Atopic dermatitis, also known as eczema, is a disorder of the skin that causes intense itchy patches of skin that become inflamed, red, and cracked. The wounds can also exude a clear, sticky fluid. These itchy patches are much different than having an itch, often the urge to scratch the affected skin is uncontrollable and painful. The cause of eczema is unknown but it often is seen in children who also have atopy. Atopy is a word that describes the predisposition of someone to developing allergic or hypersensitivity reactions. Atopy covers conditions like asthma, food allergy, and eczema. Currently, eczema affects 31.6 million people in the US with 17.8 million of those people having severe eczema. Eczema is found in 10.7% of all children in the US and 1 in every 3 kids with eczema has the severe form of the disease. Currently the treatments include the use of moisturizers, topical steroids, modification of diet, and avoidance of wool, perfumes, and soaps. Unfortunately, in people with severe disease topical treatments have little effect and the use of oral steroids come with some serious side effects that limit them to only the most debilitating cases. However, there is hope as a new compound called dupilumab has shown promise in two phase 3 clinical trials.
The drug is an antibody that targets a receptor on the surface of the cells involved in inflammation, a key component in the development of atopy and eczema. Specifically, the receptor that is targeted binds two molecules important in inflammation, interleukin-4 (IL-4) and interleukin-13 (IL-13). These compounds are released by the immune system to fight invading microbes but in disease they act uncontrolled and are wildly increased. The drug stops IL-4 and IL-13 from attaching to the receptor, therefore stopping them from causing inflammation. In the clinical trials patients who were at least 18 years old, had severe eczema, and for whom topical treatments had already failed were recruited. There were a total of 671 patients enrolled in the first study and 708 enrolled in the second study. The researchers were interested in whether treatment with the drug would improve the severity of the eczema for the patients (make it less severe) and if it reduced the area affected by the eczema from the start of the study to the end. Patients received either placebo, injection of dupilumab once a week, or injection of dupilumab once every other week.
The results, published in the New England Journal of Medicine, showed that injection with dupilumab, either each week or on alternating weeks, reduced the severity of the eczema to the point where nearly 40% of the patients were free or almost free of eczema compared to the placebo where only 10% of the patients were free or almost free. Additionally, the drug reduced the severity of eczema by 75% in over half of the patients, the placebo only resulted 1 in every 10 patients improving. The treatment also significantly improved the quality of life of the participants (compared to placebo) and a reduction in depression and anxiety was also seen.
This is a huge step forward in helping those people who suffer from severe eczema. Eczema doesn’t only affect the skin; patients with severe disease will often suffer from depression, social isolation, and fear of exclusion because of the way their skin looks. This treatment promises to help improve the quality of their life.
Image Credit: Flickr sarahluv