Clinical Characteristics of Super Responders to Anti-IL-4Rα Biologic Therapy in Atopic Dermatitis.

IF 4.2 3区医学 Q1 DERMATOLOGY

Dermatology and Therapy Pub Date : 2025-10-01 Epub Date: 2025-08-16 DOI:10.1007/s13555-025-01514-y

Litian Zhang, Linglu Fang, Kun Zhong, Ying Zhou

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引用次数: 0

Abstract

Introduction: Biologics have revolutionized the treatment of moderate-to-severe atopic dermatitis (AD), with dupilumab, an anti-interleukin-4Rα monoclonal antibody, showing notable clinical efficacy. However, some patients achieve rapid and profound improvement-termed super responders (SRs), while others respond poorly. This study aimed to identify SRs to dupilumab in patients with AD and analyze their clinical characteristics to inform personalized treatment strategies.

Methods: A retrospective analysis was conducted on patients with moderate-to-severe AD treated with dupilumab, sourced from the National Clinical Research Center for Skin and Immune Diseases in China. Clinical and follow-up data were reviewed. Categorical variables were compared using Chi-square or Fisher's exact tests, while continuous variables were compared via t-tests or Mann-Whitney U tests. Furthermore, a logistic regression model was employed to evaluate the predictive ability of clinical and demographic variables collected at baseline on the probability of becoming SRs.

Results: Among 1,034 patients with AD, 125 (12.09%) were identified as SRs, achieving significant clinical improvement within 16 weeks. Further univariate analysis indicated that factors closely associated with SRs included: older age, higher body mass index, later disease onset, higher baseline scores of pruritus intensity (Peak pruritus Numerical Rating Scale, PP-NRS)/disease severity (Eczema Area and Severity Index, EASI)/quality of life (Dermatology Life Quality Index, DLQI), prior systemic therapy use, no prior biologics, elevated eosinophil count, high-dose dupilumab, shorter dosing intervals of dupilumab, and absence of concomitant therapies. Logistic regression identified moderate baseline pruritus (PP-NRS) and higher baseline DLQI scores (moderate-to-severe impact) as strong predictors of SRs (moderate pruritus Adj odds ratio (OR): 8.38, 95% confidence interval (CI) 2.56-27.42; moderate DLQI Adj OR: 11.01, 95% CI 3.34-36.29; severe DLQI Adj OR: 14.52, 95% CI 4.70-44.91; all p < 0.001).

Conclusions: Baseline pruritus and quality of life impairment are key predictors of super response to dupilumab in AD. Early identification may guide more tailored, effective treatment strategies.

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抗il - 4r α生物治疗对特应性皮炎超应答者的临床特点

生物制剂已经彻底改变了中重度特应性皮炎（AD）的治疗，dupilumab是一种抗白细胞介素- 4r α单克隆抗体，显示出显著的临床疗效。然而，一些患者获得快速和深刻的改善-称为超级反应（SRs），而其他患者反应较差。本研究旨在确定AD患者对dupilumab的副作用，并分析其临床特征，为个性化治疗策略提供信息。方法：回顾性分析来自中国国家皮肤与免疫疾病临床研究中心的dupilumab治疗的中重度AD患者。回顾临床和随访资料。分类变量的比较采用卡方检验或Fisher精确检验，而连续变量的比较采用t检验或Mann-Whitney U检验。此外，采用逻辑回归模型来评估基线收集的临床和人口统计学变量对成为SRs概率的预测能力。结果：1034例AD患者中，125例（12.09%）被确定为SRs，在16周内取得了显著的临床改善。进一步的单因素分析表明，与SRs密切相关的因素包括：年龄较大，体重指数较高，发病较晚，瘙痒强度基线评分较高（峰值瘙痒数值评定量表，PP-NRS）/疾病严重程度（湿疹面积和严重程度指数，EASI）/生活质量（皮肤病生活质量指数，DLQI），既往使用全身治疗，既往未使用生物制剂，嗜酸性粒细胞计数升高，大剂量杜匹单抗，杜匹单抗给药间隔较短，缺乏伴随治疗。Logistic回归发现中度基线瘙痒（PP-NRS）和较高基线DLQI评分（中重度影响）是SRs的强预测因子(中度瘙痒Adj优势比（OR）： 8.38, 95%可信区间（CI） 2.56-27.42；中度DLQI Adj OR: 11.01, 95% CI 3.34-36.29；重度DLQI Adj: 14.52, 95% CI 4.70-44.91；结论：基线瘙痒和生活质量损害是AD患者dupilumab超反应的关键预测因素。早期识别可以指导更有针对性、更有效的治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Dermatology and Therapy Medicine-Dermatology

CiteScore

6.00

自引率

8.80%

发文量

187

审稿时长

6 weeks

期刊介绍： Dermatology and Therapy is an international, open access, peer-reviewed, rapid publication journal (peer review in 2 weeks, published 3–4 weeks from acceptance). The journal is dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of dermatological therapies. Studies relating to diagnosis, pharmacoeconomics, public health and epidemiology, quality of life, and patient care, management, and education are also encouraged. Areas of focus include, but are not limited to all clinical aspects of dermatology, such as skin pharmacology; skin development and aging; prevention, diagnosis, and management of skin disorders and melanomas; research into dermal structures and pathology; and all areas of aesthetic dermatology, including skin maintenance, dermatological surgery, and lasers. The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports/case series, trial protocols, and short communications. Dermatology and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an International and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of quality research, which may be considered of insufficient interest by other journals. The journal appeals to a global audience and receives submissions from all over the world.