Dupilumab: a future option for severe hand eczema?

In a small study, treating different severe hand eczemas with dupilumab led to favourable results. At week 16, 19 of 20 participants reached HECSI75.

Treatment options are limited, specially when alitretinoin fails

Currently, treatment options for chronic hand eczema are still limited with alitretinoin being the only systemic option for severe cases1. As dupilumab has shown promise in case reports and results from studies on patients with atopic dermatitis and hand eczema, the agent was now tested in a Dutch phase 2 proof-of-concept study (NCT04512339). In 2 treatment arms, adults who had failed or not tolerated alitretinoin therapy for their severe hand eczema received either dupilumab (n=20) or placebo (n=9) over 16 weeks after an initial wash-out period for prior topical and systemic treatments.

The study cohort had a mean age of about 44 years and included 6 women. Aetiological subtypes included were irritant as well as allergic contact dermatitis. The mean HECSI at baseline was over 85 and median scores of about 60 in the Quality of Life in Hand Eczema Questionnaire (QOLHEQ) demonstrated a severe impairment.

Promising results, and subtypes of hand eczema should be looked into

The primary endpoint of HECSI75 at week 16 was achieved by 95% on dupilumab and 33.3% on placebo (P<0.01). Evaluating severity by using the photographic guide demonstrated 70% with a response on dupilumab, meaning clear or almost clear. In the placebo arm, this response was found in 33.3%. Furthermore, the rates for reaching a minimal important change in the QOLHEQ were 70.6% versus 33.3% in favour of the dupilumab treatment after 6 months.

“No serious adverse events were reported, no adverse events led to discontinuation of dupilumab, and especially no conjunctivitis was reported,” Dr Laura Loman (University Medical Centre Groningen, Netherlands) commented on the safety results.

“Further investigation of the efficacy in larger studies is needed, including the refinement of the study population with different subtypes of hand eczema,” Dr Loman concluded her talk.

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  1. Loman L. Efficacy and safety of dupilumab in patients with severe chronic hand eczema with inadequate response or intolerance to alitretinoin: a randomized, double-blind, placebo-controlled phase IIb proof-of-concept study. FC05.3, EADV Congress 2023, 11–14 October, Berlin, Germany.