Dupilumab: a viable option for atopic hand and foot eczema

Dupilumab showed superiority over placebo as a treatment of atopic dermatitis (AD) affecting hands and feet. In the phase 3 LIBERTY-AD-HAFT trial, 40.3% of the patients achieved an Investigator’s Global Assessment (IGA) of clear or almost clear (0/1) skin.

Atopic dermatitis on hands and feet can have a substantial impact on the quality of life of patients and as AD at these sites is often difficult to manage, potential therapeutic options are of particular interest [1,2]. The LIBERTY-AD-HAFT (NCT04417894) trial, presented by Prof. Eric Simpson (Oregon Health & Science University, OR, USA), included 133 patients with hand and/or foot AD, randomised to 16 weeks of treatment with dupilumab or placebo and 12 more weeks of safety follow-up [2]. All participants were at least 12 years old and presented with moderate-to-severe eczema on hands and feet (i.e. an IGA of 3 or 4).

The mean age in the dupilumab and the placebo study arms were 35.8 and 33.4 years, with 20.9% and 19.7% of the participants being under 18 years of age. Of the participants, 32.8% and 57.6% were women in the dupilumab and placebo groups, respectively. The mean duration of hand and foot AD was around 15.5 years, a baseline hand and foot IGA of 3 was present in just over 70%, and at least 70% of the participants also suffered from moderate-to-severe AD in other body locations.

At week 16, the study result was statistically significant, with a higher proportion of participants in the dupilumab arm (40.3%) meeting the primary endpoint of a hand and foot IGA 0/1, compared with 16.7% on placebo (P<0.01). The key secondary endpoint of achieving a ≥4-point improvement in the Peak Pruritus Numerical Rating Scale was also met at week 16: 52.2% versus 13.6% in favour of dupilumab (P<0.0001). Furthermore, the Hand Eczema Severity Index (HECSI) and the modified total lesion-symptom score for hand and foot and quality of life were significantly ameliorated in the dupilumab group over placebo.

Concerning safety, results were in line with dupilumab’s previously observed profile. In the group of treatment-emergent adverse events that were reported from at least 5% of patients in comparison of the dupilumab to the placebo arm, nasopharyngitis (16.4% vs 10.6%) was the most common.

“Hopefully, we will get access to a drug like this soon, this will greatly improve the quality of life of our patients,” Prof. Simpson concluded.

1. Thyssen JP, et al. Contact Dermatitis. 2022;86:357–78.
2. Simpson EL. Dupilumab treatment in patients with hand and foot atopic dermatitis: results from a phase 3, randomised, double-blind, placebo-controlled trial. S025, AAD Annual Meeting 2023, 17-21 March, New Orleans, USA.

Posted on 15 May 2023