Efficacy and safety of dupilumab in complex treatment of patients with severe atopic dermatitis

Abstract

The increased level of interleukins IL-4 and IL-13 in the area of skin lesions, which are secreted by type 2 T-helpers, eosinophils and other immunocompetent cells, plays a main role in the pathogenesis of AD according to modern concepts. The genetically engineered drug dupilumab selectively binds to the subunit of IL-4Rα receptor complexes for IL-4 and IL-13 and inhibits the signaling function of these cytokines. The drug is approved for the treatment of patients with moderate to severe AD who have indications for systemic therapy, regardless of the use of topical corticosteroids from 6 years age. The efficacy and safety of dupilumab in the treatment of patients with atopic dermatitis has been confirmed by the results of numerous clinical studies. Material and methods.The study included 11 patients with moderate and severe AD at the age from 18 to 48 years. All patients received systemic treatment with dupilumab, topically used methylprednisolone aceponate (two times a day for the first 4 weeks, then a calcineurin inhibitor two times a day until the end of the observation period), emollients (two times a day). The initial dose of dupilumab was 600 mg (two injections of 300 mg at different injection sites), then 300 mg every 2 weeks. Results. After 6 months of complex therapy 73 % of patients achieved IGA 0/1. The SCORAD index decreased by an average of 71.7 % after 6 months. The mean value of the NRS scale decreased by 63.2 %. There were no adverse events reported that would lead to drug withdrawal. Conjunctivitis was noted in 2 (18.2 %) patients. Conclusion. There was a marked decrease in the intensity of the main clinical symptoms (SCORAD), including pruritus (NRS), a significant decrease in the manifestations of anxiety and depression (PROMIS).