A post-hoc analysis of the phase 3 trial LIBERTY AD ADOL showed that dupilumab entails a rapid itch reduction after only 5 days in adolescents with moderate-to-severe atopic dermatitis (AD) [1].
Itch is the moth bothersome symptom for patients with AD most and it is furthermore associated with sleep loss, reduced quality of life, and reduced productivity. “With our analysis, we wanted to find out how long it will take to relieve itch. This is especially interesting in comparison with JAK inhibitors,” said Prof. Eric Simpson (Oregon Health & Science University, USA). The LIBERTY AD ADOL trial included 251 adolescent patients (aged 12 to 18 years). They were randomised to subcutaneous dupilumab every 2 weeks in 2 dosages according to body weight (< 60 kg or ≥ 60 kg), dupilumab every 4 weeks, or placebo over 16 weeks. The co-primary endpoints of the study were: percentage of participants with almost clear or clear skin according to the Investigator Global Assessment (IGA) score (0/1 score) and reduction from baseline of ≥ 2 points, and percentage of patients with an improvement of the EASI score by 75%. These endpoints were met in all dupilumab treated patients.
The current analysis evaluated change from baseline through day 15 in daily Peak Pruritus Numerical Rating Scale (NRS) scores (see Figure). The Peak Pruritus NRS is a well-defined, reliable, sensitive and valid scale for evaluating worst itch intensity in patients with moderate-to-severe AD [2]. It measures the intensity of worst itch in the previous 24 hours on a scale of 0-10.
Treatment with dupilumab resulted in rapid and significant improvement of itch in adolescent patients with moderate-to-severe AD as early as day 5 in those patients treated with dupilumab every 2 weeks or day 6 in patients treated with dupilumab every 4 weeks. A clinically meaningful improvement was already observed from day 13 in those receiving dupilumab every 2 weeks.
Figure: Change from baseline (%) through day 15 in daily Peak Pruritus NRS scores [1] 
*P<0.05; **P<0.01; ***P<0.0001 vs placebo
LS, least squares; SE, standard error
1 Simpson E, et al. P0283, EADV 2019, 9-13 Oct, Madrid, Spain.
2 Yosipovitch G, et al. Br J Dermatol 2019;181(4):761-9.