Treatment with dupilumab results in significant improvements in the signs and symptoms of moderate-to-severe atopic dermatitis (AD) in adult Asian patients without any serious adverse effects, a Singapore study has shown.
“However, the extent of improvement was considerably lower than that reported in other Asian clinical cohorts,” the researchers said. “Eye symptoms and head and neck dermatitis also featured more prominently in our patients.”
The study included a retrospective cohort of 51 patients with moderate-to-severe AD (mean age 36.5 years, 80.4 percent Chinese) who received dupilumab at a tertiary skin institute from January 2018 to February 2020. Of these, 43 (84.3 percent) had classic AD with disease onset in childhood, and eight (15.7 percent) had adult-onset AD exacerbation. [Singapore Med J 2026;67:302-308]
The research team analysed the following outcome measures at baseline and after 16 weeks of treatment: Scoring Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI), and Dermatology Quality of Life Index (DLQI). They also measured laboratory tests at the respective time points.
Patients treated with dupilumab had consistent decreases in the involved body surface area (BSA), as well as reduced SCORAD, EASI, and DLQI score.
Of the patients, 85.4 percent showed improvements in BSA, 89.7 percent in SCORAD, 87.0 percent in EASI, and 75 percent in DLQI scores at 1 month. At 4 months, the corresponding proportion of patients who had score improvements was 93.5 percent, 92.3 percent, 94.7 percent, and 100 percent.
At the same time, patients showed a downward trend in serum immunoglobulin E (IgE) and absolute eosinophil count at 4 months of dupilumab treatment. A transient increase in mean serum IgE was observed at 1 month of treatment.
With regard to safety, 42.0 percent of patients developed eye symptoms, while 35.3 percent developed head and neck dermatitis. However, no severe adverse events occurred. Notably, childhood-onset AD was more likely to show improvements in BSA scores than adult-onset AD.
“Our study confirms the efficacy of dupilumab with real-world data in an adult Asian population,” the researchers said. “Higher proportions of eye symptoms, and head and neck dermatitis were observed in our cohort compared to other Asian clinical cohort studies.”
Asian studies
The extent of improvement observed in this study is considerably lower than that seen in other Asian studies. For instance, the finding on EASI-75 was much lower than that of the original SOLO trial and a recent Chinese study (31.6 percent vs 51.0 percent and 64.5 percent). [N Engl J Med 2016;375:2335-2348; J Eur Acad Dermatol Venereol 2022;36:1064-1073; Indian J Dermatol 2021;66:297-301]
“Many external confounding factors in the real-world setting, such as treatment compliance of topicals and emollients, environmental factors, and types of AD, could have affected its treatment efficacy,” the researchers said. “We observed that patients who had previously tried azathioprine, a third-line oral immunosuppressant for AD, were less likely to have clinical improvement.”
Furthermore, regarding adverse events, more dupilumab-treated patients developed eye symptoms in the current study than those in previous clinical trials and other studies. Only one study in Japan reported a similar rate. [Br J Dermatol 2019;181:1083-1085; J Clin Med 2020;9:1982; Br J Dermatol 2019;181:459-473]
Likewise, the proportion of patients with head and neck dermatitis in the current study was higher than that observed among European adults in previous studies. [Br J Dermatol 2020;183:745-749; JAMA Dermatol 2019;155:1312-1315]
“Further clinical investigations with a larger study population may be necessary to elucidate the associations and findings reported,” the researchers said.