Dupilumab Leads to Complete Remission of Hand Eczema, Quality of Life Improvement

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Dupilumab is efficacious in treating chronic hand eczema, according to recent findings, with approximately 85% of patients achieving complete remission following a 3-year treatment period.¹

The existence of atopic dermatitis on a patient’s hands is linked to a lower quality of life, given the inflammatory skin condition's impact on one’s daily life and social connections. To assess dupilumab’s effectiveness in addressing this condition, new research was carried out by investigators such as Gabriele Perego, MD, from the department of pathophysiology and transplantation at the University of Milan.

“Hands are essential tools for daily activities, and the presence of (atopic dermatitis) in this area significantly impacts the patient's quality of life (QoL),” Perego and colleagues wrote. “Dupilumab, a monoclonal antibody targeting IL-4 and IL-13 signalling, is highly effective for treating (atopic dermatitis), although its specific efficacy on the hands has been minimally assessed in the literature.”^1,2

Background and Design

The investigators used a retrospective, single-study research design, conducting their work at a center and assessing 485 individuals known to have severe atopic dermatitis affecting the hands. Among those participating, 52.5% were noted as being male and the subjects’ average age by the initiation of treatment was 38 years, with ages ranging from 13 - 88.

Those who were suspected of having allergic contact dermatitis as well as atopic dermatitis were put through patch testing, and subjects with positive results were excluded from the team’s research. The included subjects received dupilumab as a medication, with the regimen involving the administration of a subcutaneous 600 mg loading dose and then 300 mg every 2 weeks.

The Eczema Area and Severity Index (EASI), Atopic Dermatitis Control Tool (ADCT), Pruritus Numerical Rating Scale (NRS), and the Dermatology Life Quality Index (DLQI) were all implemented for clinical evaluations by the investigators. They gathered the necessary data at baseline and then every 4 months throughout the study’s treatment period.

The research team defined a complete remission as a participant reporting an EASI score of 0 as well as a Pruritus NRS score of 0 during a follow-up interaction. However, they did this under the condition that the subjects had not utilized calcineurin inhibitors or used topical corticosteroids in the prior 4 month-timeframe.

Emollient creams were allowed by the team throughout their study period. The investigators used statistical analyses such as t-tests and Mann-Whitney U-tests when looking at differences of ADCT and DLQI scores. All of their analyses were 2-tailed with an alpha error set at 0.05, and findings in which a P-value of less than 0.05 were observed were decided to be statistically significant.

Major Findings on Dupilumab

Overall, after 4 months on the medication, it was determined that 62.7% of study participants successfully achieved complete remission in their hand eczema. This rate reached 76.5% after 1 year and then 85.6% following 3 years of therapy, indicating a rising rate of complete remission.

At the 4, 12, and 24-months points, the research team noted that non-responders were shown to have consistently higher DLQI and ADCT scores versus subjects who responded to treatment, though the exception was for DLQI scores compared by the 4-month mark.

In their conclusion, the investigators noted that data on hand eczema’s response to dupilumab had been largely scarce, highlighting that their research contributes to this literature.

“Prolonging treatment may benefit a subgroup of initially unresponsive patients, both in achieving (complete remission) and in transitioning from a persistent into an intermittent form,” they wrote. “This could suggest not discontinuing dupilumab prematurely in favour of alternative therapeutic agents.”¹

The findings of this study regarding chronic hand eczema treatment with dupilumab support the potential for hands as a site prone to therapeutic responses, despite their commonly-known identification as a difficult-to-treat region on the body.

References

1. ^{Perego, G., Aromolo, I.F., Barei, F., Zussino, M., Valtellini, L., Marzano, A.V. and Ferrucci, S.M. (2024), Special sites in atopic dermatitis: Effectiveness of dupilumab on the hands in a single-centre study on 485 patients. Australas J Dermatol. https://doi.org/10.1111/ajd.14372.}
2. ^{Simpson EL, Silverberg JI, Worm M, Honari G, Masuda K, Syguła E, et al. Dupilumab treatment improves signs, symptoms, quality of life, and work productivity in patients with atopic hand and foot dermatitis: results from a phase 3, randomized, double-blind, placebo-controlled trial. J Am Acad Dermatol. 2024; 90(6): 1190–1199. https://doi.org/10.1016/j.jaad.2023.12.066.}