Clinical research by Celeste Boesjes and colleagues at the National Expertise Center on Atopic Dermatitis at UMC Utrecht on the management of atopic dermatitis has revealed that treatment with dupilumab as well as JAK-inhibitors results in good relief of symptoms in most patients. The studies also showed that dupilumab has a favorable long-term safety profile, while JAK-inhibitors still need to prove their safety during long-term use.
Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases worldwide. Until recently, adequate systemic treatment options for patients with moderate-to-severe AD were limited. Due to the increased understanding of the underlying pathophysiology of AD in the past decade, more targeted therapies for moderate-to-severe AD have been developed that address this unmet need. The advent of these new advanced systemic drugs since 2017, including biologics (i.e. dupilumab and tralokinumab) and Janus kinase (JAK)-inhibitors (i.e. baricitinib, upadacitinib and abrocitinib), therefore represents an important advancement in the therapeutic landscape for AD. In her PhD thesis, Celeste Boesjes, MD (Department of Dermatology & Allergology, UMC Utrecht) further explored optimization of AD treatment by gaining more knowledge on the efficacy and safety of dupilumab and JAK-inhibitors.
Celeste Boes, MD PhD
In her PhD thesis, using data from the real-life Dutch BioDay registry, Celeste Boesjes and colleagues demonstrated that dupilumab treatment resulted in a significant improvement of clinical and patient-reported outcomes together with a significant decrease in severity-associated serum biomarkers and alterations in the skin microbiome moving it towards healthy skin. Effectiveness of dupilumab was sustained even during long-term (up to 5 years) use in both pediatric, adult and elderly patients as well as in patients with or without genetic predisposition for AD. In addition, more than 65 percent of patients was able to prolong their dosing interval, resulting in significant cost savings.
JAK-inhibitors also showed to be effective treatment options for adult patients with moderate-to-severe AD in daily practice. Upadacitinib and abrocitinib provided the highest effectiveness rates based on both physician and patients’ perspectives. However, there are signals suggesting that treatment with JAK-inhibitors is associated with more discontinuations due to adverse events and an increased risk of infections.
Celeste Boesjes concluded that treatment of atopic dermatitis with advanced therapies such as dupilumab or JAK-inhibitors results in most patients in a remarkable and sustained improvement of symptoms in daily practice. In addition, safety assessments showed that dupilumab has a favorable long-term safety profile, while the JAK-inhibitors still need to prove their safety in the long-term use.
AD is one of the most common chronic inflammatory skin diseases worldwide, with a prevalence of up to 15 percent in children and up to 10 percent in adults. AD is characterized by itchy, red, swollen and ‘cracked’ skin, resulting in persistent pruritus, pain, sleep disturbances and symptoms of anxiety and depression. This may lead to a profound impairment of quality of life. It is a disease for which there is an innate ‘predisposition’ and which is associated with asthma and hay fever. According to the RIVM, nearly 400,000 people in the Netherlands have AD with a health care cost of approx. € 150 million per year.
The Dutch Federation of University Medical Centers (NFU) has designated the Department of Dermatology & Allergology at UMC Utrecht as the National Center of Expertise for patients with difficult-to-treat AD. The center, headed by prof. Marjolein de Bruin-Weller, is heavily involved in clinical and translational AD research and patients from all over the Netherlands are referred to UMC Utrecht because of its specific expertise.
Celeste Mirte Boesjes, MD (1994, Doorn) defended her PhD thesis on December 17, 2024 at Utrecht University. The title of her thesis was “Effectiveness and safety of dupilumab and JAK-inhibitors in daily practice – optimizing treatment for atopic dermatitis”. Supervisors were prof. Marjolein de Bruin-Weller, MD, PhD (Department of Dermatology & Allergology, UMC Utrecht) and Marie-Louise Schuttelaar, MD, PhD (Department of Dermatology, UMC Groningen). Co-supervisors were Marlies de Graaf, MD, PhD and Daphne Bakker, MD, PhD (both Department of Dermatology & Allergology, UMC Utrecht). In April 2024 Celeste Boesjes started her residency in dermatology at UMC Utrecht. In addition, she works part-time as a post-doc in the atopic eczema research team at UMC Utrecht.
