D1.376 - Emerging inmunomodulatory agents for atopic dermatitis
Background
Therapeutic options for patients with moderate to severe atopic dermatitis, refractory to topical and systemic treatment, have expanded in recent years. Several studies indicate that the introduction of immunomodulatory drugs has demonstrated high efficacy and safety in their use. We present our experience.
Method
We performed a retrospective descriptive study on the use of immunomodulatory drug treatment in patients with moderate to severe atopic dermatitis at the Hospital Universitario de Burgos from 2014 to 2024.
Results
We included 53 patients, 28 were men and 25 women, with an average of 30.7 years, (range: 6–65). All had previously received topical and systemic corticosteroids with limited efficacy. The average initial scores were as follows: EASI 30.9; SCORAD 61; vIGA-AD 4.8; and BSA 41%. 92.45% had relevant allergic history.
A total of 23 patients (43.40%) were started on treatment with Omalizumab. Prior to this, 14 of these patients had been treated with cyclosporine and 6 with methotrexate. Subsequently, the treatment was modified to Dupilumab for 17 patients, while the rest were discontinued due to clinical remission.
Dupilumab was initiated de novo in 30 patients (56.6%), all after treatment failure with cyclosporine, and in 8 patients with methotrexate. Among the 47 patients who received Dupilumab, treatment was discontinued in three cases: one due to hypereosinophilia (10540 cells/mm³), another due to therapeutic failure that was replaced to Upadacitinib, and another after being diagnosed with mycosis fungoides.
At 16 weeks of treatment, 96% of patients achieved an EASI 75 response (average EASI 5,96) and a mean vIGA-AD score of 1.13. After 52 weeks of treatment, 43 patients reached an EASI 90 (average 1.59) and a mean vIGA-AD score of 0.5. The remaining patients have not yet completed one year of treatment.
Conclusion
Our findings demonstrate a significant improvement in the signs of AD that were observed in the measured scales, such as EASI and vIGA-AD, at 16 weeks, with further progress at 52 weeks of treatment. These results suggest that immunomodulatory treatments are both effective and safe in the long-term management of moderate to severe atopic dermatitis.
