度普利尤单抗对中重度特应性皮炎的疗效与安全性分析

Efficacy and safety of dupilumab in the treatment of moderate to severe atopic dermatitis

目的分析度普利尤单抗对中重度特应性皮炎(AD)的疗效与安全性。方法回顾性分析2020年8月至2022年11月在中南大学湘雅医院皮肤科接受度普利尤单抗治疗的中重度AD患者的临床资料,共259例。分别在治疗前、治疗后第2、4、16、24周采用湿疹面积和严重程度指数评分(EASI)、特应性皮炎评分(SCORAD)、瘙痒峰值数字评分(NRS)、以患者为导向的湿疹测量评分(POEM)和皮肤病学生活质量指数(DLQI)评估患者疗效,同时记录治疗期间发生的不良反应。比较治疗前后不同时间点的评分变化和实验室指标变化。结果259例患者的年龄为(35.4±25.9)岁,AD病程[M(Q_(1),Q_(3))]为4.00(2.00,9.00)年,男性占64.1%(166例)。度普利尤单抗治疗第2、4、16、24周的EASI、SCORAD、POEM、DLQI和NRS评分与治疗前相比均下降(均P<0.001)。第16周时EASI50、EASI75和EASI90构成分别为91.0%(101/111)、71.2%(79/111)和40.5%(45/111),第24周时构成分别为95.0%(76/80)、80.0%(64/80)和45.0%(36/80)。第24周的基础总IgE水平(P=0.005)和嗜酸性粒细胞(EOS)计数(P<0.001)与治疗前相比降低。54(20.9%)例患者出现不良事件,主要表现为面颈部顽固性红斑(5.0%,13例)和结膜炎(1.9%,5例)。结论度普利尤单抗可有效改善中重度AD的皮疹面积、皮疹严重程度和瘙痒程度等,提高患者生活质量,并且不良反应发生率较低。

Objective To analyse the efficacy and safety of dupilumab in the treatment of moderate to severe atopic dermatitis(AD).Methods The clinical data of moderate to severe AD patients who received dupilumab therapy in the Department of Dermatology,Xiangya Hospital,Central South University from August 2020 to November 2022 were retrospectively analyzed.The efficacy was evaluated by Eczema Area and Severity Index(EASI),SCORing Atopic Dermatitis(SCORAD),Numerical Rating Scale(NRS),Patient Oriented Eczema Measure(POEM),and Dermatology Quality of Life Index(DLQI)before treatment and 2,4,16 and 24 weeks after treatment.Adverse events that occurred during treatment were recorded.Repeated Measures ANOVA and Generalized Estimating Equations were used to compare changes in scores and changes in laboratory indices at different time points before and after treatment.Results The age of 259 patients was(35.4±25.9)years,the duration of AD was 4.00(2.00,9.00)years,and 64.1%(166 patients)were men patients.The scores of EASI,SCORAD,POEM,DLQI and NRS at 2,4,16 and 24 weeks after treatment with dupilumab were significantly lower than those before treatment(all P<0.001).The proportions of EASI50,EASI75,and EASI90 were 91.0%(101/111),71.2%(79/111),and 40.5%(45/111)at 16 weeks,and 95.0%(76/80),80.0%(64/80)and 45.0%(36/80)at 24 weeks,respectively.Basal total IgE levels(P=0.005)and EOS counts(P<0.001)at Week 24 were significantly lower than those before treatment.Adverse events occurred in 54 patients(20.9%),mainly manifested as intractable erythema of the face and neck(5.0%,13 patients)and conjunctivitis(1.9%,5 patients).Conclusions Dupilumab can effectively improve the rash area,rash severity and itchiness of moderate to severe atopic dermatitis,improve the quality of life of patients,and reduce the incidence of adverse effects.