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Opinion
Video
Investigating Hand-Foot Atopic Dermatitis
Author(s):
Peter Lio, MD, takes a deep dive into the results of the 3 LIBERTY-AD-HAFT study and how it impacts the treatment of hand-foot atopic dermatitis.
In the Dermatology Times Expert Perspectives series "Advancements in Atopic Dermatitis: Insights from the 2024 Masterclasses in Dermatology Conference," leading dermatologists discuss the advancements in treatments and data for atopic dermatitis (AD) with hand-foot involvement, diversity in clinical trials, and pearls from the American Academy of Dermatology's AD treatment guidelines.
Earlier this year, the US Food and Drug Administration approved an update to the label for dupilumab (Dupixent) in AD, specifically addressing patients aged 12 years and older with uncontrolled moderate to severe hand and/or foot involvement. The label update is based on findings from the phase 3 LIBERTY-AD-HAFT trial, a double-blind, placebo-controlled study involving 133 adult and adolescent patients with AD and moderate to severe hand and/or foot involvement.1
In this episode, Peter Lio, MD, clinical assistant professor of dermatology and pediatrics at Northwestern University Feinberg School of Medicine in Chicago, Illinois, explains key takeaways for clinicians about data and treatments available.
Episode Transcript
Lio: In terms of the efficacy and how I interpret the findings [of the LIBERTY-AD-HAFT trial], I think we've known for a longtime that all body locations of eczema are not equal, right?
So if you say somebody has 5 % body surface area (BSA), 10% BSA, it matters a lot where that is. The hands and feet are particularly important. They might not be a huge percentage, but they can affect every aspect of life when you're shaking hands, when you're using computers, when you're using tools, all of those things. So I think what we're looking for are treatments that can be used in these areas or can show improvement in these areas, and that's what's so exciting about this trial. It shows that we are able to get patients with significant hand and feet involvement much, much better.
I think we understand that with any medication, with any treatment, there are limitations. I wish I had something that was a magic wand and got 100% of patients 100% clear. We're not there yet, so I think when we look at studies like this we tend to look at what are the primary and secondary outcome measures and typically they're thinking things like getting clear or almost clear, which is really our goal, but we almost never see 100% in something like that, and just to see something 30%, 40%, 50% is fantastic, because we know that at least a substantial group of those patients is going to be clear or almost clear, and then there are sometimes less rigorous or less stringent measures that we can get a sense of how many people are going to be helped, and when we look at a trial like this and the data like this, it really suggests that that, most patients are really going to see 100% in something [and] see some improvement. And then a good chunk of them are going to have that clear, almost clear primary endpoint.
The truth is the dosing: it matters a little bit on the weight and the age. and we just follow along with it. It's pretty straightforward. It doesn't really affect my direct prescribing. It adds a tiny bit of complexity. You have to look at the chart [because] it's not as simple as sort of one size fits all, but that's okay. It also tells us that this is really customized treatment for different age groups and different weights, which is really nice.
Transcript edited for clarity
Reference
1. Andrus E. FDA updates dupilumab label with hand, foot atopic dermatitis involvement. Dermatology Times. January 16, 2024. Accessed March 18, 2024. https://www.dermatologytimes.com/view/fda-updates-dupilumab-label-with-hand-foot-atopic-dermatitis-involvement
