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Among the six patients who stopped treatment owing to AD remission, the median duration of treatment was 57 weeks (IQR 44-25-65-25). From a total of 968 patients treated with dupilumab during the study period, 150 patients (15-5%) discontinued treatment after a median treatment duration of 5 months [interquartile range (IQR) 3-10]. Dear Editor, Dupilumab, an anti-interleukin-4 monoclonal antibody, has shown a positive benefit-risk ratio when treating moderate-to-severe atopic dermatitis (AD) in clinical studies.1 High persistence for patients on dupilumab has recently been reported in a clinical practice setting, with 77% of patients remaining in treatment for 12 months in a retrospective study that included 1963 patients with AD; however, reasons for discontinuation were not investigated.2 Investigating the reasons for treatment discontinuation in chronic diseases permits the assessment of both the safety and the effectiveness of a given treatment in a clinical practice setting. [Extracted from the article]

Trials assessing dupilumab in atopic dermatitis (AD) showed transient eosinophilia in less than 2% of patients.1 The frequency of hypereosinophilia (HE), defined as eosinophil blood count (EBC) >=1500/mm SP 3 sp ,2 was higher (15.8%) in our previous real-life cohort of AD patients treated with dupilumab.3 Since symptomatic HE was reported in asthma trials, we aimed to assess the clinical impact of HE in AD patients receiving dupilumab. Dupilumab-associated hypereosinophilia in patients treated for moderate-to-severe atopic dermatitis Fifty-nine patients with HE were included among a total of 653 patients receiving dupilumab from 12 hospital centres (Table 1), allowing us to estimate a mean prevalence of HE under dupilumab of 9% {95% CI [7.0-11.6]}. [Extracted from the article]

Atopic Dermatitis (AD) is a chronic, relapsing inflammatory skin disease that carries a significant burden of disease and patient quality-of-life impairment. Several disorders known or supposed to be associated with AD were collected: atopic manifestations, cardiometabolic diseases, neuropsychiatric disorders, auto-immune or inflammatory diseases, addictions, neoplasia and patient-reported past skin infections. [Extracted from the article]

Résumé: La dermatite atopique (DA) et l’urticaire chronique spontanée (UCS) sont deux dermatoses inflammatoires chroniques fréquentes, qui peuvent altérer considérablement la qualité de vie. Il n’est pas rare de se trouver en situation d’échec avec les traitements dits conventionnels, à savoir les dermocorticoïdes pour la DA et les antihistaminiques de seconde génération pour l’UCS. Le recours à des traitements immunosuppresseurs peut alors être envisagé, mais leur mode d’action n’est pas spécifique de l’affection et leur utilisation non dénuée d’effets indésirables. La révolution thérapeutique que nous avons connue avec l’arrivée des biomédicaments dans le psoriasis nous incite à porter notre espoir dans le développement de thérapies davantage ciblées sur la physiopathologie de la DA et de l’UCS. [ABSTRACT FROM AUTHOR]

Nevertheless, this therapeutic class can promote immune dysbalance, since two recent cases of baricitinib-induced paradoxical psoriasis have been reported.13 The mechanisms of psoriasis' development during dupilumab treatment in AD patients are unknown. Atopic dermatitis (AD) and psoriasis are T cell-mediated inflammatory diseases: a Th2-component with interleukin (IL)-4 and IL-13 production in AD, a Th17/IL-23 and TNF response in psoriasis. [Extracted from the article]