Effect of dupilumab on hand eczema in patients with atopic dermatitis: An observational study

• Published in: Journal of dermatology Vol. 46; no. 8; pp. 680 - 685
• Main Authors: Oosterhaven, Jart A.F., Voorberg, Angelique N., Romeijn, Geertruida L.E., de Bruin‐Weller, Marjolein S., Schuttelaar, Marie L.A.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.08.2019; John Wiley and Sons Inc
• Subjects: Adult; Aged; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal, Humanized; Atopic dermatitis; biological; Chronic Disease - drug therapy; Dermatitis; Dermatitis, Atopic - complications; Dermatitis, Atopic - drug therapy; Double-Blind Method; Drug Administration Schedule; Drug therapy; dupilumab; Eczema; Eczema - complications; Eczema - diagnostic imaging; Eczema - drug therapy; Eczema - immunology; Female; Hand; hand eczema; Humans; Immunotherapy; Injections, Subcutaneous; Interleukin-4 Receptor alpha Subunit - antagonists & inhibitors; Interleukin-4 Receptor alpha Subunit - immunology; Male; Middle Aged; Monoclonal antibodies; Observational studies; Original; Patient Reported Outcome Measures; Patients; Photography; Prospective Studies; Quality of Life; Recurrence; Severity of Illness Index; treatment; Treatment Outcome; Young Adult; hand eczema; treatment; atopic dermatitis; biological; dupilumab
• ISSN: 0385-2407; 1346-8138; 1346-8138
• DOI: 10.1111/1346-8138.14982

Systemic treatment options for chronic hand eczema are limited. Dupilumab is used in atopic dermatitis (AD) but is not licensed for (isolated) hand eczema. In this observational prospective study we aimed to determine the response of hand eczema to dupilumab in patients with AD. Adult patients with hand eczema and AD received dupilumab s.c. at a 600 mg loading dose, followed by 300 mg every 2 weeks. Primary outcome was a minimum improvement of 75% on the Hand Eczema Severity Index after 16 weeks (HECSI‐75). Secondary outcomes were severity, measured using the Photographic guide; quality of life improvement as patient‐reported outcome, measured using the Dermatology Life Quality Index (DLQI); and AD severity, measured using the Eczema Area and Severity Index (EASI). Forty‐seven patients were included (32 males; mean age, 45 years). HECSI‐75 was achieved by 28 (60%). Mean HECSI score reduction was 49.2 points (range, 0–164; 95% within‐subject confidence interval, 46.4–52.0), which was already significantly decreased after 4 weeks (P < 0.001). DLQI score mean improvement was 8.8 points (standard deviation [SD], 6.0) or 70.0% decrease (SD, 26.4) (P < 0.001). Eighteen patients (38%) were classified as responders on the Photographic guide. There was no difference in response between chronic fissured and recurrent vesicular clinical subtypes. Similar percentages of patients achieving EASI‐75 and HECSI‐75 were seen after 16 weeks. In conclusion, this study shows a favorable response of hand eczema to dupilumab in patients with AD. This raises the question whether a response will also be seen in isolated hand eczema.