Dupilumab Improves Skin Barrier Function, Reduces Staphylococcus Aureus in AD Patients

Lisa Beck, MD

A new investigation presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting (AAAAI) 2022 demonstrated that dupilumab improved skin barrier function and reduced staphylococcus aureus abundance in patients with atopic dermatitis.

The biologic is is responsible for inhibiting IL-4 and IL-13 biological actions in patients. However, it was unknown prior to the study if dupilumab treatment improved skin microbial and barrier abnormalities in patients with atopic dermatitis.

As such, investigators led by Lisa Beck, MD, University of Rochester, set out to determine the effect of dupilumab on the host-microbe interface of atopic dermatitis.

The Methods

Beck and colleagues utilized a multi-center, randomized, double-blind, placebo-controlled trial designed by the Atopic Dermatitis Research Network.

The trial included skin sampling to quantify microbial changes. Sampling was done at baseline and 3, 4, 14, 21, 28, and 42 days into the trial.

Investigators established the primary endpoint to be SA abundance (femA qPCR) on lesional skin at 28 days. Secondary endpoints included lesional SA abundance at remaining timepoints and non-lesional skin at all timepoints, skin barrier Transepidermal Water Loss (TEWL), and EASI, IGA, SCORing Atopic Dermatitis (SCORAD), and NRS scores.

The Findings

A total of 72 adults with moderate-to-severe atopic dermatitis were randomized 2:1 to dupilumab versus placebo.

Investigators observed that lesional staphylococcus aureus qPCR abundance was reduced in subjects treated with dupilumab by days (P50.019), but were more robustly reduced at 14,21,28, and 42 days, (P<_0.004).

This was replicated by culture quantification with reductions at 7,14, 21, 28, and 42 days (P<_0.006).

Additionally, reductions in SA were observed in nonlesional skin at 7 and 28 says (P<_0.03), and lesional TEWL was significantly reduced in patients treated with dupilumab at 3 and 42 days d (P<_0.03) and trended downward at 28d (P50.07).> <_0.03) before trending downward at 28 days. (P=0.07).

Beck and colleagues believed that the randomized populations were well matched, and the study provided the first demonstration that the biologic improved skin barrier function.

“The next steps will address whether reductions in SA or improvements in skin barrier are key determinants of disease improvement,” the team wrote.