Biologics safe and effective for young patients with AD

However, researchers say more work is needed to optimise the benefits of these treatments in children and adolescents.

New research supports the efficacy and safety of biologic therapies in improving outcomes for young patients with difficult-to-control atopic dermatitis.

But while the results for dupilumab, lebrikizumab and tralokinumab in the treatment of children and adolescents with AD are promising, the Brazilian researchers say further work is essential for validating these findings and optimising treatment strategies for this patient cohort.

The researchers said their meta-analysis represented the first comprehensive examination providing broader insights into the use of biological drugs in children and adolescents with AD.

Their findings were published this week in the Australasian Journal of Dermatology.

“These findings support the efficacy and safety of dupilumab, lebrikizumab, and tralokinumab in the treatment of children and adolescents with AD. However, further high-quality RCTs with longer-term follow-up are still warranted to substantiate their therapeutic benefits.”

A systematic search yielded a total of five studies encompassing 973 patients. Among the participants, 576 (59.1%) received dupilumab, 191 (19.6%) received tralokinumab and 206 (21.2%) received lebrikizumab.

Patients receiving biologic drugs had significantly greater improvements in disease severity compared to those on placebo. This was evident through:

• Investigator Global Assessment (IGA) Score: Odds Ratio (OR) of 5.05 for achieving an IGA score of 0 or 1; and
• Eczema Area and Severity Index (EASI): Significant improvements were observed with EASI 75 (OR 6.87), EASI 50 (OR 8.89), and EASI 90 (OR 8.30) indicating substantial reduction in eczema severity.

In relation to pruritus relief, patients reported a higher likelihood of achieving a 3-point or more (OR 6.56) and 4-point or more (OR 8.09) reduction in peak pruritus NRS, reflecting improved itch relief.

There was no significant difference in the incidence of adverse events between biologic drugs and placebo (OR 0.79), suggesting a comparable safety profile. There was a notable increase in conjunctivitis was observed in the biologic group (OR 2.08).

“Importantly, our analysis did not identify any statistically significant difference in the occurrence of conjunctivitis between treatment with dupilumab, tralokinumab or lebrikizumab and placebo,” the researchers wrote.

“This finding is consistent with a previous study involving our patient population, which also found no statistically significant difference in the incidence of conjunctivitis when comparing dupilumab, tralokinumab or lebrikizumab.

“Nonetheless, it is crucial to note that our meta-analysis revealed a slightly higher frequency of conjunctivitis in patients receiving biologic medications. This occurrence is likely attributed to the suppression of IL-4 and IL-13 signalling, leading to an increased number of Demodex, which subsequently triggers an IL-17-mediated rosacea-like inflammation.”

Australasian Journal of Dermatology 2024, online 5 August