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

Angela L Bosma; Wouter Ouwerkerk; Madeline J Heidema; David Prieto-Merino; Michael R Ardern-Jones; Paula Beattie; Sara J Brown; John R Ingram; Alan D Irvine; Graham Ogg; Prakash Patel; Nick J Reynolds; R M Ross Hearn; Mandy Wan; Richard B Warren; Richard T Woolf; Ariënna M Hyseni; Louise A A Gerbens; Phyllis I Spuls; Carsten Flohr; Maritza A Middelkamp-Hup; TREAT NL registry and UK-Irish A-STAR Study Groups

doi:10.1016/j.jdin.2022.09.006

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

JAAD Int. 2022 Oct 10:10:14-24. doi: 10.1016/j.jdin.2022.09.006. eCollection 2023 Mar.

Authors

Angela L Bosma¹, Wouter Ouwerkerk^{1

2}, Madeline J Heidema¹, David Prieto-Merino^{3

4}, Michael R Ardern-Jones^{5

6}, Paula Beattie⁷, Sara J Brown⁸, John R Ingram⁹, Alan D Irvine¹⁰, Graham Ogg¹¹, Prakash Patel⁴, Nick J Reynolds¹², R M Ross Hearn¹³, Mandy Wan^{14

15}, Richard B Warren¹⁶, Richard T Woolf¹⁷, Ariënna M Hyseni¹, Louise A A Gerbens¹, Phyllis I Spuls¹, Carsten Flohr⁴, Maritza A Middelkamp-Hup¹; TREAT NL registry and UK-Irish A-STAR Study Groups

Affiliations

¹ Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands.
² NHRIS, National Heart Centre Singapore, Singapore.
³ Faculty of Medicine, Universidad de Alcalá, Madrid, Spain.
⁴ Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King's College London, London, UK.
⁵ Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
⁶ Department of Dermatology, University Hospitals NHS Foundation Trust, Southampton, UK.
⁷ Department of Dermatology, Royal Hospital for Children NHS Trust, Glasgow, UK.
⁸ Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, UK.
⁹ Department of Dermatology, Division of Infection & Immunity, Cardiff University, Cardiff, UK.
¹⁰ Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland.
¹¹ MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK.
¹² Department of Dermatology, Institute of Cellular Medicine, Medical School, Newcastle University, Royal Victoria Infirmary and NIHR Newcastle Biomedical Research Centre Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
¹³ Department of Dermatology & Photobiology, Ninewells Hospital and Medical School, Dundee, UK.
¹⁴ Pharmacy Department, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
¹⁵ Institute of Pharmaceutical Science, King's College London, London, UK.
¹⁶ Dermatology Centre, Salford Royal NHS Foundation Trust, NIHR Manchester Biomedical 17 Research Centre, University of Manchester, Manchester, UK.
¹⁷ St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK.

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.

Keywords: AD, atopic dermatitis; AE, adverse event; DLQI, Dermatology Life Quality Index; DST, Dark Skin Type(s); EASI, Eczema Area and Severity Index; IQR, interquartile range; LST, Light Skin Type(s); NRS, Numerical Rating Scale; POEM, Patient-Oriented Eczema Measure; SD, Standard Deviation; atopic dermatitis; atopic eczema; ciclosporin; daily practice; dupilumab; effectiveness; ethnicity; methotrexate; morphology; race; registry; routine clinical care; safety; skin type; systemic treatment.

Abstract

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