Atopic dermatitis, a.k.a. eczema, remains a major clinical problem despite a growing number of agents approved to treat it. At the now-cancelled American Academy of Allergy, Asthma, and Immunology’s annual meeting (shuttered because of COVID-19), many of the scheduled research presentations addressed the topic. Here are some of the most interesting.

Many Patients May Need Long-Term Crisaborole

When treatment with topical crisaborole (Eucrisa) was discontinued, some people with mild to moderate atopic dermatitis saw rebound of their disease, researchers reported (abstract #608).

In the 28-day hiatus in treatment after receiving good results with crisaborole, 20% or more patients regressed, reported Mark Lebwohl, MD, of Icahn School of Medicine at Mount Sinai in New York City.

He said that 77% of patients were able to achieve a clear or almost clear score (0-1) on the Investigator’s Static Global Assessment with one cycle of treatment with crisaborole, but after the four-week interruption, only 51% of those 133 patients remained clear or almost clear.

Lebwohl said the pattern held for patients who, in a 48-week open-label extension trial, required two cycles of treatment to reach a 0-1 score. In the trial, 76.3% of patients reached the goal with two cycles, but after a 28-day stoppage, just 36.7% of the group remained clear.

Similar patterns were seen among patients receiving crisaborole for three or four cycles to achieve the clear-skin goal followed by a 28-day hiatus.

“Continuous long-term treatment with crisaborole beyond 28 days may be necessary to maintain control of atopic dermatitis symptoms in some patients with mild-to-moderate atopic dermatitis,” he suggested.

Crisaborole is indicated for topical treatment of mild to moderate atopic dermatitis in patients age 2 and older. The trial was sponsored by the drug’s manufacturer, Pfizer.

Rhinitis Has No Effect on Dupilumab

Efficacy of the atopic dermatitis agent dupilumab (Dupixent) was not compromised in adolescents with a co-history of allergic rhinitis, researchers said (abstract #611).

In a double-blind, placebo-controlled, phase III trial, some 250 patients ages 12-17 were randomized in equal numbers to receive placebo or dupilumab at 200 mg or 300 mg every other week, reported Lawrence Sher, MD, of Peninsula Research Associates, Rolling Hills Estates, California. About three-quarters of each group also had a history of allergic rhinitis.

After 16 weeks, more patients in the dupilumab groups achieved a 0-1 score on the Investigator’s Global Assessment than did those on placebo, irrespective of allergic rhinitis status.

Among patients with allergic rhinitis, 22% achieved the clear or nearly clear observation in the 200 mg group, as did 25.4% of patients in the 300 mg group; only 3.5% of the placebo group achieved the goal. A similar pattern was seen in participants with no history of allergic rhinitis.

The story was much the same for an outcome of a 4-point or greater improvement in pruritus on the Numerical Rating Scale, and a 6-point or greater improvement from baseline in the Children’s Dermatology Lie Quality Index, Sher reported.

“Dupilumab improved atopic dermatitis signs and symptoms in adolescents with moderate-to-severe disease regardless of history of allergic rhinitis,” he reported.

The trial was supported by Regeneron and Sanofi-Genzyme.

Baricitinib Studies Show Benefits

Patients diagnosed with moderate to severe atopic dermatitis were more likely to get relief with baricitinib (Olumiant) than placebo, according to Andreas Wollenberg, MD, of Ludwig-Maximilian University, Munich, Germany, and colleagues (abstract #610).

Their report described results pooled from two similar phase III trials, BREEZE-AD1 and BREEZE-AD2 with a total of about 1,240 patients.

“In patients with moderate-to-severe atopic dermatitis with an additional comorbid atopic condition, baricitinib treatment resulted in clinically meaningful improvements in skin symptoms and itch without a differential safety profile,” Wollenberg reported.

At week 16, among patients with atopic comorbidities, significantly more patients in the baricitinib groups (4-mg, 2-mg, and 1-mg, respectively) versus placebo had Investigator’s Global Assessment rated mild or less – ratings of less than 2. About 30% of the patients on the 4-mg dose met the goal, as did 25% of those receiving a 2 mg dose and 18.6% of those assigned to a 1 mg dose, compared to 9.8% of patients on placebo (P<0.01 for all comparisons with placebo).

An improvement of 4 or more points in the pruritus scale was achieved by 21.6% of patients on the 4-mg dose; 16.6% of those on 2 mg baricitinib and 10.2% of patients on the 1-mg dose compared with 4.4% of patients on placebo (P<0.05). There were no significant treatment effect differences in patients with or without atopic comorbidities. Wollenberg noted.

BREEZE-AD1 and BREEZE-AD2 were independent 16-week randomized, double-blind, parallel-group, placebo-controlled trials conducted at 173 sites in Europe, Asia, Latin America, and Australia. Patients were randomized 2:1:1:1 to once-daily placebo or the three baricitinib doses. The trial was supported by Eli Lilly.

Atopy Severity Tied to Staph Bacterial Persistence

The presence of Staphylococcus aureus was associated with atopic dermatitis in children, and was more persistent in moderate to severe atopy than in milder cases, researchers reported (abstract #625).

Among all of the 163 children in the study who had at least two clinic visits in the Mechanisms of the Progression of Atopic Dermatitis to the Asthma in Children (MPAACH) cohort, S. aureus colonization decreased over time from 27.0% to 12.3% (P<0.001) from the first to the second visits, reported Tammy Gonzalez, an MD/PhD student at Cincinnati Children’s Hospital.

Children with persistent moderate-to-severe atopic dermatitis were more likely to be colonized with S. aureus at both visit 1 (41.9% vs 23.5%, P=0.037) and visit 2 (25.8% vs 9.1%, P=0.011) when compared to children without persistent moderate-to-severe disease.

Atopic dermatitis is a chronic inflammatory skin condition marked by barrier dysfunction and has previously been associated with S. aureus skin colonization, the researchers noted. However, the relationship between S. aureus colonization and persistent moderate-to-severe pediatric atopic dermatitis was less clear.

“We aimed to determine the association between S. aureus colonization at visits 1 and 2 and persistent moderate-to-severe atopic dermatitis in children using the MPAACH,” the group’s abstract stated.

“We demonstrate that S. aureus colonization in pediatric atopic dermatitis decreases over time regardless of severity,” it continued. “However S. aureus colonization remains higher in children with persistent moderate-to-severe atopic dermatitis, suggesting a potential relationship between S. aureus and the stability of atopic dermatitis severity.”