Promising results for treatment of severe chronic hand eczema with dupilumab

Extract

https://doi.org/10.1093/bjd/ljad199

In most countries, alitretinoin is the only drug licensed for the systemic treatment of severe chronic hand eczema (CHE).¹ Alternatives are lacking, which is particularly unfortunate when alitretinoin is not effective or contraindicated. Dupilumab inhibits the signalling of interleukin (IL)-4 and IL-13, and is licensed for the treatment of moderate-to-­severe atopic dermatitis (AD) but not for isolated CHE. In patients with AD, dupilumab has been shown to be effective for accompanying CHE, suggesting it may be a suitable treatment option for CHE.^2,3

In this issue of the BJD, Voorberg et al. present the results of a randomized, double-blind, placebo-controlled phase IIb proof-of-concept study that evaluated the safety and efficacy of dupilumab in 30 adults with severe CHE requiring medical attention and no current AD on other body areas.⁴ The patients had either an inadequate response or intolerance to alitretinoin or treatment with alitretinoin was medically not advisable. Treatment with dupilumab (300 mg every 2 weeks) resulted in more patients with CHE achieving at least 75% improvement in the hand eczema severity index after 16 weeks than those receiving placebo. Adverse events were similar in both groups and mostly mild. The majority of patients had no history of AD; a subanalysis revealed that treatment response did not differ significantly between patients with or without a history of AD. Further studies with a higher number of participants are necessary. However, the presented results are promising and provide preliminary evidence for the efficacy and safety of dupilumab for the treatment of severe CHE, independently of AD.