: Background: A shared definition of therapeutic targets in the treatment of atopic dermatitis (AD) allows for the identification of patients who respond rapidly (early responders [ERs]) and optimally (super responders [SRs]) to systemic treatments. A concomitant achievement of EASI75/≤7, PP-NRS ≤ 4, SCORAD-75/≤24, POEM ≤ 7, and DLQI ≤ 5 at 6 months of treatment has been defined as an ideal target for AD. Methods: Patients aged ≥ 12 years treated with dupilumab for moderate-to-severe AD in an Italian center for at least 2 years were analyzed. We defined ERs as those who achieved EASI ≤ 7, PP-NRS ≤ 4, POEM ≤ 7, and DLQI ≤ 5 within 32 weeks, and SRs and long responders (LRs) as those who maintained the target at 1 year and at 2 years, respectively. We subsequently compared baseline characteristics between those who fell within the above definitions and those who did not. Results: Of 171 patients with AD, 76.6% were ERs, 49.1% SRs, and 40.4% LRs. Achievement of combined outcomes was shown by 37.11% of patients at 16 weeks, and increased at the following time points by more than half of patients at 2 years of treatment. Except for a high baseline POEM that appears to be unfavorable for achieving early response (OR 0.93, CI 0.88-0.98, p = 0.006), no baseline characteristics were associated with ERs, SRs, or LRs in this population. Conclusions: According to our definition of responders, we were unable to identify a patient profile at baseline that predicts optimal therapeutic outcomes with dupilumab. Only baseline POEM seems to affect achievement of the selected outcomes. Dupilumab showed a rapid achievement of the outcomes with a stable response after 4 months of treatment, according our definitions. Shared definitions of the different categories of patient responders and a common therapeutic target are necessary for optimal management of AD.
Super Responders in Moderate-to-Severe Atopic Dermatitis Under Treatment with Dupilumab: An Explorative Real-World Study
Mastorino, Luca;Cavaliere, Giovanni;Siliquini, Niccolo;Ortoncelli, Michela;Quaglino, Pietro;Ribero, Simone
2025-01-01
Abstract
: Background: A shared definition of therapeutic targets in the treatment of atopic dermatitis (AD) allows for the identification of patients who respond rapidly (early responders [ERs]) and optimally (super responders [SRs]) to systemic treatments. A concomitant achievement of EASI75/≤7, PP-NRS ≤ 4, SCORAD-75/≤24, POEM ≤ 7, and DLQI ≤ 5 at 6 months of treatment has been defined as an ideal target for AD. Methods: Patients aged ≥ 12 years treated with dupilumab for moderate-to-severe AD in an Italian center for at least 2 years were analyzed. We defined ERs as those who achieved EASI ≤ 7, PP-NRS ≤ 4, POEM ≤ 7, and DLQI ≤ 5 within 32 weeks, and SRs and long responders (LRs) as those who maintained the target at 1 year and at 2 years, respectively. We subsequently compared baseline characteristics between those who fell within the above definitions and those who did not. Results: Of 171 patients with AD, 76.6% were ERs, 49.1% SRs, and 40.4% LRs. Achievement of combined outcomes was shown by 37.11% of patients at 16 weeks, and increased at the following time points by more than half of patients at 2 years of treatment. Except for a high baseline POEM that appears to be unfavorable for achieving early response (OR 0.93, CI 0.88-0.98, p = 0.006), no baseline characteristics were associated with ERs, SRs, or LRs in this population. Conclusions: According to our definition of responders, we were unable to identify a patient profile at baseline that predicts optimal therapeutic outcomes with dupilumab. Only baseline POEM seems to affect achievement of the selected outcomes. Dupilumab showed a rapid achievement of the outcomes with a stable response after 4 months of treatment, according our definitions. Shared definitions of the different categories of patient responders and a common therapeutic target are necessary for optimal management of AD.
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