Premium
Long‐term management of moderate‐to‐severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS): a critical appraisal
Author(s) -
Thomson J.,
Wernham A.G.H.,
Williams H.C.
Publication year - 2018
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.16520
Subject(s) - medicine , dupilumab , atopic dermatitis , adverse effect , placebo , dermatology , dosing , randomized controlled trial , concomitant , critical appraisal , alternative medicine , pathology
Summary Atopic dermatitis (AD) is a common, chronic inflammatory skin disorder. The mainstay of treatment is daily moisturiser and anti‐inflammatory cream, usually topical corticosteroid (TCS). Immune‐suppressive medicines, used in severe cases, can cause adverse effects (unwanted side effects). Last year a trial of a new immune‐suppressive treatment for AD called dupilumab was published in The Lancet . Here, dermatologists from Nottingham in the UK critically review that study. The industry‐sponsored research examined the long‐term efficacy and safety of dupilumab, a “biologic” medicine that selectively suppresses immune cells involved in AD. The randomised, double‐blinded, placebo‐controlled trial was carried out across 161 clinics internationally. Dupilumab 300mg was injected in adults with moderate to severe AD, weekly (319 patients) or fortnightly (106 patients), for 52 weeks All patients, including 315 given placebo, continued to use TCS as required. The researchers found that dupilumab + TCS was well tolerated (meaning patients were able to stay on the treatment) and improved AD more than TCS alone but was associated with more adverse effects (particularly conjunctivitis). No difference in efficacy was reported between weekly and fortnightly injections. This was generally a well‐conducted study, but the reviewers had some reservations. More participants were recruited than could be justified statistically: this suggests “seeding”, that is widespread testing to promote familiarity and confidence in the drug. The reviewers’ re‐analysis showed that fortnightly dosing was more effective than weekly, at half the cost. Most participants had moderate AD, but biologics are usually reserved for patients with severe disease. The comparison could have been with another systemic immune‐suppressant rather than placebo. These factors may bias conclusions in favour of the drug.