Atopic hand eczema: similar treatment success for dupilumab and topical delgocitinib

An indirect matching-adjusted comparison of phase 3 trial data evaluating delgocitinib cream and subcutaneous dupilumab for atopic hand eczema treatment revealed no significant differences between the 2 treatments. The analysis, evaluating Hand Eczema Severity Index (HECSI) responses and Investigator Global Assessment (IGA), suggests that both treatments may offer comparable efficacy.

“There are no head-to-head trials between delgocitinib and dupilumab for patients with atopic hand dermatitis but, in the absence of head-to-head trials, we as dermatologists still have to make a decision when we see our patients in the clinic –when both therapies are available–, which therapy may benefit our patients,” Prof. April Armstrong (University of California Los Angeles, CA, USA) stated, adding that delgocitinib has just been approved in Europe [1].

To support decision-making, Prof. Armstrong presented an anchored matching-adjusted indirect comparison between delgocitinib and dupilumab for patients with atopic hand dermatitis. This method is what she described as “the next best thing to a head-to-head comparison.” The analysis included individual patient data from the phase 3 DELTA 1 and 2 trials (NCT04871711 and NCT04872101) for delgocitinib in chronic hand eczema (CHE) and aggregate data from the phase 3 LIBERTY-AD-HAFT trial (NCT04417894) for dupilumab in atopic dermatitis with hand/foot involvement. The analysis focused on participants with atopic hand eczema in DELTA 1 and 2 (n=345), matching them according to age, race, sex, and baseline HECSI score to LIBERTY-AD-HAFT participants (n=133). The resulting cohort had a mean age of 35.8 years in the treatment arms and 33.4 years in the placebo arms and a mean baseline HECSI score of 46.2 and 47.4, respectively.

HECSI-75 response rates were 54.1% and 46.9% in the delgocitinib and dupilumab arms versus 23.1% and 21.5% in the respective vehicle/placebo arms. The corresponding results for the achievement of 0/1 in the IGA-CHE (DELTA trials) or IGA (LIBERTY-AD-HAFT) were 35.4% and 40.3% on the study drugs versus 12.4% and 16.7% on placebo. Furthermore, all anchor-adjusted odds ratios for the comparisons between delgocitinib and dupilumab in terms of IGA-CHE/HF-IGA, HECSI-75, HECSI-90, and HECSI percentage improvement at week 16, did not reach statistical significance. However, the point estimates suggested a trend favouring delgocitinib.

“The key message to take away from this is that there were no statistical differences between topical delgocitinib twice daily versus subcutaneous injection of dupilumab by week 16 in the treatment of patients with atopic hand dermatitis,” Prof. Armstrong underlined.

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   1. Armstrong AW. Matching-adjusted indirect comparison of the efficacy of delgocitinib and dupilumab in the treatment of moderate to severe atopic hand eczema. D3T01.4B, EADV Congress 2024, 25–28 September, Amsterdam, the Netherlands.

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Posted on 6 November 20246 November 2024