Dupilumab Treatment Improved Epidermal Neuroanatomy in Patients With Atopic Dermatitis

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A recent study, DIFFERENSTAD (NCT04823130), explored the effects of dupilumab treatment on epidermal neuroanatomy.

Results of the study were presented in a poster at the 2023 Revolutionizing Atopic Dermatitis (RAD) Virtual Conference on December 10. Investigators had sought to explore the role of treatment with dupilumab and its potential effects on epidermal neuroanatomy. They sought to explore this role by first quantifying intraepidermal nerve fiber density (IENFD).

The open-label, exploratory study enrolled individuals aged 18 and above with moderate-to-severe atopic dermatitis (AD), enduring pruritus for over 6 weeks, and a Worst Itch Numerical Rating Scale (WI-NRS) score of ≥ 4, alongside matched healthy controls.

Patients with AD were administered dupilumab 300 mg every 2 weeks for 16 weeks. Skin biopsies were taken from patients' lesional skin at baseline and matched skin at week 17 (end of treatment) along with healthy controls. The primary endpoint was IENFD, defined as the number of nerve fibers crossing the basement membrane per millimeter.

The study included 31 patients with moderate-to-severe AD and 10 matched controls. The results demonstrated a significant increase in IENFD in patients with AD from baseline to end of treatment (mean: 7.7 [1.3] at baseline vs. 12.1 [2.0] at end of treatment, reaching levels comparable to the control group (mean: 12.4 [2.3]; P for control group vs. end of treatment in patients with AD = 0.9374).

Dupilumab treatment also showed significant improvements in clinical signs, as evidenced by the mean Eczema Area and Severity Index (EASI) total score, and pruritus symptoms measured by WI-NRS.

Both showed a substantial reduction from baseline to end of treatment (EASI: 22.5 [1.5] to 5.1 [1.1], WI-NRS: 8.5 [0.3] to 3.1 [0.5]), with P < 0.0001 for both changes from baseline.

Reported safety signals of dupilumab were consistent with the drug's known safety profile, according to the study.

"Dupilumab treatment significantly increased IENFD to levels similar to those of healthy subjects, suggesting restored neuroanatomy in patients with moderate-to-severe AD," study authors wrote. "Dupilumab also significantly improved clinical signs and pruritus symptoms of AD."

Reference

Ständer S, Agelopoulos K, Nattkemper L, et al. Dupilumab Treatment Normalizes Intraepidermal Nerve Fiber Density in Patients with Moderate- to-Severe AD. Poster presented at: 2023 Revolutionizing Atopic Dermatitis (RAD) Virtual Conference; December 10, 2023.