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, ,

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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 languageEnglish
Pages (from-to)14-24
Number of pages11
JournalJAAD International
Volume10
Early online date10 Oct 2022
DOIs
Publication statusE-pub ahead of print - 10 Oct 2022

Keywords

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

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