More Potential Help for Chronic Hand Eczema

Two different Janus kinase (JAK) inhibitors, one systemic and the other topical, showed activity in preliminary clinical trials of difficult-to-treat chronic hand eczema.

The oral multitargeted drug gusacitinib reduced the target lesion symptom score (TLSS) by as much as 70% at 16 weeks, and almost a third of patients treated with the higher of two doses achieved Physician Global Assessment (PGA) of 0-1 (clear/nearly clear) at the same time point. Adverse events across the range of doses evaluated were mostly sporadic and mild or moderate in severity, reported Howard Sofen, MD, of Dermatology Research Associates in Los Angeles, during the European Academy of Dermatology and Venereology Virtual Congress.

“Gusacitinib showed rapid efficacy in moderate to severe chronic hand eczema,” said Sofen. “The 80-mg dose met the primary endpoint of percent reduction in the modified TLSS at week 16. Rapid and significant improvement in PGA 0-1 was observed versus placebo with 80 mg. There was dose-dependent and rapid improvement in pruritus. Gusacitinib was well tolerated, and the safety has been consistent across studies involving more than 350 patients.”

In another study, as many as 37% of patients treated with topical delgocitinib met criteria for Investigator’s Global Assessment (IGA) of treatment success at 16 weeks. Patients treated with the two highest concentrations had statistically greater improvement at 4 to 6 weeks and maintained the difference to the end of the study, reported Margitta Worm, MD, of Charite Hospital in Berlin.

Multitargeted Oral Drug

Chronic hand eczema is a complex disease that affects about 7 million people in the U.S. The disease has a multifactorial etiology and pathogenesis that includes genetics, atopy, contact allergens, and irritating substances, said Sofen. Gusacitinib inhibits JAK1, JAK2, JAK3, TYK2, and SYK to target TH1 and TH2 pathways, TH17 and TH22 pathways, and SYK-mediated interleukin-17 signaling in keratinocytes.

Sofen reported findings from the first part of a phase IIb trial involving 105 patients with chronic hand eczema. The patients were randomized to placebo or one of two doses of gusacitinib. Randomized treatment continued for 16 weeks, at which point placebo-treated patients could switch to the higher dose of gusacitinib for continued treatment. The primary endpoint was percent change in the modified TLSS.

The study population had a mean baseline mTLSS of 13 and a mean baseline hand eczema severity index (HECSI) score of 63; 39% of the patients had a baseline PGA score of 3.

The 16-week results showed that patients allocated to the higher dose (80 mg) of gusacitinib had a 69.5% reduction in mTLSS, as compared with 49% of patients in the 40-mg group, and 33.5% of those assigned to placebo. Both gusacitinib groups had significantly greater improvement in mTLSS compared with placebo by week 2 (P<0.005), and patients in the higher-dose arm maintained that difference to 16 weeks.

The proportion of patients who achieved PGA 0-1 status by week 16 was 31.3% in the gusacitinib 80-mg arm, 21.25% in the 40-mg arm, and 6.3% in the placebo group. Significantly more patients in both

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Food Allergy Testing for Eczema in Kids Varies By Specialty

Specialists vary on their opinion about the ordering of food allergy tests for children with eczema, a recent survey reveals.

A child with eczema will more likely be given food allergy tests if seen by an allergist or a pediatrician and less likely if seen by a general practitioner or dermatologist.

Dr Matthew Ridd

“In our survey, we found evidence of variation in practice and a spectrum of opinion on what to do to treat eczema in children,” Matthew Ridd, MD, University of Bristol, United Kingdom, told Medscape.

His clinician survey was sent to 155 healthcare providers. Findings were presented at FAAM-EUROBAT Digital this week. They revealed big differences in the way physicians follow up on eczema. For a child with eczema with reported reactions to food, 20 of 22 (91%) allergists and 22 of 30 (73%) pediatricians always order food allergy tests.

But only 16 of 65 (25%) general practitioners and 3 of 12 (25%) dermatologists always order tests in the same situation.

A total of 155 healthcare practitioners responded to the survey, sent by a UK research team. Of those, 26 were unable to order allergy tests. Of the remaining 129, 65 (50%) specialized in general practice, 30 (23%) in pediatrics, 22 (17%) in the treatment of allergies, and 12 (9%) in dermatology.

Their opinions varied on when to order food allergy tests. For children with severe eczema who had no prior reaction to food, 8 of 22 (36%) practitioners specializing in allergy said they would order food allergy tests, as did 9 of 30 (30%) in pediatrics.

Of those surveyed, only 6 of 65 in general practice (9%) said they would request an allergy test for severe eczema for a patient with no allergy history, and no dermatologists (0%) would order the tests.

Only if a parent specifically requested a food allergy test would practitioners respond in a similar way. About two thirds of all respondents said they would sometimes order the test if a parent asked (general practice, 75%; pediatrics, 63%; allergy, 68%; dermatology, 75%).

Ridd told Medscape that it’s not surprising there’s a wide variation in practice, inasmuch as the guidelines are quite convoluted and complex. “Eczema is a common problem, but we don’t have any good evidence to guide clinicians on when to consider food allergy as a possible cause.”

Current guidelines advise calling for allergy tests only when eczema is difficult to treat. “But this is a complex decision. We know that a third of children with eczema are at higher risk for food allergy,” Ridd said. A 2014 study published in Clinical and Experimental Allergy showed that infants with eczema are six times more likely to have egg allergy and 11 times more likely to have peanut allergy by 12 months than infants without eczema (Clin Exp Allergy. 2014;45:255-64).

Food allergy is a sticky subject, he said. “So we have to wonder, are general practitioners frightened to raise the question?…

“We definitely see uncertainty around it.”

He suspects that parents may also

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