Efficacy Of Dupilumab In The Treatment Of Moderate To Severe Atopic Dermatitis And Its Effect On Comorbidities

Objective:Epidemiological investigations have shown that patients with atopic dermatitis(AD)are often combined with one or more allergic diseases,which may be related to the fact that many allergic diseases such as AD,allergic rhinitis(AR),and asthma are united by a type 2 inflammatory cascade.Studies have confirmed the efficacy of dupilumab in the treatment of AD,but there are few studies on this drug for the treatment of co-morbidities in moderate to severe AD in China.This study aims to provide reference for the clinical treatment of AD with comorbidity by observing the curative effect of dupilumab on AD with comorbidity.Methods:Ninety-eight patients with moderate to severe AD treated with dupilumab who attended the outpatient clinic of the Department of Dermatology at the Second Hospital of Jilin University in July 2020 July 2022 were selected for the study.There were 36 patients with combined AR and 13 patients with combined asthma.The basic information and data of all the subjects were collected,and the scores of scoring atopic dermatitis index(SCORAD),eczema area and severity index(EASI)score,numeric rating scale(NRS)score,investigator’s global assessment(IGA)score,dermatology quality of life index(DLQI)score.,and changes in DLQI scores were observed in patients who discontinued or continued maintenance therapy after completing 16 weeks of treatment.The scores of rhinitis control assessment test(RCAT)in 36 patients with AR at 0,4,8,12 and 16 weeks and the scores of asthma control test(ACT)in 13 patients with asthma at 0,4,8,12 and 16 weeks were calculated.Adverse reactions during medication were recorded.Results:1.The rate of improvement in SCORAD from baseline at the treatment endpoint at week 16 was consistently higher,with a statistically significant difference of 73.4%improvement in SCORAD score from baseline values(P < 0.001).The number(percentage)of patients achieving EASI50(50% clearance of lesions),EASI75(75%clearance of lesions),and EASI90(90% clearance of lesions)at the treatment endpoint was 96(97.96%),63(64.29%),and 29(29.59%),with a statistically significant difference of 78.7% improvement in EASI score from baseline values(P<0.001).The number of patients who reached IGA0/1 at the end of treatment was 67(68.4%),itching was significantly relieved,NRS score continued to decrease,and NRS score at the end of treatment decreased by 72.9% compared with the baseline,with statistical significance(P<0.001).The quality of life was significantly improved,and the DLQI score at the end of treatment was improved by 69.2% compared with the baseline,with statistical significance(P < 0.001).Mild adverse reactions were found in 8 cases of injection site reactions,6 cases of conjunctivitis,and 2 cases of upper respiratory tract infection,which could resolve spontaneously and did not lead to termination of treatment.Purpura-like changes were found in one patient during treatment,and it was not determined whether they were associated with dupilumab.2.After 16 weeks of treatment,a total of 18 patients(18.4 %)discontinued and80 patients(81.6 %)continued regular medication.Taking the DLQI at the 16 th week of treatment as the baseline,the DLQI score at the 24 th week of withdrawal was slightly higher than the baseline in 15 patients with a withdrawal cycle of more than half a year(Z =-2.000,P = 0.046).The DLQI scores of 10 patients who discontinued the drug for more than 1 year were slightly higher than the baseline at the 48 th week(Z =-2.460,P = 0.014).In 71 patients(72.4 %)who continued treatment for more than half a year,the DLQI score at the 24 th week of treatment was lower than that at the baseline(Z = 6.712,P < 0.001).In 34 patients(34.7 %)who continued treatment for more than one year,the DLQI score at the 48 th week of treatment was significantly lower than that at the baseline(Z = 4.875,P < 0.001).3.After 16 weeks of treatment,the symptoms of 36 AD patients with AR were slightly relieved,and the RCAT score was continuously increased compared with the baseline(16 weeks vs.baseline : Z =-5.258,P < 0.001).Mild adverse reactions were found in 2 cases of injection site reaction,which could be relieved by themselves.4.After 16 weeks of treatment,the symptoms of 13 AD patients with allergic asthma were improved,and the ACT score continued to increase compared with the baseline(16 weeks vs.baseline : Z=-3.241,P < 0.001).One case of mild adverse reaction conjunctivitis was found,which could be relieved by itself.Conclusions:1.Dupilumab improves clinical symptoms and quality of life in patients with moderate to severe atopic dermatitis in the short term with a high safety profile,and long-term regular treatment can better control the recurrence of atopic dermatitis.2.16 weeks of treatment with dupilumab can only slightly improve allergic rhinitis complicated with moderate and severe atopic dermatitis,with high safety,and the curative effect of dupilumab on allergic rhinitis needs to be observed for a longer treatment period.3.16 weeks of treatment with dupilumab provides good clinical symptom control in allergic asthma and has a high safety profile,but further large sample studies are needed to confirm this.4.Atopic dermatitis has a high incidence of co-morbidities and should be treated as a systemic disease to further improve the treatment plan and better inhibit the development of the atopic process.