The edition · Dermatology
In atopic dermatitis remission, oral drugs relapsed early when stopped; biologics held longer
A network meta-analysis of 55 studies compared withdrawal, dose reduction and interval extension with continuation. Also: phase 2 litifilimab in cutaneous lupus, and how ruxolitinib cream lowers an interferon marker in vitiligo.
The edition in brief
A systematic review and network meta-analysis of 55 studies examined what happens when systemic atopic dermatitis treatment is withdrawn, reduced or spaced out after remission. Stopping oral therapies led to early relapse, while biologics maintained EASI-75 responses better after withdrawal or interval extension, with lebrikizumab showing the lowest risk of losing response in the network analysis. In the phase 2 part of AMETHYST, litifilimab 225 mg every four weeks gave more clear or almost clear cutaneous lupus erythematosus at week 16 than placebo (14.7% vs 2.9%) and more CLASI-70 responses at week 24 (21.7% vs 5.8%); absolute response rates were modest and the phase 3 part is still running. A phase 2 mechanism study of ruxolitinib 1.5% cream in 60 adults with vitiligo showed falls in the interferon-gamma chemokine CXCL10 in blood and skin that tracked repigmentation, with facial VASI reduced by about half at 24 weeks. The pearl covers smoking and hydroxychloroquine in cutaneous lupus.
Litifilimab improved cutaneous lupus in a phase 2 trial, but most patients did not clear
Litifilimab is a promising but unapproved option for cutaneous lupus; keep standard treatment as the basis of care until phase 3 reports.
Ruxolitinib cream lowered CXCL10 in vitiligo, and the fall tracked repigmentation
Counsel patients that topical JAK inhibitor response in vitiligo is slow and best on the face; CXCL10 is a research marker, not a clinic test.
Smoking blunts hydroxychloroquine in cutaneous lupus
Before escalating treatment for cutaneous lupus that seems resistant to hydroxychloroquine, check smoking, adherence and photoprotection.
Stopping oral therapy in atopic dermatitis remission led to early relapse; biologics held longer
In atopic dermatitis remission, consider spacing out biologic doses rather than continuing unchanged, and expect early relapse if an oral therapy is stopped.
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