Comparison of real-world treatment outcomes of systemic immunomodulating therapy in atopic dermatitis patients with dark and light skin types

Bosma, Angela L., Ouwerkerk, Wouter, Heidema, Madeline J., Prieto-Merino, David, Ardern-Jones, Michael R., Beattie, Paula, Brown, Sara J., Ingram, John ORCID: https://orcid.org/0000-0002-5257-1142, Irvine, Alan D., Ogg, Graham, Patel, Prakash, Reynolds, Nick J., Ross Hearn, R.M., Wan, Mandy, Warren, Richard B., Woolf, Richard T., Hyseni, Ariënna M., Gerbens, Louise A.A., Spuls, Phyllis I., Flohr, Carsten and Middelkamp-Hup, Maritza A. 2023. Comparison of real-world treatment outcomes of systemic immunomodulating therapy in atopic dermatitis patients with dark and light skin types. JAAD International 10 , pp. 14-24. 10.1016/j.jdin.2022.09.006

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Abstract

Background Few data exist on differences in treatment effectiveness and safety in atopic dermatitis patients of different skin types. Objective To investigate treatment outcomes of dupilumab, methotrexate, and ciclosporin, and morphological phenotypes in atopic dermatitis patients, stratified by Fitzpatrick skin type. Methods In an observational prospective cohort study, pooling data from the Dutch TREAT (TREatment of ATopic eczema) NL (treatregister.nl) and UK-Irish A-STAR (Atopic eczema Systemic TherApy Register; astar-register.org) registries, data on morphological phenotypes and treatment outcomes were investigated. Results A total of 235 patients were included (light skin types [LST]: Fitzpatrick skin type 1-3, n = 156 [Ethnicity, White: 94.2%]; dark skin types [DST]: skin type 4-6, n = 68 [Black African/Afro-Caribbean: 25%, South-Asian: 26.5%, and Hispanics: 0%]). DST were younger (19.5 vs 29.0 years; P < .001), more often had follicular eczema (22.1% vs 2.6%; P < .001), higher baseline Eczema Area and Severity Index (EASI) scores (20.1 vs 14.9; P = .009), less allergic contact dermatitis (30.9% vs 47.4%; P = .03), and less previous phototherapy use (39.7% vs 59.0%; P = .008). When comparing DST and LST corrected for covariates including baseline EASI, DST showed greater mean EASI reduction between baseline and 6 months with only dupilumab (16.7 vs 9.7; adjusted P = .032). No differences were found for adverse events for any treatments (P > .05). Limitations Unblinded, non-randomized. Conclusion Atopic dermatitis differs in several characteristics between LST and DST. Skin type may influence treatment effectiveness of dupilumab.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
ISSN:	0190-9622
Date of First Compliant Deposit:	7 November 2022
Date of Acceptance:	18 September 2022
Last Modified:	08 May 2023 01:49
URI:	https://orca.cardiff.ac.uk/id/eprint/154020

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