but much less so for the elderly. Evaluating the disease in the over-65 population is complicated due the adverse effects of traditional anti-inflammatory drugs and the presence of other medical conditions.

Recently, elderly AD has been considered its own clinical type, the authors point out. For younger adults, the eczema is usually in the creases and folds of the skin, while for those over 65, it is characterized by hardened, leathery skin behind the elbows and knees. The elderly also may have prurigo nodularis, where hard crusty lumps form that itch intensely, nummular eczema with its coin-shaped spots, or generalized eczema.

The condition in those 65 and over may also be challenging to diagnose due to medications they take for aging and other comorbidities, the authors said. Furthermore, their diagnosis is complicated by the need to rule out other conditions such as cutaneous T-cell lymphoma, allergic contact dermatitis, scabies, or adverse drug reactions.

The authors said the strength of the trial was that patients were not selected as in clinical trials. However, they said, the number of elderly patients was “not sufficient to draw robust conclusions.”

Reference

Patruno C, Napolitano M, Argenziano G, et al. Duplimumab therapy of atopic dermatitis of the elder: a mulitcentre, real-life study. J Eur Acad Dermatol Venereol. Published online December 17, 2020. doi:10.1111/jdv.17094