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Comparison of real-world treatment outcomes of systemic immunomodulating therapy in atopic dermatitis patients with dark and light skin types

Comparison of real-world treatment outcomes of systemic immunomodulating therapy in atopic dermatitis patients with dark and light skin types
Comparison of real-world treatment outcomes of systemic immunomodulating therapy in atopic dermatitis patients with dark and light skin types

Background: few data exist on differences in treatment effectiveness and safety in atopic dermatitis patients of different skin types.

Objective: to investigate treatment outcomes of dupilumab, methotrexate, and ciclosporin, and morphological phenotypes in atopic dermatitis patients, stratified by Fitzpatrick skin type.

Methods: in an observational prospective cohort study, pooling data from the Dutch TREAT (TREatment of ATopic eczema) NL (treatregister.nl) and UK-Irish A-STAR (Atopic eczema Systemic TherApy Register; astar-register.org) registries, data on morphological phenotypes and treatment outcomes were investigated.

Results: a total of 235 patients were included (light skin types [LST]: Fitzpatrick skin type 1-3, n = 156 [Ethnicity, White: 94.2%]; dark skin types [DST]: skin type 4-6, n = 68 [Black African/Afro-Caribbean: 25%, South-Asian: 26.5%, and Hispanics: 0%]). DST were younger (19.5 vs 29.0 years; P < .001), more often had follicular eczema (22.1% vs 2.6%; P < .001), higher baseline Eczema Area and Severity Index (EASI) scores (20.1 vs 14.9; P = .009), less allergic contact dermatitis (30.9% vs 47.4%; P = .03), and less previous phototherapy use (39.7% vs 59.0%; P = .008). When comparing DST and LST corrected for covariates including baseline EASI, DST showed greater mean EASI reduction between baseline and 6 months with only dupilumab (16.7 vs 9.7; adjusted P = .032). No differences were found for adverse events for any treatments (P > .05).

Limitations: unblinded, non-randomized.

Conclusions: atopic dermatitis differs in several characteristics between LST and DST. Skin type may influence treatment effectiveness of dupilumab.

atopic dermatitis, atopic eczema, ciclosporin, daily practice, dupilumab, effectiveness, ethnicity, methotrexate, morphology, race, registry, routine clinical care, safety, skin type, systemic treatment
2666-3287
14-24
Bosma, Angela L.
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Ouwerkerk, Wouter
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Heidema, Madeline J.
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Prieto-Merino, David
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Ardern-Jones, Michael R.
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Beattie, Paula
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Brown, Sara J.
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Ingram, John R.
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Irvine, Alan D.
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Ogg, Graham
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Patel, Prakash
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Reynolds, Nick J.
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Hearn, R.M. Ross
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Wan, Mandy
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Warren, Richard B.
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Woolf, Richard T.
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Hyseni, Ariënna M.
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Gerbens, Louise A.A.
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Spuls, Phyllis I.
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Flohr, Carsten
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Middelkamp-Hup, Maritza A.
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TREAT NL registry and UK-Irish A-STAR Study Groups
Bosma, Angela L.
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Ouwerkerk, Wouter
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Heidema, Madeline J.
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Prieto-Merino, David
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Ardern-Jones, Michael R.
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Beattie, Paula
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Brown, Sara J.
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Ingram, John R.
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Irvine, Alan D.
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Ogg, Graham
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Patel, Prakash
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Reynolds, Nick J.
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Hearn, R.M. Ross
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Wan, Mandy
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Warren, Richard B.
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Woolf, Richard T.
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Hyseni, Ariënna M.
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Gerbens, Louise A.A.
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Spuls, Phyllis I.
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Flohr, Carsten
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Middelkamp-Hup, Maritza A.
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Bosma, Angela L., Ouwerkerk, Wouter, Heidema, Madeline J., Prieto-Merino, David, Ardern-Jones, Michael R., Beattie, Paula, Brown, Sara J., Ingram, John R., Irvine, Alan D., Ogg, Graham, Patel, Prakash, Reynolds, Nick J., Hearn, R.M. Ross, Wan, Mandy, Warren, Richard B., Woolf, Richard T., Hyseni, Ariënna M., Gerbens, Louise A.A., Spuls, Phyllis I., Flohr, Carsten and Middelkamp-Hup, Maritza A. , TREAT NL registry and UK-Irish A-STAR Study Groups (2022) Comparison of real-world treatment outcomes of systemic immunomodulating therapy in atopic dermatitis patients with dark and light skin types. JAAD international, 10, 14-24. (doi:10.1016/j.jdin.2022.09.006).

Record type: Article

Abstract

Background: few data exist on differences in treatment effectiveness and safety in atopic dermatitis patients of different skin types.

Objective: to investigate treatment outcomes of dupilumab, methotrexate, and ciclosporin, and morphological phenotypes in atopic dermatitis patients, stratified by Fitzpatrick skin type.

Methods: in an observational prospective cohort study, pooling data from the Dutch TREAT (TREatment of ATopic eczema) NL (treatregister.nl) and UK-Irish A-STAR (Atopic eczema Systemic TherApy Register; astar-register.org) registries, data on morphological phenotypes and treatment outcomes were investigated.

Results: a total of 235 patients were included (light skin types [LST]: Fitzpatrick skin type 1-3, n = 156 [Ethnicity, White: 94.2%]; dark skin types [DST]: skin type 4-6, n = 68 [Black African/Afro-Caribbean: 25%, South-Asian: 26.5%, and Hispanics: 0%]). DST were younger (19.5 vs 29.0 years; P < .001), more often had follicular eczema (22.1% vs 2.6%; P < .001), higher baseline Eczema Area and Severity Index (EASI) scores (20.1 vs 14.9; P = .009), less allergic contact dermatitis (30.9% vs 47.4%; P = .03), and less previous phototherapy use (39.7% vs 59.0%; P = .008). When comparing DST and LST corrected for covariates including baseline EASI, DST showed greater mean EASI reduction between baseline and 6 months with only dupilumab (16.7 vs 9.7; adjusted P = .032). No differences were found for adverse events for any treatments (P > .05).

Limitations: unblinded, non-randomized.

Conclusions: atopic dermatitis differs in several characteristics between LST and DST. Skin type may influence treatment effectiveness of dupilumab.

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Accepted/In Press date: 18 September 2022
e-pub ahead of print date: 10 October 2022
Published date: 12 November 2022
Additional Information: Funding Information: The authors would like to acknowledge Manja Bloem for her support in preparing the data for analysis. NJR is a National Institute for Health and Care Research (NIHR) Senior Investigator and by the NIHR Newcastle Biomedical Research Center. RBW is supported by the Manchester NIHR Biomedical Research Centre .
Keywords: atopic dermatitis, atopic eczema, ciclosporin, daily practice, dupilumab, effectiveness, ethnicity, methotrexate, morphology, race, registry, routine clinical care, safety, skin type, systemic treatment

Identifiers

Local EPrints ID: 477003
URI: http://eprints.soton.ac.uk/id/eprint/477003
ISSN: 2666-3287
PURE UUID: 629de2e9-3bc3-4343-bb78-6abf40518595
ORCID for Michael R. Ardern-Jones: ORCID iD orcid.org/0000-0003-1466-2016

Catalogue record

Date deposited: 23 May 2023 16:36
Last modified: 17 Mar 2024 03:10

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Contributors

Author: Angela L. Bosma
Author: Wouter Ouwerkerk
Author: Madeline J. Heidema
Author: David Prieto-Merino
Author: Paula Beattie
Author: Sara J. Brown
Author: John R. Ingram
Author: Alan D. Irvine
Author: Graham Ogg
Author: Prakash Patel
Author: Nick J. Reynolds
Author: R.M. Ross Hearn
Author: Mandy Wan
Author: Richard B. Warren
Author: Richard T. Woolf
Author: Ariënna M. Hyseni
Author: Louise A.A. Gerbens
Author: Phyllis I. Spuls
Author: Carsten Flohr
Author: Maritza A. Middelkamp-Hup
Corporate Author: TREAT NL registry and UK-Irish A-STAR Study Groups

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