Publications by authors named "Alan Irvine"
In a randomized phase 2b trial (NCT03703102) for adult patients with moderate-to-severe atopic dermatitis (AD), treatment with the T cell rebalancing anti-OX40 receptor antibody rocatinlimab (AMG 451/KHK4083) led to significant improvements in clinical measurements versus placebo including whole-body Eczema Area and Severity Index (EASI) score. AD manifestations can impact variable anatomic regions, and involvement of the head and neck, a sensitive, hard-to-treat area, can negatively impact quality of life. In this post hoc analysis, we investigated response to rocatinlimab treatment across anatomic regions, including the head and neck.
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- The Measure Up 1, 2, and AD Up studies assessed the effectiveness and side effects of upadacitinib for treating atopic dermatitis in adolescents aged 12-17 over a period of 76 weeks, extending the research beyond the previously available 52-week data.
- In a randomized clinical trial, participants received either upadacitinib (15 mg or 30 mg) or a placebo, with some receiving topical corticosteroids, allowing for varied analysis of its efficacy and safety.
- Results showed that a significant percentage of adolescents achieved a major improvement in their condition, with 89.1%, 84.4%, and 87.8% meeting the criteria for reduction in severity, showcasing the medication
Background: Janus kinase inhibitors (JAKi) have the potential to alter the landscape of atopic dermatitis (AD) management dramatically, owing to promising efficacy results from phase III trials and their rapid onset of action. However, JAKi are not without risk, and their use is not appropriate for all patients with AD, making this a medication class that dermatologists should understand and consider when treating patients with moderate-to-severe AD.
Objectives: To provide a consensus expert opinion statement from the International Eczema Council (IEC) that provides a pragmatic approach to prescribing JAKi, including choosing appropriate patients and dosing, clinical and laboratory monitoring and advice about long-term use.
Article Synopsis
- Atopic dermatitis (AD) is a prevalent skin condition that can occur in individuals of any age, and while dupilumab shows promising efficacy as a monoclonal antibody therapy, its use has been linked to a higher occurrence of ocular side effects.
- The British Association of Dermatologists and the Royal College of Ophthalmologists developed guidance on how to manage these dupilumab-related ocular surface disorders (DROSD) after forming a multidisciplinary group to review literature and recommendations.
- Key recommendations include that treatment with dupilumab should not be delayed for most eye issues, hydration drops are not advised as preventive measures, and specific guidance is provided for managing DROSD in both children under 7 and those older, with a focus on
Article Synopsis
- - The study focused on atopic dermatitis (AD) and evaluated how much time patients spent with clear skin and minimal itch while being treated with upadacitinib compared to a placebo and dupilumab.
- - Researchers analyzed data from three phase 3 studies involving nearly 2,400 patients, with treatments lasting from 16 to 24 weeks and assessed using established skin severity and itch scales.
- - Results showed that patients on upadacitinib experienced significantly more days with better skin conditions and reduced itching compared to those on placebo or dupilumab.
Article Synopsis
- * Key discussions included the prevalence of AD, advancements in treatment and management, and the importance of considering environmental and lifestyle factors affecting patients.
- * The forum emphasizes the need for increased awareness and collaboration among stakeholders to close the gap between research advancements and practical applications in patient care.
Background: Despite the widespread off-label use of methotrexate (MTX) for the treatment of atopic dermatitis (AD), there is limited high-quality evidence on dosing regimens and existing guidelines do not provide clear recommendations regarding dosing strategies.
Objective: The aim of this study was to achieve international consensus among AD experts to standardize the dosing regimen for MTX treatment in adults and children with AD.
Methods: An electronic Delphi (eDelphi) study was conducted from October 2021 to September 2022.
Article Synopsis
- The study compares the real-world effectiveness and safety of three treatments for atopic dermatitis: dupilumab, ciclosporin (CyA), and methotrexate (MTX), using data from the A-STAR register in the UK and Ireland.
- It involved 488 patients (adults and children) and measured treatment outcomes like the Eczema Area and Severity Index (EASI) and quality of life scales over 12 months.
- Results showed that dupilumab and CyA led to faster improvements in skin severity scores and overall patient outcomes compared to MTX, indicating dupilumab is an effective option in managing atopic dermatitis.
Increased loss-of-function filaggrin gene mutation prevalence in atopic dermatitis patients across northern latitudes indicates genetic fitness: A systematic review and meta-analysis.
Exp Dermatol
July 2024
Article Synopsis
- Loss-of-function mutations in the filaggrin gene (FLG) are the strongest genetic risk factor for atopic dermatitis (AD), with a prevalence of 19.1% in AD patients compared to 5.8% in the general population.
- A systematic review and meta-analysis analyzed data from 248 studies to assess the geographic and ethnic distribution of these mutations, finding they are more common in populations living farther north of the Equator.
- Despite a significant association between AD and LoF FLG mutations in the Northern hemisphere, these mutations are less prevalent or absent in some ethnic groups, like Middle Easterners and most Africans, indicating a need for tailored AD management strategies.
Article Synopsis
- Staphylococcus aureus (SA) colonizes and harms skin in atopic dermatitis, while Staphylococcus epidermidis (SE) can reduce SA's harmful effects.
- Researchers created a model called a virtual skin site to explore how SA, SE, and the skin barrier interact in atopic dermatitis, leading to skin damage.
- The study found that stronger growth inhibition of SA by SE prevented skin damage, suggesting a combination treatment targeting both bacteria may restore healthier skin better than just killing SA alone.
Article Synopsis
- Lebrikizumab, an antibody targeting IL-13, showed effectiveness in treating moderate-to-severe atopic dermatitis (AD) in adolescents during three Phase 3 trials (ADvocate1, ADvocate2, ADhere).
- The analysis focused on 16-week outcomes from these trials, evaluating both physician and patient-reported improvements in symptoms like itching and sleep loss.
- Results indicated significant improvements in clinical measures for adolescents receiving lebrikizumab compared to placebo, reinforcing its potential as an effective treatment option for AD.
Atopic dermatitis (AD) is an inflammatory skin condition with a childhood prevalence of up to 25%. Microbial dysbiosis is characteristic of AD, with Staphylococcus aureus the most frequent pathogen associated with disease flares and increasingly implicated in disease pathogenesis. Therapeutics to mitigate the effects of S.
View Article and Find Full Text PDFBackground: Chronic spontaneous urticaria (CSU) is a common, debilitating skin disorder characterized by recurring episodes of raised, itchy and sometimes painful wheals lasting longer than 6 weeks. CSU is mediated by mast cells which are absent from peripheral blood. However, lineageCD34CD117FcεRI cells in blood have previously been shown to represent a mast cell precursor.
View Article and Find Full Text PDFWhereas clinically apparent atopic dermatitis (AD) can be confirmed by validated diagnostic criteria, the preclinical phenotype of infants who eventually develop AD is less well-characterized. Analogous to unaffected or nonlesional skin in established AD, clinically normal-appearing skin in infants who will develop clinical AD has distinct changes. Prospective studies have revealed insights into this preclinical AD phenotype.
View Article and Find Full Text PDFBackground: The Short-Term Topical Application for Prevention of Atopic Dermatitis (STOP AD) study, a randomized, open-label trial evaluating the effect of short-term (from the first 4 postnatal days to age 8 weeks) skin barrier protection using Aveeno Dermexa Fast & Long-Lasting Balm (Johnson & Johnson, New Brunswick, NJ) in infants with a parent with allergic disease, demonstrated decreased cumulative incidence and decreased prevalence of atopic dermatitis (AD) at age 12 months.
Objective: In the STOP AD study, we aimed to identify skin biomarkers that are associated with risk of development of AD.
Methods: Skin swabs were collected from the cheek and antecubital fossa (AF) at baseline, age 8 weeks, and age 12 months from subsets of study participants from the intervention arm (n = 43 of 119) and control arm (n = 43 of 138) and were analyzed for specific cytokines (CCL27, CXCL2, human β-defensin-1 [hBD-1], IL-18, IL-8, IL-1α, IL-1 receptor antagonist [IL-1RA], IL-1β, S100A8/9, and IL-36γ) by ELISA.
Importance: Current measures of alopecia areata (AA) severity, such as the Severity of Alopecia Tool score, do not adequately capture overall disease impact.
Objective: To explore factors associated with AA severity beyond scalp hair loss, and to support the development of the Alopecia Areata Severity and Morbidity Index (ASAMI).
Evidence Review: A total of 74 hair and scalp disorder specialists from multiple continents were invited to participate in an eDelphi project consisting of 3 survey rounds.
Article Synopsis
- - Atopic dermatitis (AD) is a significant global skin condition affected by climate and pollution, but its link to increasing climate hazards is not well understood.
- - A review of 18 studies showed that various climatic hazards, such as wildfires and droughts, can worsen AD either directly or indirectly.
- - The research identified important knowledge gaps needing further exploration, including the combined effects of climate hazards on AD, long-term impacts, and how these issues affect different vulnerable groups.
Article Synopsis
- Immune-mediated inflammatory diseases, such as rheumatoid arthritis and Crohn's disease, significantly impact patients' quality of life, and upadacitinib is a new oral treatment option for these conditions.
- A systematic review assessed the safety of upadacitinib compared to other treatments by analyzing 25 randomized controlled trials published between 2018 and 2022.
- The majority of studies found no significant safety differences between upadacitinib and other treatments or placebo, though some reported mixed results regarding adverse events.
Introduction: We explored patient satisfaction with baricitinib, an oral Janus kinase inhibitor, in patients with atopic dermatitis (AD) treated in routine clinical practice.
Methods: Adults with moderate-to-severe AD treated with baricitinib in clinical practice for ≥4 weeks in France, Germany, and the UK completed a one-time online survey under market research methodologies. Treatment satisfaction was assessed using a Likert scale and abbreviated Treatment Satisfaction Questionnaire for Medication (TSQM-9).