Chronic hand eczema: a new therapy, and soft hands?

Chronic hand eczema (CHE) is a recurrent inflammatory reaction around the hands. Often visible, it adds a psychological burden for those affected. Delgocitinib showed a good effect with a favorable side effect profile.

Delgocitinib shows effect in chronic hand eczema

Chronic hand eczema (CHE) is a recurrent inflammatory reaction of the skin around the hands. Often, the externally visible skin appearance additionally means a high psychological burden for the affected person. In a recent study, delgocitinib showed a good effect with a favorable side effect profile.

Dr. Margitta Worm reported on her Phase-2b study on the effect of delgocitinib in chronic hand eczema. There are only a few treatment options available for this multifactorial inflammatory skin disease. The topical corticosteroids (TCS), which are usually applied topically, are effective, but their application duration is limited by local side effects such as cracked skin or atrophy.

New JAK inhibitor under test

The new Janus kinase (JAK) inhibitor delgocitinib offers a new therapeutic approach. It works by blocking the four enzymes in the JAK family (JAK 1-3 and tyrosine kinase 2). The double-blind, randomized trial investigated the dose-response relationship of delgocitinib in adults with mild to severe chronic hand eczema over a period of 16 weeks.

Delgocitinib was used twice a day as an ointment in different doses (1.3, 8 or 20mg/g, depending on the group). The results were evaluated:

• the IGA-CHE score (Investigator's Global Assessment for CHE, scale of 0 (=clear) -4) 
• the Hand Eczema Severity Index (HECSI)

Highest effectiveness at higher dosage

Overall, a significant improvement in symptoms was observed at all dosages after 16 weeks - starting from the condition at the beginning of the study compared to the control group (IGA-CHE score and HECSI). The effect was fastest at doses of 8 or 20mg/g.

No treatment-related adverse effects of delgocitinib were observed in any of the patients during the study period. 

Conclusion

In summary, twice-daily topical use of delgocitinib in adults with mild to severe chronic hand eczema showed significant efficacy - with the greatest effect at higher doses. At the same time, the active ingredient has a favourable side effect profile.

Reference:
Prof. Dr. med. M Worm, Charité - Universitätsklinikum Berlin - Klinik für Allergologie und Immunologie, "The topical pan-JAK inhibitor delgocitinib cream demonstrates dose response in a 16-week phase 2b trial in chronic hand eczema", EADVirtual 2020, 29.10.2020.