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Understanding Dupilumab Treatment Response in Atopic Dermatitis


Dr Andrew Blauvelt discusses the relevance of dupilumab treatment response as seen in the LIBERTY AD OLE and LIBERTY AD CHRONOS studies and shares his approaches to improving atopic dermatitis management.

Andrew Blauvelt, MD, MBA: When we have atopic dermatitis [AD] data published, the most important publications are the initial ones reporting the primary end point data. That gives us the bulk of the information we need about new drugs. What happens, though, is that the data sets are so rich. There are so many pieces of information, and the trials often go on for many years. As the trials go on, we start to do subanalyses. All of us in dermatology are used to seeing the main initial papers, and they’re usually in famous journals, like the New England Journal of Medicine or The Lancet. Those are great, and you really need to know those papers. But then you have subsequent subanalyses like what was just published with dupilumab. For me, the usefulness there are nuggets of information—not the main information, but fine-tuning our knowledge about the drugs a little more. You can become an expert with the drug or with treatment of AD if you pay attention to the subanalysis papers. That’s what I would recommend with these 2 new pieces of data for dupilumab, which is that they offer nuggets of information that should help your care of patients on dupilumab. To summarize, the first piece is that after 4 months of dupilumab therapy, if there’s not a horrific response and there’s no compelling reason to switch therapy or a big move for that, if you continue dupilumab beyond 4 months, then you can expect continued improvement over the next several years. That’s the first piece of new information from this new study.

The second piece of new information is this whole topic about facial erythema with dupilumab. What is it? How do we treat it? How often is it? We just published that over 1 year with topical steroids in dupilumab, you see improvement in all body areas, including the head and neck. The small piece of information is that the head and neck didn’t do as well as other body areas, and that may reflect individuals having persistent facial erythema. That’s a more complex topic. We didn’t specifically study persistent facial erythema, but if you have that as an adverse effect in your patients, then you should first think of it as residual atopic dermatitis and treat it. That’s my recommendation from common experience with this type of issue. Sometimes it’s something else. Sometimes it’s contact dermatitis, and you need to do a good history for that. Sometimes it’s rosacea. Sometimes it’s a photosensitivity. Other things can be going on with facial erythema, but don’t forget about it possibly being residual atopic dermatitis that you need to be a little more aggressive in treating.

Transcript Edited for Clarity

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