Comparison of real-world treatment outcomes of systemic immunomodulating therapy in atopic dermatitis patients with dark and light skin types.
Bosma AL., Ouwerkerk W., Heidema MJ., Prieto-Merino D., Ardern-Jones MR., Beattie P., Brown SJ., Ingram JR., Irvine AD., Ogg G., Patel P., Reynolds NJ., Hearn RMR., Wan M., Warren RB., Woolf RT., Hyseni AM., Gerbens LAA., Spuls PI., Flohr C., Middelkamp-Hup MA., TREAT NL registry and UK-Irish A-STAR Study Groups None.
BackgroundFew data exist on differences in treatment effectiveness and safety in atopic dermatitis patients of different skin types.ObjectiveTo investigate treatment outcomes of dupilumab, methotrexate, and ciclosporin, and morphological phenotypes in atopic dermatitis patients, stratified by Fitzpatrick skin type.MethodsIn an observational prospective cohort study, pooling data from the Dutch TREAT (TREatment of ATopic eczema) NL (treatregister.nl) and UK-Irish A-STAR (Atopic eczema Systemic TherApy Register; astar-register.org) registries, data on morphological phenotypes and treatment outcomes were investigated.ResultsA total of 235 patients were included (light skin types [LST]: Fitzpatrick skin type 1-3, n = 156 [Ethnicity, White: 94.2%]; dark skin types [DST]: skin type 4-6, n = 68 [Black African/Afro-Caribbean: 25%, South-Asian: 26.5%, and Hispanics: 0%]). DST were younger (19.5 vs 29.0 years; P P P = .009), less allergic contact dermatitis (30.9% vs 47.4%; P = .03), and less previous phototherapy use (39.7% vs 59.0%; P = .008). When comparing DST and LST corrected for covariates including baseline EASI, DST showed greater mean EASI reduction between baseline and 6 months with only dupilumab (16.7 vs 9.7; adjusted P = .032). No differences were found for adverse events for any treatments (P > .05).LimitationsUnblinded, non-randomized.ConclusionAtopic dermatitis differs in several characteristics between LST and DST. Skin type may influence treatment effectiveness of dupilumab.