Stephan Weidinger

A distinct proportion of patients with atopic dermatitis and dupilumab treatment does not reach the primary endpoint of an eczema area severity index (EASI)-75 or investigator global assessment 0/1 after 16 weeks. Little is known about poor responders to dupilumab in real life scenarios. The study objective was to identify the percentage and characteristics of patients with insufficient treatment response to dupilumab based on “TREATgermany” registry data from dermatological routine care. Between 06/2016 and 12/2024, 476 patients matched the study criteria. In total, 4% of patients (n=19) were identified as dupilumab poor responders, i.e. reduction in EASI ≤40% at the 1st follow-up visit after 8 to 20 weeks and a consecutive 2nd follow-up visit up to 52 weeks of treatment. 44% (n=209) were classified as stable responders, i.e. decrease in EASI≥75% at both follow-up visits. Poor responders were significantly more often male, more frequently exhibited smoking, arterial hypertension and a higher body mass index. This TREATgermany data analysis demonstrates a proportion of 4% dupilumab poor responders within the first year of treatment. Male sex, smoking, arterial hypertension and increased body mass index were identified as potential risk factors. Further translational research is needed to confirm these clinical findings.

Zusammenfassung: Hintergrund und Ziele: Atopische Dermatitis und Psoriasis sind chronisch‐entzündliche Hauterkrankungen, die häufig mit psychischem Stress einhergehen. Integrative Versorgungsmodelle fehlen weitestgehend. Diese randomisierte Pilotstudie hatte zum Ziel, zu der dermatologischen Behandlung eine begleitende schematherapeutisch ausgerichtete psychoedukative Kurzzeitintervention für dermatologische Patienten zu entwickeln und zu testen. Patienten und Methodik: Patienten aus einem ambulanten Entzündungszentrum mit einem PHQ‐2 (Patient Health Questionnaire‐2) Score ≥ 3 wurden randomisiert und einer Interventions‐ oder Kontrollgruppe zugewiesen. Die Interventionsgruppe erhielt drei standardisierte Sitzungen mit den Schwerpunkten maladaptive Schemata, Bewältigungsstrategien, Psychoedukation und emotionsfokussierte Techniken (zum Beispiel Stuhldialoge, Imagination). Ergebnisse: 19 Betroffene erhielten die Intervention, 13 gehörten zur Kontrollgruppe. Nach der Intervention wurden signifikante Verbesserungen der dermatologischen Lebensqualität (DLQI), des subjektiven Wohlbefindens (WHO‐5) und der depressiven Symptome (PHQ‐9, BDI‐II) beobachtet. Sie waren weitgehend unabhängig vom Schweregrad der Erkrankung (PASI, EASI). Qualitative Rückmeldungen hoben die Benutzerfreundlichkeit, das Erlernen spezifischer Techniken und eine vertrauensvolle therapeutische Beziehung hervor. Schlussfolgerungen: Eine kurze psychologische Intervention reduziert die psychische Belastung bei dermatologischen ambulanten Patienten signifikant. Weitere Studien sollten die langfristigen Auswirkungen und eine breitere Umsetzung untersuchen.

Atopic dermatitis (AD) is driven by type 2 inflammation, with interleukin-13 (IL-13) as one of the central operators. Lebrikizumab is a monoclonal antibody that inhibits IL-13 signalling. Adult patients with moderate-to-severe AD who received lebrikizumab in the TREATgermany registry until 12/2024 were selected, and patient characteristics as well as effectiveness and safety outcomes after 1, 3 and 6 months were evaluated. A total of 108 patients were initiated on lebrikizumab, with 80 having follow-up data available for this analysis (“registry cohort”). Forty-one patients were switched to lebrikizumab without a “washout period” from another advanced systemic therapy (“switchers”). The mean Eczema Area and Severity Index (EASI) decreased from 14.8 at baseline to 5.6 and 3.0 at month 3 and month 6 and was comparable between switchers and nonswitchers. Clinically meaningful improvements were also seen across all patient reported outcomes (PROs) equally in both groups, e.g. a decrease of the mean peak pruritus numeric rating scale (PP-NRS) from 6.6 to 3.8 and 3.4 and the Dermatology Life Quality Index (DLQI) from 11.9 to 4.9 and 4.8. Overall, adverse events (AEs) were reported for 26.6% of patients within the first 3. The most frequently reported AE was conjunctivitis or other ocular complications, reported in 13 patients (20.3%). 32 patients (40%) had an initial EASI≥16 and were comparable to patients in lebrikizumab phase 3 studies. In this “trial-like” cohort, EASI-75 and EASI-90 response rates were 60% and 26.7% at month 3 and 70% and 50% at month 6. Lebrikizumab shows effectiveness in routine care well comparable to observations made in randomized controlled trials.

Atopic dermatitis (AD) is a chronic inflammatory skin disorder with heterogeneous skin manifestations, symptoms, and severity, necessitating the flexibility to tailor treatment regimens to manage c...

We appreciate Dr Hidayat’s careful consideration of our recent publication and for highlighting important methodological and conceptual considerations regarding the interpretation of sustained off-...

Background: Atopic dermatitis (AD) substantially affects quality of life, yet standardized severity measures may not capture patient‐centred priorities, making systematic needs assessment essential for personalized care. Objectives: This study aimed to systematically assess and rank treatment needs in adults with moderate to severe AD, identify patient subgroups with distinct need profiles and evaluate how well these needs were met after 2 years of specialized dermatological care. Methods: In this prospective observational study from the TREATgermany registry, 697 adults with moderate to severe AD completed the validated Patient Benefit Index (PBI) at baseline (T1) and at 2‐year follow‐up (T2), capturing treatment goal importance and achievement. Subgroup analyses were performed based on age, sex, educational status and age at AD onset. Associations between clinical measures and perceived benefit were analysed. Results: The most frequently prioritized treatment goals were being free of itching (97.8% high agreement), regaining control of the disease (95.3%) and relief from skin burning (92.0%). The importance of itch reduction was not correlated with baseline pruritus intensity, and perceived benefit was more closely linked to relative clinical improvement than to absolute disease severity. Beyond these shared priorities, treatment needs varied across subgroups: older patients valued treatment safety and reduced dependence on medical care, women emphasized psychosocial and appearance‐related goals, individuals with lower educational status highlighted financial concerns and patients with adult‐onset AD prioritized diagnostic certainty and disease control. After 2 years, 96.6% of patients reported meaningful treatment benefit. Patient‐reported outcomes (POEM) were more strongly associated with perceived benefit than physician‐assessed measures (oSCORAD, EASI). Conclusion: Patient treatment needs in AD vary by demographic and clinical factors, with pruritus consistently rated as the highest priority. Patient‐reported outcomes align more closely with perceived benefit than physician assessments, underscoring the value of systematic needs assessments to guide individualized treatment decisions and shared decision‐making.

Atopic dermatitis (AD) is the most common inflammatory skin disease and carries the highest disability-adjusted life-years burden, ranking 15th among all non-fatal diseases globally. It is characterized by intensely itchy skin and is associated with multiple comorbidities, such as food allergy, asthma, allergic rhinitis and eosinophilic oesophagitis, which are mainly driven by type 2 immune responses. Other comorbidities include mental health disorders, disordered bone health, and cutaneous and extracutaneous infections. AD is also associated with other immune-mediated inflammatory diseases, including alopecia areata, vitiligo and inflammatory bowel disease. AD most often starts in the first 2 years of life but can occur at any life stage and onset at >60 years of age is increasingly common. The twenty-first century has brought greater insights into disease pathology, with an understanding of the complex interplay between the skin barrier, cutaneous and systemic immune pathways, cutaneous microbiome and neural networks. This improved mechanistic understanding has enabled rational drug design and a shift from non-specific broad immunomodulation to targeted biologic therapies and small molecules for severe disease and from topical corticosteroids to next-generation therapies for mild and moderate disease. Yet, considerable global inequity remains in access to these novel therapeutics.