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

Angela L. Bosma; Wouter Ouwerkerk; Madeline J. Heidema; David Prieto-Merino; Michael R. Ardern-Jones; Paula Beattie; Sara J. Brown; John R. Ingram; Alan D. Irvine; Graham Ogg; Prakash Patel; Nick J. Reynolds; R. M.Ross Hearn; Mandy Wan; Richard B. Warren; Richard T. Woolf; Ariënna M. Hyseni; Louise A.A. Gerbens; Phyllis I. Spuls; Carsten Flohr; Maritza A. Middelkamp-Hup

doi:10.1016/j.jdin.2022.09.006

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

Angela L. Bosma (Lead / Corresponding author), Wouter Ouwerkerk, Madeline J. Heidema, David Prieto-Merino, Michael R. Ardern-Jones, Paula Beattie, Sara J. Brown, John R. Ingram, Alan D. Irvine, Graham Ogg, Prakash Patel, Nick J. Reynolds, R. M.Ross Hearn, Mandy Wan, Richard B. Warren, Richard T. Woolf, Ariënna M. Hyseni, Louise A.A. Gerbens, Phyllis I. Spuls, Carsten FlohrMaritza A. Middelkamp-Hup, ,

Biological Chemistry and Drug Discovery

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

Original language	English
Pages (from-to)	14-24
Number of pages	11
Journal	JAAD International
Volume	10
Early online date	10 Oct 2022
DOIs	https://doi.org/10.1016/j.jdin.2022.09.006
Publication status	Published - 1 Mar 2023

Keywords

atopic dermatitis
atopic eczema
ciclosporin
daily practice
dupilumab
effectiveness
ethnicity
methotrexate
morphology
race
registry
routine clinical care
safety
skin type
systemic treatment

ASJC Scopus subject areas

Dermatology

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Bosma, A. L., Ouwerkerk, W., Heidema, M. J., Prieto-Merino, D., Ardern-Jones, M. R., Beattie, P., Brown, S. J., Ingram, J. R., Irvine, A. D., Ogg, G., Patel, P., Reynolds, N. J., Hearn, R. M. R., Wan, M., Warren, R. B., Woolf, R. T., Hyseni, A. M., Gerbens, L. A. A., Spuls, P. I. (2023). 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. https://doi.org/10.1016/j.jdin.2022.09.006

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

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. Conclusion: Atopic dermatitis differs in several characteristics between LST and DST. Skin type may influence treatment effectiveness of dupilumab.",

keywords = "atopic dermatitis, atopic eczema, ciclosporin, daily practice, dupilumab, effectiveness, ethnicity, methotrexate, morphology, race, registry, routine clinical care, safety, skin type, systemic treatment",

author = "Bosma, {Angela L.} and Wouter Ouwerkerk and Heidema, {Madeline J.} and David Prieto-Merino and Ardern-Jones, {Michael R.} and Paula Beattie and Brown, {Sara J.} and Ingram, {John R.} and Irvine, {Alan D.} and Graham Ogg and Prakash Patel and Reynolds, {Nick J.} and Hearn, {R. M.Ross} and Mandy Wan and Warren, {Richard B.} and Woolf, {Richard T.} and Hyseni, {Ari{\"e}nna M.} and Gerbens, {Louise A.A.} and Spuls, {Phyllis I.} and Carsten Flohr and Middelkamp-Hup, {Maritza A.}",

note = "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 . Copyright: {\textcopyright} 2022 Published by Elsevier Inc on behalf of the American Academy of Dermatology, Inc.",

year = "2023",

month = mar,

day = "1",

doi = "10.1016/j.jdin.2022.09.006",

language = "English",

volume = "10",

pages = "14--24",

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Bosma, AL, Ouwerkerk, W, Heidema, MJ, Prieto-Merino, D, Ardern-Jones, MR, Beattie, P, Brown, SJ, Ingram, JR, Irvine, AD, Ogg, G, Patel, P, Reynolds, NJ, Hearn, RMR, Wan, M, Warren, RB, Woolf, RT, Hyseni, AM, Gerbens, LAA, Spuls, PI, Flohr, C, Middelkamp-Hup, MA 2023, 'Comparison of real-world treatment outcomes of systemic immunomodulating therapy in atopic dermatitis patients with dark and light skin types', JAAD International, vol. 10, pp. 14-24. https://doi.org/10.1016/j.jdin.2022.09.006

TY - JOUR

T1 - Comparison of real-world treatment outcomes of systemic immunomodulating therapy in atopic dermatitis patients with dark and light skin types

AU - Bosma, Angela L.

AU - Ouwerkerk, Wouter

AU - Heidema, Madeline J.

AU - Prieto-Merino, David

AU - Ardern-Jones, Michael R.

AU - Beattie, Paula

AU - Brown, Sara J.

AU - Ingram, John R.

AU - Irvine, Alan D.

AU - Ogg, Graham

AU - Patel, Prakash

AU - Reynolds, Nick J.

AU - Hearn, R. M.Ross

AU - Wan, Mandy

AU - Warren, Richard B.

AU - Woolf, Richard T.

AU - Hyseni, Ariënna M.

AU - Gerbens, Louise A.A.

AU - Spuls, Phyllis I.

AU - Flohr, Carsten

AU - Middelkamp-Hup, Maritza A.

N1 - 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 . Copyright: © 2022 Published by Elsevier Inc on behalf of the American Academy of Dermatology, Inc.

PY - 2023/3/1

Y1 - 2023/3/1

N2 - 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. Conclusion: Atopic dermatitis differs in several characteristics between LST and DST. Skin type may influence treatment effectiveness of dupilumab.

AB - 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. Conclusion: Atopic dermatitis differs in several characteristics between LST and DST. Skin type may influence treatment effectiveness of dupilumab.

KW - atopic dermatitis

KW - atopic eczema

KW - ciclosporin

KW - daily practice

KW - dupilumab

KW - effectiveness

KW - ethnicity

KW - methotrexate

KW - morphology

KW - race

KW - registry

KW - routine clinical care

KW - safety

KW - skin type

KW - systemic treatment

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U2 - 10.1016/j.jdin.2022.09.006

DO - 10.1016/j.jdin.2022.09.006

M3 - Article

C2 - 36387062

AN - SCOPUS:85141779007

VL - 10

SP - 14

EP - 24

JO - JAAD International

JF - JAAD International

ER -

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

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Keywords

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