Parking this abstract on the under-appreciated dupilumab asset...
J Allergy Clin Immunol. 2014 Dec;134(6):1293-300. doi: 10.1016/j.jaci.2014.10.013.
Dupilumab improves the molecular signature in skin of patients with moderate-to-severe atopic dermatitis.
Hamilton JD1, Suárez-Fariñas M2, Dhingra N2, Cardinale I2, Li X2, Kostic A1, Ming JE3, Radin AR1, Krueger JG2, Graham N1, Yancopoulos GD1, Pirozzi G3, Guttman-Yassky E4.
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Abstract
BACKGROUND:Severe atopic dermatitis (AD) has a high unmet need for effective and safe therapeutics. In early-phase trials, dupilumab, a fully human mAb targeting IL-4 receptor a, markedly improved disease activity, but the effect of IL-4/IL-13 blockade on AD at the molecular level has not been characterized.
OBJECTIVES:We sought to evaluate dupilumab modulation of the AD molecular signature.
METHODS:We performed transcriptomic analyses of pretreatment and posttreatment skin biopsy specimens from patients with moderate-to-severe AD treated weekly with 150 or 300 mg of dupilumab or placebo.
RESULTS:Exacerbation of the AD transcriptome was observed in placebo-treated patients. Dupilumab improved the AD signature in a dose-dependent manner. Expression of genes upregulated in AD lesions decreased in patients treated with dupilumab by 26% (95% CI, 21% to 32%) and 65% (95% CI, 60% to 71%) for treatment with 150 and 300 mg, respectively. Genes downregulated in AD lesions increased by 21% (95% CI, 16% to 27%) and 32% (95% CI, 26% to 37%) with dupilumab (150 and 300 mg, respectively). The molecular changes paralleled improvements in clinical scores. A dupilumab treatment signature of 821 probes (>2-fold change, P < .05) significantly modulated in the 300-mg dupilumab group at week 4 compared with baseline was identified in this sample set. Significant (P < .05) decreases in mRNA expression of genes related to hyperplasia (K16 and MKI67), T cells, and dendritic cells (CD1b and CD1c) and potent inhibition of TH2-associated chemokines (CCL17, CCL18, CCL22, and CCL26) were noted without significant modulation of TH1-associated genes (IFNG).
CONCLUSIONS:This is the first report showing rapid improvement of the AD molecular signature with targeted anti-IL-4 receptor a therapy. These data suggest that IL-4 and IL-13 drive a complex, TH2-centered inflammatory axis in patients with AD.
Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved. |
