AJMC Staff

, conducted in Singapore, looked the efficacy and safety of dupilumab in a group of Asian children and adolescents with moderate‐to‐severe 

Poorly controlled AD, a recurrent inflammatory skin disease, can lead to reduced quality of life (QoL) and psychosocial issues. Dupilumab is the first approved biologic targeting type 2 inflammation, for adolescent and adult patients with moderate‐to‐severe AD.

A total of 12 patients were recruited, with 9 adolescents (>12 years) and 3 children (≤12 years). Ten were male patients (78%) and 2 were female patients. The mean duration of treatment was 9.2 months (range 3‐21 months).

Previous treatments included azathioprine (3 patients), cyclosporine (7 patients), methotrexate (5 patients) and mycophenolate mofetil (1 patient); 9 had phototherapy.

The mean duration of AD before starting dupilumab was 9.8 years; patients’ mean age was 13.3 years when they started the therapy.

Comorbidities included 8 (67%) with allergic rhinitis; 3 (25%) with asthma; 3 patients (25%) with allergic conjunctivitis; 1 patient (8%) with retinal detachment; 1 patient (8%) with raised intraocular pressure; 1 patient (8%) with depression; and 2 patients (17%) with attention deficit hyperactivity disorder.

Three patients had serious complications related to chronic AD and/or long‐term use of topical corticosteroids. Two (17%) had adrenal suppression that required long‐term physiological oral hydrocortisone replacement and 1 patient (8%) had growth failure and pubertal delay as a result of chronic poorly‐controlled AD.

Response to dupliumab was documented with investigator global assessment (IGA) and eczema area and severity index (EASI) scores. Improvement in QoL was assessed using child dermatology life quality index (CDLQI) or teenager's quality of life (T‐QoL). Caregivers' QoL was assessed using dermatitis family impact (DFI) questionnaire.

At baseline, the mean IGA score was 4 and the mean EASI was 48.2. The mean T‐QoL and DFI scores at baseline were 18.7 and 19.6, respectively.

Mean EASI fell to 19.3 with mean reduction of 28.9

Mean T‐QoL fell to 7.5 with mean reduction of 11.2

Mean DFI decreased to 8.6 with mean reduction of 11.

Adverse events included mild conjunctivitis in 2 patients and paradoxical head and neck erythema in 1 patient.

The authors said the study “supports dupilumab as an effective and safe treatment option for Asian children and adolescents with moderate‐to‐severe AD.”

Chia SY, Wee LWY, Koh MJA. Dupilumab for children and adolescents with atopic dermatitis: An Asian perspective.

Articles

Patients had atopic dermatitis for nearly 10 years before starting the biologic therapy.

Retrospective Study Examines Dupilumab Performance in Asian Youth Population

A recent case study describes a situation where a female patient was diagnosed with other conditions for about a year before specialists diagnosed her with 

 (PsA); the authors said they wrote the case to show how PsA can mimic other conditions.

If left untreated, patients with PsA are at risk of irreversible joint damage, cardiovascular disease, and death. Some other conditions conflated with PsA include chronic eczema, seborrheic dermatitis, onychomycosis, lichen planus, and nodular prurigo.

In this situation, the patient, age 50, had noticed some of her fingers had become deformed a year earlier, without pain; general practitioners had diagnosed her as having hand osteoarthritis. In addition, she had noticed multiple pruritic skin rashes over both ankles and knees and was also diagnosed with lichen planus; treatment with topical agents were ineffective.

By the time she saw specialists, she had severe pain, early-morning stiffness and swelling over the joints of her left ring and little fingers.

Physical examination revealed a fixed flexion deformity, swelling and tenderness of the left ring and little fingers’ distal interphalangeal (DIP) joints; a left hand radiograph showed sclerotic joint margin, narrowed joint space, and marginal osteophytes of the affected DIP joints.

A dermoscopic examination showed red-violaceous, flat-topped papules and plaques with minimal scales on both ankles; both knees and vertical fingernail ridges had hyperpigmented scaly plaques.

While serum autoimmune screening and inflammatory markers were unremarkable, a left ankle skin biopsy showed features consistent with psoriasis. Specifically, it showed “parakeratosis at the surface of the epidermis with elongation of the rete ridges; spongiosis of the epidermal layer and small capillaries proliferation seen in the papillary dermis with surrounding mixture of inflammatory cells, predominantly lymphocytes,” 

PsA was diagnosed. The patient began a weekly oral methotrexate 7.5 mg titrated up to 15 mg with folic acid supplement and topical betamethasone valerate cream 0.5%. She showed significant improvement after 1 month.

The authors said the case “highlights the importance of distinguishing psoriasis from other skin disorders especially lichen planus.” They also said that while both share common features, reports of both coexisting are rare.

Anne LJ, Rahim MJC, Ghazali WSW, et al. More than meets the naked eye: an unusual psoriatic arthritis mimicry and the important role of dermoscopic examination. 

 . Published online April 12, 2021. doi: 10.1186/s41927-021-00182-7

If left untreated, patients with psoriatic arthritis (PsA) are at risk of irreversible joint damage, cardiovascular disease, and death. Some other conditions conflated with PsA include chronic eczema, seborrheic dermatitis, onychomycosis, lichen planus, and nodular prurigo.



Case Study Describes Importance of Distinguishing PsA From Other Disorders

Information on the risk of death from COVID-19 in individuals with 

from the United Kingdom sought to examine whether gout and RA are risk factors for COVID-19 diagnosis or death.

Researchers used data from for UK Biobank, which contains the records of about half a million participants; recruitment began in 2006 with planned follow-up for at least 30 years. The analysis included those who had a positive SARS-CoV2 test result and/or an 

International Classification of Diseases, Tenth Revision

 code for confirmed COVID-19 or probable COVID-19 as well as a variety of methods to determine RA or gout: self-reported gout, hospital codes for gout, self-reported RA, hospital codes for RA, and hospital records of either illness.

They created and analyzed 3 case-controlled datasets:

Analysis A tested for association with COVID‐19 diagnosis in a population‐based cohort, consisting of 2118 case patients and 471,021 controls

Analysis B tested for association with death from COVID‐19 in people with COVID‐19, consisting of 457 people diagnosed with COVID‐19 who died and 1602 people diagnosed with COVID‐19 who survived

Analysis C tested for association with death related to COVID‐19 in a population‐based cohort, consisting of 457 people diagnosed with COVID‐19 who died and 472,682 others, including 1616 people diagnosed with COVID‐19 not known to have died

Multivariable-adjusted analysis showed that RA, but not gout, was associated with COVID‐19 diagnosis in analysis A.

Neither RA nor gout was associated with risk of death in the group diagnosed with COVID‐19 in analysis B.

However, in analysis C, RA was associated with risk of death related to COVID‐19, independent of comorbidities and other measured risk factors (OR, 1.9; 95% CI, 1.2–3.0). Gout was not associated with death related to COVID‐19 in the same UK Biobank analysis (OR 1.2; 95% CI, 0.8–1.7).

The study had a number of limitations, which the researchers hope could be overcome in future, larger studies. For one thing, the influence of RA therapies was not known. In addition UK Biobank registrants are middle-aged, white Europeans and so can't be generalized to other ethnic groups or in individuals younger than 50. There is also no information on recovery status, so it is possible that the cohort in analysis B may have had unidentified COVID-19 deaths later.

Topless RK, Phipps-Green A, Leask M, et al. Gout, rheumatoid arthritis, and the risk of death related to coronavirus disease 2019: An analysis of the UK Biobank. 

 Published online April 15, 2021. doi: 10.1002/acr2.11252.

Researchers did not find an association in people who had gout. 

UK Biobank Study Finds Elevated Risk of Death From COVID-19 in Those With RA 

 referenced an article published on AJMC.com, the website of 

Cancer Care Delays in COVID-19 Could Lead to Higher Morbidity, Mortality

,” indicated that screening and treatments for breast, colon, prostate, and lung cancers saw sharp declines in 2020 due to the COVID-19 pandemic, with oncology care delivery yet to fully rebound.

 cited a contributor article posted on AJMC.com titled “

.” The article spotlighted the insulin crisis, which in recent years has seen prices for a 1-month supply of insulin grow markedly, with one brand increasing its price by 1200% in the last 25 years.

 referenced a piece on AJMC.com covering the pandemic. “

A Timeline of COVID-19 Developments in 2020

” took a look back at how the pandemic evolved and progressed through 2020, which closed with the arrival of vaccines but also continued challenges.

 cited a contributor article published on AJMC.com titled “

Telehealth Claim Lines Rise 2980% in One-Year Period Through September 2020

.” The article tracked telehealth service claims over the past year, finding that from September 2019 to September 2020, claims rose from 0.16% to 5.07%.

Coverage of our peer-reviewed research and news reporting in the health care and mainstream press.

AJMC Staff

Articles

Retrospective Study Examines Dupilumab Performance in Asian Youth Population

Case Study Describes Importance of Distinguishing PsA From Other Disorders

UK Biobank Study Finds Elevated Risk of Death From COVID-19 in Those With RA

AJMC® in the Press, April 16, 2021