Patients with chronic actinic dermatitis can achieve long term control with dupilumab, according to two case reports that dermatologists say highlight the potential of the agent in resistant disease.
In both cases, the patients had trialled systemic agents with little success before dupilumab was commenced, following which each showed “significant improvement” within weeks.
Representing the first local documented uses of the monoclonal antibody for CAD, the cases have now been reported in a research letter to the Australasian Journal of Dermatology (link here).
Indeed, a literature review had unearthed a total of only 28 previous patients at sites outside Australia treated with dupilumab for CAD, said the team, based out of St Vincent’s Hospital, Melbourne.
Nevertheless, there has been increasing evidence supporting dupilumab use in cutaneous conditions other than atopic dermatitis, the authors led by Dr Zachary Holmes said.
Case one described an 85-year-old man with more than a 10-year history of CAD diagnosed on phototesting and photopatch testing, who had not responded to photoprotection, multiple systemic agents and topical betamethasone dipropionate 0.05%.
Dupilumab was prescribed in accordance with the atopic dermatitis schedule, commencing at 600 mg, followed by 300 mg every two weeks
“Within weeks significant improvement was noted, with complete resolution of CAD after three months,” the authors wrote.
“This was sustained at his most recent follow-up and he remains on dupilumab with a total duration of 19 months to date.”
Case two was a 75-year-old man presented with a severe, generalised flare of longstanding atopic dermatitis with superimposed CAD.
This patient had also long history of previous treatment, including methotrexate 10 mg weekly for two years, narrowband ultraviolet B phototherapy and topical mometasone furoate 0.1% ointment, all of which had been ineffective.
Dupilumab was prescribed to the same schedule as the first case, in addition to strict photoprotection, emollients and topical betamethasone dipropionate 0.05% ointment.
At five months, the truncal involvement had almost completely cleared and the sun-exposed areas had improved significantly, and at 10 months, pruritus had almost entirely resolved and there was only minimal facial erythema, the authors said.
“There was a sustained improvement at the latest follow-up 12 months later and he remains on dupilumab with a total duration of 22 months to date,” they wrote.
Referring to the 28 previous cases documented in the literature, they added: “All patients had trialled at least one systemic agent prior to commencing dupilumab and half were treated concurrently with at least one other systemic agent.”
“Most patients (26/28) showed a partial to complete reduction in disease severity.”
“This is consistent with the two cases we present, who both maintained long-term control of CAD while receiving dupilumab.”
They concluded: “Our report is limited by small patient numbers and publication bias, but indicates that dupilumab has the potential to play a role in the management of resistant CAD.”
“Further studies are required to substantiate this claim.”