The application of the biological treatment in atopic dermatitis: focus on dupilumab

Y.S. Smolkin 1,2,3, S.S. Masalskiy 1,3, O.Y. Smolkina 3

1 Association Pediatric Allergist and Immunologist Russia
2 Academy Postgraduate Education «Federal State Budget Founding Federal Research and Clinical Center of specialized types of health care and medical technology of the Federal Medical and Biological Agency», Department of Clinical Immunology and Allergology
3 «Scientific-Clinical Consultative Center of Allergology and Immunology», Ltd.

ALLERGOLOGY AND IMMUNOLOGY IN PEDIATRICS, Volume 61 • Number 2 • June 2020, pp. 27 – 40
DOI: 10.24411/2500-1175-2020-10005

Atopic dermatitis (AD) significantly reduces the quality of life of patients. Skin lesions, itching, and sleep dysfunction lead to impaired social adaptation and work performance.
Systemic immunosuppressants are used for the treatment of severe AD. The use of antihistamines and antileukotrienes in the monotherapy or the combination with topical steroids is not recommended and not effective for treatment AD. This group of medicine drugs applied in the cases of the сo-morbidity with allergic rhinitis, food allergy and asthma.
If it is necessary to use systemic drugs for the treatment of severe dermatitis, the appointment of biological therapy (anti-IL4Rα) is recommended from the 12 years. Dupilumab has a high-efficiency profile (LIBERTY and ADOL study): by 12–16 weeks in children, about 80% of patients have an EASI index halved, about half of patients report a decrease in EASI<75% of the initial values. Dupilumab in recommended doses-200 mg (≤60 kg; ≤18 years) or 300 mg 2 times a month relieves skin lesions, itching and significantly improves the quality of life of patients. Serological markers of allergic inflammation (IgE, periostin, chemokine CCL17) are reduced during treatment.
Clinical studies (CHRONOS) showed no serious side effects and a decrease in the frequency of skin infections and herpetic eczema when using dupilumab, but a slight increase in the frequency of non-severe respiratory diseases and conjunctivitis. Conjunctivitis was not the cause of drug withdrawal according to research data. When co-morbidity dermatitis and asthma, dupilumab reduces the number of exacerbations of both diseases.
Other monoclonal antibodies (omalizumab, reslizumab, mepolizumab, benralizumab) are not effective for therapy allergic eczema.
Cyclosporin at a dose of 2.5–5 mg/kg/day has comparable effectiveness with dupilumab in the 2 weeks of administration. Then cyclosporin’s results get worse. Systemic side effects limit the use of cyclosporine for more than 8 weeks. Oral steroids can be prescribed in a short course for severe exacerbations (0.5–1 mg/kg/day, ≈ 1 week). Dupilumab is the drug of choice for systemic treatment of dermatitis in patients ≥12 years. The long-term safety-effectiveness profile of dupilumab is better than any other systemic treatment. The drug is used for any phenotype of dermatitis, independently of the increase in serum IgE.

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Smolkin YS, Masalskiy SS, Smolkina OY. The application of the biological treatment in atopic dermatitis: focus on dupilumab. Allergology and Immunology in Pediatrics. 2020;61(2):27-40. (In Russ.)

For correspondense

Yury S. Smolkin, doctor of medical sciences, professor of Department of Clinical Immunology and Allergology Academy of postgraduate educational under FSBU FSCC of FMBA, vicepresident APAIR
ORCID ID: 0000-0001-7876-6258
Address: 6 Ostrovityanova Str., Moscow, 117513, Russia