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The effectiveness and safety profile of Dupilumab in elderly atopic dermatitis patients are similar to those in young patients.
In a meta-analysis, Dupilumab was comparably effective and safe in both older and younger patients battling atopic dermatitis. S S Wang et al. aimed to systematically gauge the safety and effectiveness of novel systemic treatments, including biological agents and Janus kinase (JAK) inhibitors, in elderly individuals with moderate-to-severe atopic dermatitis.
To find relevant literature on the treatment of atopic dermatitis with new systemic therapies, a comprehensive search was conducted across various databases, including VIrus Protein (VIP) domain, Wanfang, China National Knowledge Infrastructure (CNKI), ClinicalTrials.gov, the Global Resource of Eczema Trials database, Cochrane, Web of Science, PubMed, and Embase. Randomized controlled trials (RCTs) and real-world studies were the focus of the search.
Two investigators independently conducted the literature screening, data extraction, and assessment of the studies' risk of bias. With the utilization of Review Manager 5.3 software, analysis of data was performed for conducting meta-analyses. The effect statistics were demonstrated as odds ratios (OR) along with corresponding 95% confidence intervals. Furthermore, heterogeneity along with the presence of publication bias in the chosen studies was explored.
The meta-analysis included 5 studies, involving 523 elderly subjects and 802 young subjects, all of whom were treated with Dupilumab. The findings indicated that Dupilumab (monoclonal antibody) demonstrated significant effectiveness in elderly individuals with atopic dermatitis. Specifically, 74.6% (390 out of 523) of elderly patients achieved an Eczema Area and Severity Index (EASI) score reduction of 75%, which was comparable to the outcomes observed in young patients (OR=0.79).
Furthermore, 68.7% (244 out of 355) of elderly patients experienced a substantial improvement in the numeric rating scale (NRS) score (≥4), with no clinically meaningful difference when compared to the younger patient group (OR=0.79). The most frequently reported adverse reactions in both groups included injection site reactions, facial and neck erythema, as well as conjunctivitis, with no occurrence of severe adverse events in either group.
The occurrence of adverse events in elderly subjects was 24.3% (65 out of 267), and this did not significantly differ from the rate observed in young patients (OR=1.07). It's worth noting that there is limited research on the use of other biological agents and JAK inhibitors in elderly atopic dermatitis patients. Only four studies involving elderly atopic dermatitis volunteers treated with JAK inhibitors were identified, comprising two studies on Abrocitinib and two on Upadacitinib.
The clinical effectiveness of Abrocitinib in elderly patients did not vary much from that noted in younger patients. However, it's essential to mention that the prevalence of severe adverse events was elevated in the elderly population and was related to the dosage of both Abrocitinib and Upadacitinib. The effectiveness and safety of Dupilumab in elderly individuals with atopic dermatitis mirrored that of younger patients, indicating comparable outcomes. However, further research and validation are required for the JAK inhibitor's performance in this context.
Chinese Medical Journal
[Efficacy and safety of new systemic therapies in moderate-to-severe atopic dermatitis in the elderly: meta-analysis]
S S Wang et al.
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