特应性皮炎（AD）前沿文献精读特辑（Clin Exp Dermatol / J Am Acad Dermatol）

Lebrikizumab, a monoclonal antibody targeting interleukin-13, has demonstrated efficacy and safety in adults with moderate-to-severe atopic dermatitis (AD), but data for older patients remain limited. We conducted a retrospective multicentre study including 90 patients aged ≥ 60 years with moderate-to-severe AD treated with lebrikizumab across 23 Italian dermatology centres. Clinical outcomes were assessed at baseline and at weeks (W) 16, 24 and 52. Mean (SD) Eczema Area and Severity Index (EASI) decreased from 23.24 (7.93) at baseline to 6.33 (6.54) at W16, 3.57 (3.74) at W24 and 2.70 (4.83) at W52 (P < 0.0001). EASI 75 (75% improvement from baseline) was achieved by 58%, 82% and 87% of patients at W16, W24 and W52, respectively. Clinical responses were similar across age groups and independent of prior biologic or Janus kinase inhibitor exposure. Adverse events occurred in 8% of patients and were mainly mild. These findings support the effectiveness and safety of lebrikizumab in older patients with AD in real-world clinical practice.

BACKGROUND: Targeted systemic therapies for atopic dermatitis (AD), including biologics and Janus kinase inhibitors, are increasingly used. However, comparative postmarketing evidence on herpetic infection-related safety signals across these therapies remains limited. OBJECTIVES: To compare safety signals of herpetic infections associated with targeted AD therapies using the Food and Drug Administration Adverse Event Reporting System (FAERS). METHODS: FAERS reports (Q2 2017 to Q1 2025) involving dupilumab, abrocitinib, baricitinib or upadacitinib were included if these agents were designated as the primary suspect drug and the indication was AD. Disproportionality analyses using four algorithms were performed to detect signals for overall and virus-specific herpetic events. Subgroup analyses by age, sex and time to onset (TTO) were conducted. RESULTS: All therapies demonstrated positive signals for herpetic infections. Baricitinib and abrocitinib showed the strongest signals, followed by upadacitinib, whereas dupilumab showed comparatively lower signals overall. Notably, dupilumab demonstrated a herpes simplex virus (HSV) signal comparable with abrocitinib and higher than for upadacitinib, and a signal for eczema herpeticum (EH) was also identified. Signals were generally higher in female patients, except for upadacitinib. Age-stratified analyses showed varying signal patterns across age groups. The median TTO differed between therapies, with an earlier onset for upadacitinib. CONCLUSIONS: Reporting patterns of herpetic infections differ across targeted AD therapies. Disproportionate reporting of HSV and EH with dupilumab warrants further investigation. Differences across sex, age and TTO suggest potential heterogeneity in reporting patterns, which may reflect underlying patient characteristics and reporting behaviours.