A regulatory T-cell enhancing biologic cut atopic dermatitis severity by 61% at sixteen weeks

The edition in brief

The novel mechanism landed today. Rezpegaldesleukin enhances regulatory T cells rather than blocking a cytokine, which is a different way of approaching inflammatory skin disease. REZOLVE-AD randomised 393 adults with moderate-to-severe atopic dermatitis across three dose regimens and placebo. All three met the primary endpoint. Mean EASI change at sixteen weeks was -61% for 24 μg/kg fortnightly, -58% for 18 μg/kg fortnightly and -53% for 24 μg/kg four-weekly, against -31% for placebo — treatment differences of 30, 27 and 22 percentage points. The tolerability question is injection-site reactions, in 70% of treated patients against 4% on placebo. More than 99% were mild to moderate and resolved, with no excess of serious or severe adverse events and no deaths during induction. Whether a 70% local reaction rate is acceptable depends entirely on what a patient is switching from. Against that, a 68-study, 15,427-patient review of JAK inhibitors across five inflammatory skin diseases puts the established class in perspective: EASI-75 of 38 to 73% in atopic dermatitis, PASI-75 of 33 to 67% in psoriasis, SALT-50 of 30 to 62% in alopecia areata, with herpes zoster reactivation in 1 to 3% and rare but real major cardiovascular events, thromboembolism and cancers. Also: sublingual minoxidil improved midfrontal hair count in transgender people on testosterone, without affecting testosterone concentrations.