Curbing Itch Intensity, Frequency in Children With Severe Eczema

Dupilumab treatment with concomitant topical corticosteroids provided rapid and sustained improvement in itch intensity and frequency in children aged 6-11 years with severe atopic dermatitis.

Dr Gil Yosipovitch

The findings come from a post hoc analysis of a phase 3 trial known as LIBERTY AD PEDS (NCT03345914) that Gil Yosipovitch, MD, presented during a late-breaking research session at the Revolutionizing Atopic Dermatitis virtual symposium.

"Severe AD is complex, highly symptomatic, multidimensional condition characterized by an intense pruritus that negatively impacts a patient's life," said Yosipovitch, professor of dermatology and director of the Miami Itch Center at the University of Miami. Published data from the double-blind, placebo-controlled, 16-week, LIBERTY AD PEDS trial in children aged 6–11 years with severe AD showed that dupilumab significantly improved AD signs, symptoms, and quality of life, with an acceptable safety profile (J Am Acad Dermatol. 2020;21:119-31).

For the current analysis, Yosipovitch and colleagues evaluated the time to onset, magnitude, and sustainability of the effect of dupilumab on different measures of itch using data from approved Food and Drug Administration doses studied in the LIBERTY AD PEDS trial. A total of 243 children aged 6-11 years were randomized to dupilumab 300 mg every 4 weeks (300 mg q4w, baseline weight of less than 30 kg; 600-mg loading dose), 200 mg every 2 weeks (200 mg q2w, baseline weight 30 kg or greater; 400-mg loading dose), or placebo. All patients received concomitant medium-potency topical corticosteroids.

The mean age of patients was 8.4 years and those in the 300-mg q4w group were about 2 years younger than those in the 200-mg q2w group. On the Peak Pruritus Numerical Rating Scale (NRS), the researchers observed that treatment with dupilumab was associated with a significant improvement from baseline in daily worst itch score through day 22 in the 300-mg q4w group and the 200-mg q2w group, compared with placebo (–29% vs. –30%, respectively; P less than or equal to .001 and P less than or equal to .05). Treatment with dupilumab was also associated with a significant improvement from baseline in weekly average of daily worst itch score through week 16, compared with placebo (–55% vs. –58%; P less than or equal to .001). Similarly, a higher daily proportion of dupilumab-treated patients achieved a 2-point or more improvement in worst itch score, compared with placebo (51% vs. 49%; P less than or equal to .001 and P less than or equal to .05). The same association held true for the daily proportion of dupilumab-treated patients who achieved a 4-point or more improvement in worst itch score, compared with placebo (21% in both groups; P less than or equal to .05).

By week 16, a higher weekly proportion of dupilumab-treated patients achieved a 2-point or more improvement in worst itch score, compared with placebo (72% in the 300-mg q4w group vs. 74% in the 200-mg q2w group; P less than or equal to .001). The same association held true for the daily proportion of dupilumab-treated patients who achieved a 4-point or more improvement in worst itch score, compared with placebo (54% vs. 61%; P less than or equal to .001).

Next, the researchers evaluated the proportion of patients reporting the number of days with itchy skin over the previous 7 days as assessed from the Patient-Oriented Eczema Measure (POEM) itch item question: "Over the last week, on how many days has your child's skin been itchy because of their eczema?" By week 16, the majority of children treated with dupilumab achieved a reduction of days experiencing itch from every day at baseline to at most 2 days, with some improvement to zero days per week.

"Overall, in the LIBERTY AD PEDS trial, dupilumab was well tolerated and data were consistent with the known dupilumab safety profile observed in adults and adolescents," Yosipovitch said. "Injection site reactions and conjunctivitis were more common with dupilumab. Infections and AD exacerbations were more common with placebo."

The study was sponsored by Sanofi and Regeneron Pharmaceuticals. Yosipovitch and coauthors reporting having received financial grants and research grants from numerous pharmaceutical companies.

This article originally appeared on MDedge.com, part of the Medscape Professional Network.

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