Systemic inflammation is well established in psoriasis but the concept of AD being a systemic disease is emerging.
There is an activated T cell response and circulatory cytokines and cardiovascular associated markers compared to control patients, and these differences are also observed when compared to psoriasis patients too .
Additionally, other studies have underlined the associations of AD with atherosclerotic signaling , cardiovascular disease  and coronary artery disease .
Further, the non-lesional AD skin is practically abnormal, unlike non-lesional skin in PsO (Th2 and Th22) .
The high-grade systemic immune activation in AD (T-cells, B cells, circulating cytokines) is responsible for the development of atopic co-morbidities (such as asthma) and other co-morbidities, such as cardiovascular and infection .
Therefore, in a patient with >10% body surface area involvement, a topical approach will not resolve the disease.
A systemic treatment approach is therefore necessary in moderate-to-severe AD due to the high level of systemic immune activation.
IL4Rα mAb potentially inhibits both IL4 and IL-13 signaling.
4-week dose response – EASI 50 was achieved in 71% of patients on the highest dose .
No difference response was independent of baseline IgE or FLG mutation status .
More evident down regulation of multiple markers in the DPL300 group .
In a longer study, the AD transcriptome was progressively reversed and at week 16 the LS phenotype of the lesional and non-lesional skin were similar, with a major reversal of dysregulated genes at Week 16 .
The AD barrier defect was also reversed at Week 16 .
This establishes the Th2 axis and IL-4 and IL-13 cytokines as pathogenic in AD and cements AD as a reversible, immune driven disease, like psoriasis.
Small study of 60 patients showed that in severe patients a significant difference in SCORAD was observed, but not in the non-severe patients .
According to baseline IL-22 expression above or below the median, the higher IL-22 baseline patients largely improved, where the other group saw no improvement with occasional worsening .
Treating psoriasis today is relatively easy as Th17 is shared across all variants.
Th2 axis is also common across the spectrum of AD subsets.
AD is more difficult to treat as there is more immune activation and more heterogeneity.
AD may require targeting of more than 1 cytokine axis or different targeting in different endotypes (personalized medicine approach).
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With this collection of summaries from selected presentations at SPIN 2019, and interviews with international experts, we hope to share with you some of the highlights of this year’s congress. The international network met … [ Read all ]