Effectiveness of ustekinumab in patients with atopic dermatitis: analysis of real-world evidence

Abstract

Introduction

Atopic dermatitis (AD) is a common chronic inflammatory condition. Ustekinumab is a human monoclonal antibody approved for psoriasis, that targets the interleukin (IL)-12 and IL-23, and it may also play a role in AD. Administration of ustekinumab in AD is presented in anecdotal reports with conflicting results. Our aim was to evaluate the precise value of ustekinumab on AD.

Material and method

We systematically reviewed published data involving AD treated with ustekinumab. The main outcome was clinical improvement. We classified this in three categories: ‘complete response,’ ‘partial response,’ and ‘no response.’ A multivariant model was used to assess the effectiveness and the following potential predictive factors: gender, age, duration of AD, asthma, previous use of biologics, previous systemic therapies,levels of IgE and duration of ustekinumab therapy.

Results

Data on 23 patients were analyzed. Complete AD remission was reported in 8 patients (34.8%), while the absence of response was observed also in 8 patients (34.8%). Partial response was reported in 7 patients (30.4%). No differences were observed with the predictive factors.

Conclusion

The IL-12/23 pathway is likely not an attractive target for AD. Other effective treatments are available and should be prioritized with a good safety profile.

WHAT’S ALREADY KNOWN ABOUT THIS TOPIC?

• Administration of ustekinumab in AD (atopic dermatitis) has been presented in anecdotical reports with conflicting results.

WHAT DOES THIS STUDY ADD?

• This work presents the largest cohort of AD patients treated with ustekinumab in a real-world setting.

• Ustekinumab resulted in similar rates of complete, partial, and negative responses.

• Our findings demonstrate the IL-12/23 pathway is not an attractive target in AD.

• More novel and effective treatments for AD are available and should be prioritized.

• The impact of anti-IL-12/IL-23p40 therapy in AD is still unclarified due to limited controlled trials.

Keywords:

• Biologic
• ustekinumab
• atopic dermatitis
• atopic eczema
• itch
• efficacy
• clinical practice

Acknowledgments

Open Access funding provided by the Qatar National Library.

Author contributions

Literature search: HHE, MS. Drafting to the manuscript: HHE. Clinical revision of the manuscript for important intellectual content: HHE, MS. Supervision: MS.

Disclosure statement

HHE and MS declare no financial or commercial conflicts of interest.