Total IgE Levels Better Predict Atopic Dermatitis Flares Than Disease Severity, and Both Are Reduced by Dupilumab Treatment.

Background

Elevated IgE levels are common in atopic dermatitis (AD). Although their role in AD pathogenesis is unclear, elevated IgE levels may be associated with disease exacerbation.

Objective

To investigate the association of total IgE and/or disease severity with flares and dupilumab's impact on IgE levels and flares in patients with AD.

Methods

Patients >18 years enrolled in LIBERTY AD CHRONOS (NCT02260986) received dupilumab 300 mg every 2 weeks or placebo + topical corticosteroids (TCS), for 52 weeks. Flares were defined as disease worsening requiring treatment escalation. Flare probability was evaluated by baseline IgE levels and disease severity (measured by the Eczema Area and Severity Index). IgE level ratio change over 52 weeks was also evaluated.

Results

Patients with higher baseline IgE treated only with TCS had a significantly higher flare probability (odds ratio [OR; 95%CI]: 1.59 [1.18-2.13], P=.002). There was no association between baseline AD severity and flares (OR [95%CI]: 1.02 [1.0-1.04], P=.058). This association between total baseline IgE and flares was significantly higher in severe (OR [95%CI]: 1.95 [1.33-2.85], P=.0006) vs moderate AD (OR [95%CI]: 1.02 [0.61-1.71], P=.95). In dupilumab-treated patients, IgE levels were significantly reduced, with no associations between total baseline IgE levels (OR [95%CI]: 0.92 [0.51-1.65], P=.78), baseline AD severity (OR [95%CI]: 0.98 [0.94-1.03], P=.42), and flares at week 52.

Conclusion

Total IgE levels were associated with an increased risk of flares in adults with moderate-to-severe AD, which were not explained by disease severity alone. Dupilumab reduces IgE levels in patients with AD, which is associated with a reduced flare probability.