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Dupilumab progressively improves systemic and cutaneous abnormalities in patients with atopic dermatitis

Open access
Guttman-Yassky, Emma, Bissonnette, Robert, Ungar, Benjamin, Suárez-Fariñas, Mayte, Ardeleanu, Marius, Esaki, Hitokazu, Suprun, Maria, Estrada, Yeriel, Xu, Hui, Peng, Xiangyu, Silverberg, Jonathan I., Menter, Alan, Krueger, James G., Zhang, Rick, Chaudhry, Usman, Swanson, Brian, Graham, Neil M.H., Pirozzi, Gianluca, Yancopoulos, George D., D. Hamilton, Jennifer D.·2019·Journal of Allergy and Clinical Immunology

Abstract

Background Dupilumab is an IL-4 receptor α mAb inhibiting signaling of IL-4 and IL-13, key drivers of type 2–driven inflammation, as demonstrated by its efficacy in patients with atopic/allergic diseases. Objective This placebo-controlled, double-blind trial (NCT01979016) evaluated the efficacy, safety, and effects of dupilumab on molecular/cellular lesional and nonlesional skin phenotypes and systemic type 2 biomarkers of patients with moderate-to-severe atopic dermatitis (AD). Methods Skin biopsy specimens and blood were evaluated from 54 patients randomized 1:1 to weekly subcutaneous doses of 200 mg of dupilumab or placebo for 16 weeks. Results Dupilumab (vs placebo) significantly improved clinical signs and symptoms of AD, was well tolerated, and progressively shifted the lesional transcriptome toward a nonlesional phenotype (weeks 4–16). Mean improvements in a meta-analysis–derived AD transcriptome (genes differentially expressed between lesional and nonlesional skin) were 68.8% and 110.8% with dupilumab and −10.5% and 55.0% with placebo (weeks 4 and 16, respectively; P < .001). Dupilumab significantly reduced expression of genes involved in type 2 inflammation ( IL13 , IL31 , CCL17 , CCL18 , and CCL26 ), epidermal hyperplasia (keratin 16 [K16] and MKi67 ), T cells, dendritic cells ( ICOS , CD11c , and CTLA4 ), and T H 17/T H 22 activity ( IL17A , IL-22 , and S100As ) and concurrently increased expression of epidermal differentiation, barrier, and lipid metabolism genes (filaggrin [FLG] , loricrin [LOR] , claudins, and ELOVL3 ). Dupilumab reduced lesional epidermal thickness versus placebo (week 4, P = .001; week 16, P = .0002). Improvements in clinical and histologic measures correlated significantly with modulation of gene expression. Dupilumab also significantly suppressed type 2 serum biomarkers, including CCL17, CCL18, periostin, and total and allergen-specific IgEs. Conclusion Dupilumab-mediated inhibition of IL-4/IL-13 signaling through IL-4 receptor α blockade significantly and progressively improved disease activity, suppressed cellular/molecular cutaneous markers of inflammation and systemic measures of type 2 inflammation, and reversed AD-associated epidermal abnormalities.

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Metadata

Authors
Guttman-Yassky, E., Bissonnette, R., Ungar, B., Suárez-Fariñas, M., Ardeleanu, M., Esaki, H., Suprun, M., Estrada, Y., Xu, H., Peng, X., Silverberg, J. I., Menter, A., Krueger, J. G., Zhang, R., Chaudhry, U., Swanson, B., Graham, N. M. H., Pirozzi, G., Yancopoulos, G. D., & D. Hamilton, J. D.
Venue
Journal of Allergy and Clinical Immunology
Publisher
Elsevier BV
Published
2019-01
Volume
143
Issue
1
Pages
155-172
ISSN
0091-6749 (ISSN-L)
OpenAlex
W2892288216
Cited by
697
References
16
FWCI
51.50
Type
journal article
Language
en
Open access
hybrid

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CoChat. (2026). Citation check: Dupilumab progressively improves systemic and cutaneous abnormalities in patients with atopic dermatitis. https://app.cochat.ai/papers/10.1016/j.jaci.2018.08.022
The paper
Guttman-Yassky, E., Bissonnette, R., Ungar, B., Suárez-Fariñas, M., Ardeleanu, M., Esaki, H., Suprun, M., Estrada, Y., Xu, H., Peng, X., Silverberg, J. I., Menter, A., Krueger, J. G., Zhang, R., Chaudhry, U., Swanson, B., Graham, N. M. H., Pirozzi, G., Yancopoulos, G. D., & D. Hamilton, J. D. (2019). Dupilumab progressively improves systemic and cutaneous abnormalities in patients with atopic dermatitis. Journal of Allergy and Clinical Immunology. https://doi.org/10.1016/j.jaci.2018.08.022

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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.