For Chronic Hand Eczema, Dupilumab Is Potential Treatment Option

The clinical response to dupilumab may be different among patients with chronic hand eczema (CHE) subtypes.

Dupilumab may be an effective treatment for patients with refractory chronic hand eczema (CHE), including those with no history of atopic dermatitis (AD), according to study findings published in the Journal of the European Academy of Dermatology and Venereology.

Researchers reported retrospective data from the first 19 adult patients with CHE who were treated with dupilumab at 2 Danish dermatologic departments.

Eligible participants were diagnosed with CHE and had a documented dupilumab prescription in an electronic patient record system. The study authors obtained data on demographics, CHE subtype, and previous treatments from the patients’ medical records.

In patient-reported outcomes, the following questions were asked:

1. After you initiated treatment with dupilumab, did you experience: improvement, no change, or worsening of hand eczema?

2. After you initiated treatment with dupilumab, did you experience: improvement, no change, or worsening of quality of life?

3. Have you experienced any side effects after you initiated treatment with dupilumab: yes or no? If yes, which side effects did you experience?

Dupilumab seems to be a promising therapeutic option for refractory CHE, both in patients with and without AD.

Differences in self-reported improvement in CHE severity and health-related quality of life (HR-QOL) among the CHE subtypes were assessed with use of the Fisher exact test.

A total of 19 patients with CHE (mean [SD] age, 55.9 [13.0] years; 84.2% women) who received a standard dose of dupilumab were included. Each patient had previously received systemic immunosuppressants. The most common CHE subtype was hyperkeratotic CHE (n=10), and 31.6% of participants had current or previous AD.

Among the cohort, 73.7% of patients reported improved CHE severity and HR-QOL, and 26.3% reported unchanged or worsened clinical severity or HR-QOL. All patients who had unchanged or worsened disease severity or HR-QOL had hyperkeratotic CHE after stratification by CHE subtypes, and participants with hyperkeratotic CHE were significantly less likely to report improvement compared with patients with all other subtypes in the pooled analysis (P =.033). After stratification by AD status, 83.4% of participants with current or previous AD had improved severity or HR-QOL vs 69.2% of patients without a history of AD.

Dupilumab was discontinued in 26.3% of patients with hyperkeratotic CHE owing to insufficient response, and 42.1% of patients had mild side effects including ocular and gastrointestinal.

The finding that patients with hyperkeratotic CHE were significantly less likely to have improvement suggests that the clinical response to dupilumab may be different among CHE subtypes, noted the investigators.

“Dupilumab seems to be a promising therapeutic option for refractory CHE, both in patients with and without AD,” stated the researchers. “Clinical trials are needed to support this conclusion.”

Disclosure: Several of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

References:

Olesen CM, Yüksel YT, Zachariae C, et al. Treatment of chronic hand eczema with dupilumab — a retrospective follow-up study. J Eur Acad Dermatol Venereol. Published online December 4, 2022. doi:10.1111/jdv.18805