Efficacy and safety of ustekinumab treatment in adults with moderate-to-severe atopic dermatitis

Saakshi Khattri, Patrick M. Brunner, Sandra Garcet, Robert Finney, Steven R. Cohen, Margeaux Oliva, Riana Dutt, Judilyn Fuentes-Duculan, Xiuzhong Zheng, Xuan Li, Kathleen M. Bonifacio, Norma Kunjravia, Israel Coats, Inna Cueto, Patricia Gilleaudeau, Mary Sullivan-Whalen, Mayte Suárez-Fariñas, James G. Krueger, Emma Guttman-Yassky

Research output: Contribution to journalArticle

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Abstract

Atopic dermatitis (AD) is the most common inflammatory skin disease, but treatment options for moderate-to-severe disease are limited. Ustekinumab is an IL-12/IL-23p40 antagonist that suppresses Th1, Th17 and Th22 activation, commonly used for psoriasis patients. We sought to assess efficacy and safety of ustekinumab in patients with moderate-to-severe AD. In this phase II, double-blind, placebo-controlled study, 33 patients with moderate-to-severe AD were randomly assigned to either ustekinumab (n=16) or placebo (n=17), with subsequent crossover at 16 weeks, and last dose at 32 weeks. Background therapy with mild topical steroids was allowed to promote retention. Study endpoints included clinical (SCORAD50) and biopsy-based measures of tissue structure and inflammation, using protein and gene expression studies. The ustekinumab group achieved higher SCORAD50 responses at 12, 16 (the primary endpoint) and 20 weeks compared to placebo, but the difference between groups was not significant. The AD molecular profile/transcriptome showed early robust gene modulation, with sustained further improvements until 32 weeks in the initial ustekinumab group. Distinct and more robust modulation of Th1, Th17 and Th22 but also Th2-related AD genes was seen after 4 weeks of ustekinumab treatment (i.e. MMP12, IL-22, IL-13, IFN-γ, elafin/PI3, CXCL1 and CCL17; P<.05). Epidermal responses (K16, terminal differentiation) showed faster (4 weeks) and long-term regulation (32 weeks) from baseline in the ustekinumab group. No severe adverse events were observed. Ustekinumab had clear clinical and molecular effects, but clinical outcomes might have been obscured by a profound "placebo" effect, most likely due to background topical glucocorticosteroids and possibly insufficient dosing for AD.

Original languageEnglish (US)
JournalExperimental Dermatology
DOIs
StateAccepted/In press - 2016

Fingerprint

Atopic Dermatitis
Safety
Placebos
Therapeutics
Elafin
Genes
Modulation
Placebo Effect
Interleukin-13
Ustekinumab
Biopsy
Interleukin-12
Transcriptome
Psoriasis
Skin Diseases
Gene expression
Skin
Chemical activation
Steroids
Tissue

Keywords

  • Atopic dermatitis
  • IL-12
  • IL-22
  • IL-23
  • P40
  • Ustekinumab

ASJC Scopus subject areas

  • Biochemistry
  • Medicine(all)
  • Molecular Biology
  • Dermatology

Cite this

Khattri, S., Brunner, P. M., Garcet, S., Finney, R., Cohen, S. R., Oliva, M., ... Guttman-Yassky, E. (Accepted/In press). Efficacy and safety of ustekinumab treatment in adults with moderate-to-severe atopic dermatitis. Experimental Dermatology. https://doi.org/10.1111/exd.13112

Efficacy and safety of ustekinumab treatment in adults with moderate-to-severe atopic dermatitis. / Khattri, Saakshi; Brunner, Patrick M.; Garcet, Sandra; Finney, Robert; Cohen, Steven R.; Oliva, Margeaux; Dutt, Riana; Fuentes-Duculan, Judilyn; Zheng, Xiuzhong; Li, Xuan; Bonifacio, Kathleen M.; Kunjravia, Norma; Coats, Israel; Cueto, Inna; Gilleaudeau, Patricia; Sullivan-Whalen, Mary; Suárez-Fariñas, Mayte; Krueger, James G.; Guttman-Yassky, Emma.

In: Experimental Dermatology, 2016.

Research output: Contribution to journalArticle

Khattri, S, Brunner, PM, Garcet, S, Finney, R, Cohen, SR, Oliva, M, Dutt, R, Fuentes-Duculan, J, Zheng, X, Li, X, Bonifacio, KM, Kunjravia, N, Coats, I, Cueto, I, Gilleaudeau, P, Sullivan-Whalen, M, Suárez-Fariñas, M, Krueger, JG & Guttman-Yassky, E 2016, 'Efficacy and safety of ustekinumab treatment in adults with moderate-to-severe atopic dermatitis', Experimental Dermatology. https://doi.org/10.1111/exd.13112
Khattri, Saakshi ; Brunner, Patrick M. ; Garcet, Sandra ; Finney, Robert ; Cohen, Steven R. ; Oliva, Margeaux ; Dutt, Riana ; Fuentes-Duculan, Judilyn ; Zheng, Xiuzhong ; Li, Xuan ; Bonifacio, Kathleen M. ; Kunjravia, Norma ; Coats, Israel ; Cueto, Inna ; Gilleaudeau, Patricia ; Sullivan-Whalen, Mary ; Suárez-Fariñas, Mayte ; Krueger, James G. ; Guttman-Yassky, Emma. / Efficacy and safety of ustekinumab treatment in adults with moderate-to-severe atopic dermatitis. In: Experimental Dermatology. 2016.
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