Transition de Otros a Dupi

Journal Scan / Commentary · October 29, 2020

Transitioning From Systemic Immunosuppressants to Dupilumab

Journal of the European Academy of Dermatology and Venereology: JEADV

TAKE-HOME MESSAGE

• The authors propose a practical treatment approach for transitioning patients with severe AD from immunosuppressants to dupilumab based on their experience with such patients (n = 88).

• In summary, patients are started on dupilumab and continued on their current regimen of immunosuppressant for 8 weeks. If disease is controlled, after 8 weeks, immunosuppressants other than cyclosporine (ie, azathioprine, mycophenolate, methotrexate, etc.) can be tapered by 50% every 4 weeks, with the earliest discontinuation after 12 weeks of dupilumab therapy. Cyclosporine may be reduced by 25% every 2 weeks with earliest discontinuation at 14 weeks of dupilumab therapy in order to prevent a rebound phenomenon. Topical treatments should also be optimized.

– Margaret Hammond, MD

Abstract

Atopic dermatitis (AD) is a complex and heterogeneous chronic inflammatory skin disease. A subset of patients requires systemic immunosuppressants including cyclosporine A (CsA), azathioprine (AZA), mycophenolate mofetil (MMF)/ mycophenolic acid (MPA) and methotrexate (MTX). Dupilumab is the first biologic for treatment of AD, mostly started in patients with insufficient effectiveness or side effects of systemic immunosuppressants. In daily practice, approximately 65% of patients are still using systemic immunosuppressants when starting dupilumab. Although a significant reduction in itch can be present by week 2, clinically relevant AD improvement continues until at least 8–12 weeks of dupilumab treatment. Additionally, abrupt discontinuation of systemic immunosuppressants is unpreferable due to a possible rebound phenomenon. We found that tapering the immunosuppressants after the start of dupilumab results in a seamless transition between therapies. In our patients (n = 88), we did not find side effects resulting from this combination treatment.

Journal of the European Academy of Dermatology and Venereology: JEADV

An Approach for the Transition From Systemic Immunosuppressants to Dupilumab

J Eur Acad Dermatol Venereol 2020 Sep 13;[EPub Ahead of Print], LEM de Wijs, JP Thyssen, C Vestergaard, HB Thio, ACM Kunkeler, T Biedermann, DJ Hijnen