Optimal Itch Response in Adults Treated with Dupilumab for Moderate-to-Severe Atopic Dermatitis

Itch control is an important treatment goal for patients with atopic dermatitis (AD). According to the treat-to-target framework, optimal treatment goals in AD were defined for various disease domains (e.g., achievement of Eczema Area and Severity Index [EASI] ≤ 7, Peak Pruritus Numeric Rating Scale [PP-NRS] ≤ 4, and Dermatology Life Quality Index [DLQI] ≤ 5) to be achieved after 6 months and sustained thereafter. In this post hoc analysis of LIBERTY AD CHRONOS (NCT02260986), we report the proportion of patients achieving an optimal itch response with or without an optimal response in signs (EASI ≤ 7) and quality of life (DLQI ≤ 5), after 24 and 52 weeks of treatment with dupilumab. The majority of patients (69 of 90; 76.7%) had an optimal itch response at week 24 as measured by treat-to-target goal PP-NRS ≤ 4; this proportion was sustained at week 52 (64 of 79; 81.0%). Using SCORing Atopic Dermatitis (SCORAD) Pruritus Visual Analog Scale (VAS) < 4 as validation, the majority of patients (76/89; 85.4%) had an optimal itch response at week 24, and this proportion was also sustained at week 52 (69 of 79; 87.3%). Around 70% of patients with an optimal itch response according to PP-NRS or SCORAD Pruritus VAS also had optimal response in EASI and DLQI at weeks 24 and 52. Dupilumab provided optimal itch response and further optimal treatment response in signs and quality of life at week 24, sustained up to 52 weeks, in the majority of patients. Graphical Abstract available for this article. NCT02260986. Patients with atopic dermatitis (AD, or eczema) experience episodes of skin rash and intense itching that can severely impact their quality of life. Controlling itch is an important treatment goal. For moderate-to-severe AD, "treat-to-target" guidelines assist doctors and patients in assessing if a treatment is effective. These guidelines define treatment goals to be reached after 24 weeks of treatment ("optimal" disease-related scores). We analyzed data from 106 patients with moderate-to-severe AD treated with a medicine called dupilumab for 52 weeks and measured how many patients achieved the optimal itch score after 24 and 52 weeks of treatment. In patients with optimal itch response, we also checked if they achieved optimal scores for skin rash and quality of life. Before treatment, most patients experienced severe itch (73%). After 24 weeks of dupilumab treatment, 77% of patients achieved optimal itch response. This improved to 81% by week 52. The majority of patients (about 70%) with optimal itch response had also achieved optimal improvements in skin rash and quality of life. Importantly, among patients with severe itch before treatment, 72% achieved optimal itch response at week 24 and 80% at week 52, similar to the overall patient group. In conclusion, dupilumab treatment led to optimal itch response in most patients with moderate-to-severe AD, including those with severe itch at the start. These improvements were typically accompanied by optimal responses in skin appearance and quality of life.