Alerting neurologists via telemedicine that a patient with suspected acute stroke is en route to the hospital significantly enhances the speed at which thrombolysis is administered and increases the number of patients who receive timelier, potentially lifesaving treatment, new research showed.

“This preliminary evidence supports adopting teleneurology prenotification as a best practice within health systems that have telestroke capabilities,” said study investigator Mark McDonald, MD, a neurologist at TeleSpecialists, Fort Myers, Florida.

The findings were presented at the 2024 annual meeting of the American Academy of Neurology.
 

Best Practices

The impact of emergency medical services prenotification, which refers to paramedics alerting receiving hospital emergency departments (EDs) of a suspected stroke on the way for appropriate preparations to be made, is well-defined, said Dr. McDonald.

“What we’re proposing as a best practice is not only should the ED or ED provider be aware, but there needs to be a system in place for standardizing communication to the neurology team so they’re aware, too.”

Prenotification allows a neurologist to “get on the screen to begin coordinating with the ED team to adequately prepare for the possibility of thrombolytic treatment,” he added.

Currently, teleneurology prenotification, he said, is variable and its benefits unclear.

Dr. McDonald said “his organization, TeleSpecialists, maintains a large detailed medical records database for emergency-related, teleneurology, and other cases. For stroke, it recommends 15 best practices” for facilities including prenotification of teleneurology.

Other best practices include evaluating and administering thrombolysis in the CT imaging suite, a preassembled stroke kit that includes antihypertensives and thrombolytic agents, ensuring a weigh bed is available to determine the exact dose of thrombolysis treatment, and implementing “mock” stroke alerts, said Dr. McDonald.

From the database, researchers extracted acute telestroke consultations seen in the ED in 103 facilities in 15 states. Facilities that did not adhere to the 14 best practices other than teleneurologist prenotification were excluded from the analysis.

Of 9290 patients included in the study, 731 were treated with thrombolysis at prenotification facilities (median age, 69 years; median National Institutes of Health Stroke Score [NIHSS], 8) and 31 were treated at facilities without prenotification (median age, 63 years; median NIHSS score, 4). The thrombolytic treatment rate was 8.5% at prenotification facilities versus 4.8% at facilities without prenotification — a difference that was statistically significant.

Prenotification facilities had a significantly shorter median door-to-needle (DTN) time than those without such a process at 35 versus 43 minutes. In addition, there was a statistically significant difference in the percentage of patients with times less than 60 minutes at approximately 88% at prenotification facilities versus about 68% at the facilities without prenotification.
 

Case-Level Analysis

However, just because a facility adheres to teleneurology prenotification as a whole, doesn’t mean it occurs in every case. Researchers explored the impact of teleneurology prenotification at the case level rather than the facility level.

“That gave us a bit more insight into the real impact because it’s not just being at a facility with the best practice; it’s actually working case by case to see whether it happened or not and that’s where we get the most compelling findings,” said Dr. McDonald.

Of 761 treatment cases, there was prenotification to the neurology team in 401 cases. In 360 cases, prenotification did not occur.

The median DTN time was 29 minutes in the group with actual prenotification vs 41.5 minutes in the group without actual prenotification, a difference that was statistically significant, Dr. McDonald said.

As for treatment within 30 minutes of arrival, 50.4% of patients in the teleneurology prenotification group versus 18.9% in the no prenotification group — a statistically significant difference.

DTN time of less than 30 minutes is increasingly used as a target. “Being treated within this time frame improves outcomes and reduces length of hospital stay,” said Dr. McDonald.

The prenotification group also had a statistically significant higher percentage of treatment within 60 minutes of hospital arrival (93.5% vs 80%).

These new findings should help convince health and telestroke systems that teleneurology prenotification is worth implementing. “We want to achieve consensus on this as a best practice,” said Dr. McDonald.

Prenotification, he added, “coordinates the process and eliminates unnecessary and time-consuming steps.”

Dr. McDonald plans to prospectively study prenotification by collecting data on a facility before and after implementing a prenotification process.
 

Compelling Evidence

Commenting on the research, David L. Tirschwell, MD, Harborview Medical Center, Department of Neurology, Seattle, who cochaired the AAN session featuring the research, said the study provides compelling evidence that teleneurologist prenotification improves DTN time.

“Prenotifications are often standard of care in many healthcare settings and should likely be considered a best practice. When possible, extending such prenotification to a teleconsultant would make sense, and these preliminary data support that approach.”

However, more details are needed “to consider whether the intervention is possibly generalizable to other telestroke practices across the United States,” said Dr. Tirschwell.

Dr. McDonald reported receiving personal compensation for serving as a consultant for Syntrillo Inc. and has stock in Syntrillo Inc. Dr. Tirschwell reported no relevant conflicts of interest.

A version of this article appeared on Medscape.com.

Alerting neurologists via telemedicine that a patient with suspected acute stroke is en route to the hospital significantly enhances the speed at which thrombolysis is administered and increases the number of patients who receive timelier, potentially lifesaving treatment, new research showed.

“This preliminary evidence supports adopting teleneurology prenotification as a best practice within health systems that have telestroke capabilities,” said study investigator Mark McDonald, MD, a neurologist at TeleSpecialists, Fort Myers, Florida.

The findings were presented at the 2024 annual meeting of the American Academy of Neurology.
 

Best Practices

The impact of emergency medical services prenotification, which refers to paramedics alerting receiving hospital emergency departments (EDs) of a suspected stroke on the way for appropriate preparations to be made, is well-defined, said Dr. McDonald.

“What we’re proposing as a best practice is not only should the ED or ED provider be aware, but there needs to be a system in place for standardizing communication to the neurology team so they’re aware, too.”

Prenotification allows a neurologist to “get on the screen to begin coordinating with the ED team to adequately prepare for the possibility of thrombolytic treatment,” he added.

Currently, teleneurology prenotification, he said, is variable and its benefits unclear.

Dr. McDonald said “his organization, TeleSpecialists, maintains a large detailed medical records database for emergency-related, teleneurology, and other cases. For stroke, it recommends 15 best practices” for facilities including prenotification of teleneurology.

Other best practices include evaluating and administering thrombolysis in the CT imaging suite, a preassembled stroke kit that includes antihypertensives and thrombolytic agents, ensuring a weigh bed is available to determine the exact dose of thrombolysis treatment, and implementing “mock” stroke alerts, said Dr. McDonald.

From the database, researchers extracted acute telestroke consultations seen in the ED in 103 facilities in 15 states. Facilities that did not adhere to the 14 best practices other than teleneurologist prenotification were excluded from the analysis.

Of 9290 patients included in the study, 731 were treated with thrombolysis at prenotification facilities (median age, 69 years; median National Institutes of Health Stroke Score [NIHSS], 8) and 31 were treated at facilities without prenotification (median age, 63 years; median NIHSS score, 4). The thrombolytic treatment rate was 8.5% at prenotification facilities versus 4.8% at facilities without prenotification — a difference that was statistically significant.

Prenotification facilities had a significantly shorter median door-to-needle (DTN) time than those without such a process at 35 versus 43 minutes. In addition, there was a statistically significant difference in the percentage of patients with times less than 60 minutes at approximately 88% at prenotification facilities versus about 68% at the facilities without prenotification.
 

Case-Level Analysis

However, just because a facility adheres to teleneurology prenotification as a whole, doesn’t mean it occurs in every case. Researchers explored the impact of teleneurology prenotification at the case level rather than the facility level.

“That gave us a bit more insight into the real impact because it’s not just being at a facility with the best practice; it’s actually working case by case to see whether it happened or not and that’s where we get the most compelling findings,” said Dr. McDonald.

Of 761 treatment cases, there was prenotification to the neurology team in 401 cases. In 360 cases, prenotification did not occur.

The median DTN time was 29 minutes in the group with actual prenotification vs 41.5 minutes in the group without actual prenotification, a difference that was statistically significant, Dr. McDonald said.

As for treatment within 30 minutes of arrival, 50.4% of patients in the teleneurology prenotification group versus 18.9% in the no prenotification group — a statistically significant difference.

DTN time of less than 30 minutes is increasingly used as a target. “Being treated within this time frame improves outcomes and reduces length of hospital stay,” said Dr. McDonald.

The prenotification group also had a statistically significant higher percentage of treatment within 60 minutes of hospital arrival (93.5% vs 80%).

These new findings should help convince health and telestroke systems that teleneurology prenotification is worth implementing. “We want to achieve consensus on this as a best practice,” said Dr. McDonald.

Prenotification, he added, “coordinates the process and eliminates unnecessary and time-consuming steps.”

Dr. McDonald plans to prospectively study prenotification by collecting data on a facility before and after implementing a prenotification process.
 

Compelling Evidence

Commenting on the research, David L. Tirschwell, MD, Harborview Medical Center, Department of Neurology, Seattle, who cochaired the AAN session featuring the research, said the study provides compelling evidence that teleneurologist prenotification improves DTN time.

“Prenotifications are often standard of care in many healthcare settings and should likely be considered a best practice. When possible, extending such prenotification to a teleconsultant would make sense, and these preliminary data support that approach.”

However, more details are needed “to consider whether the intervention is possibly generalizable to other telestroke practices across the United States,” said Dr. Tirschwell.

Dr. McDonald reported receiving personal compensation for serving as a consultant for Syntrillo Inc. and has stock in Syntrillo Inc. Dr. Tirschwell reported no relevant conflicts of interest.

A version of this article appeared on Medscape.com.

Alerting neurologists via telemedicine that a patient with suspected acute stroke is en route to the hospital significantly enhances the speed at which thrombolysis is administered and increases the number of patients who receive timelier, potentially lifesaving treatment, new research showed.

“This preliminary evidence supports adopting teleneurology prenotification as a best practice within health systems that have telestroke capabilities,” said study investigator Mark McDonald, MD, a neurologist at TeleSpecialists, Fort Myers, Florida.

The findings were presented at the 2024 annual meeting of the American Academy of Neurology.
 

Best Practices

The impact of emergency medical services prenotification, which refers to paramedics alerting receiving hospital emergency departments (EDs) of a suspected stroke on the way for appropriate preparations to be made, is well-defined, said Dr. McDonald.

“What we’re proposing as a best practice is not only should the ED or ED provider be aware, but there needs to be a system in place for standardizing communication to the neurology team so they’re aware, too.”

Prenotification allows a neurologist to “get on the screen to begin coordinating with the ED team to adequately prepare for the possibility of thrombolytic treatment,” he added.

Currently, teleneurology prenotification, he said, is variable and its benefits unclear.

Dr. McDonald said “his organization, TeleSpecialists, maintains a large detailed medical records database for emergency-related, teleneurology, and other cases. For stroke, it recommends 15 best practices” for facilities including prenotification of teleneurology.

Other best practices include evaluating and administering thrombolysis in the CT imaging suite, a preassembled stroke kit that includes antihypertensives and thrombolytic agents, ensuring a weigh bed is available to determine the exact dose of thrombolysis treatment, and implementing “mock” stroke alerts, said Dr. McDonald.

From the database, researchers extracted acute telestroke consultations seen in the ED in 103 facilities in 15 states. Facilities that did not adhere to the 14 best practices other than teleneurologist prenotification were excluded from the analysis.

Of 9290 patients included in the study, 731 were treated with thrombolysis at prenotification facilities (median age, 69 years; median National Institutes of Health Stroke Score [NIHSS], 8) and 31 were treated at facilities without prenotification (median age, 63 years; median NIHSS score, 4). The thrombolytic treatment rate was 8.5% at prenotification facilities versus 4.8% at facilities without prenotification — a difference that was statistically significant.

Prenotification facilities had a significantly shorter median door-to-needle (DTN) time than those without such a process at 35 versus 43 minutes. In addition, there was a statistically significant difference in the percentage of patients with times less than 60 minutes at approximately 88% at prenotification facilities versus about 68% at the facilities without prenotification.
 

Case-Level Analysis

However, just because a facility adheres to teleneurology prenotification as a whole, doesn’t mean it occurs in every case. Researchers explored the impact of teleneurology prenotification at the case level rather than the facility level.

“That gave us a bit more insight into the real impact because it’s not just being at a facility with the best practice; it’s actually working case by case to see whether it happened or not and that’s where we get the most compelling findings,” said Dr. McDonald.

Of 761 treatment cases, there was prenotification to the neurology team in 401 cases. In 360 cases, prenotification did not occur.

The median DTN time was 29 minutes in the group with actual prenotification vs 41.5 minutes in the group without actual prenotification, a difference that was statistically significant, Dr. McDonald said.

As for treatment within 30 minutes of arrival, 50.4% of patients in the teleneurology prenotification group versus 18.9% in the no prenotification group — a statistically significant difference.

DTN time of less than 30 minutes is increasingly used as a target. “Being treated within this time frame improves outcomes and reduces length of hospital stay,” said Dr. McDonald.

The prenotification group also had a statistically significant higher percentage of treatment within 60 minutes of hospital arrival (93.5% vs 80%).

These new findings should help convince health and telestroke systems that teleneurology prenotification is worth implementing. “We want to achieve consensus on this as a best practice,” said Dr. McDonald.

Prenotification, he added, “coordinates the process and eliminates unnecessary and time-consuming steps.”

Dr. McDonald plans to prospectively study prenotification by collecting data on a facility before and after implementing a prenotification process.
 

Compelling Evidence

Commenting on the research, David L. Tirschwell, MD, Harborview Medical Center, Department of Neurology, Seattle, who cochaired the AAN session featuring the research, said the study provides compelling evidence that teleneurologist prenotification improves DTN time.

“Prenotifications are often standard of care in many healthcare settings and should likely be considered a best practice. When possible, extending such prenotification to a teleconsultant would make sense, and these preliminary data support that approach.”

However, more details are needed “to consider whether the intervention is possibly generalizable to other telestroke practices across the United States,” said Dr. Tirschwell.

Dr. McDonald reported receiving personal compensation for serving as a consultant for Syntrillo Inc. and has stock in Syntrillo Inc. Dr. Tirschwell reported no relevant conflicts of interest.

A version of this article appeared on Medscape.com.

Key clinical point: Specific behavioral patterns of attention-deficit/hyperactivity disorder, such as impulsivity and hyperactivity, were associated with the development of prurigo nodularis (PN) in children with atopic dermatitis (AD), regardless of AD severity.

Major finding: Among children with AD, the impulsivity/hyperactivity score was significantly higher in those with vs without PN (5.5 ± 4.2 vs 2.9 ± 2.9; P = .038); no significant differences were observed in Eczema Area Severity Index scores, itch numeric rating scale scores, or other AD outcomes in children with vs without PN (P > .05).

Study details: This cross-sectional study included 39 children with AD who did (n = 21) or did not (n = 18) have PN.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Kim Y, Lee J, Shin K, et al. Association between prurigo nodularis and behavioural patterns of attention-deficit/hyperactivity disorder in children with atopic dermatitis: A cross-sectional study. J Eur Acad Dermatol Venereol. 2024(Mar 27). doi: 10.1111/jdv.19967  Source

Key clinical point: Specific behavioral patterns of attention-deficit/hyperactivity disorder, such as impulsivity and hyperactivity, were associated with the development of prurigo nodularis (PN) in children with atopic dermatitis (AD), regardless of AD severity.

Major finding: Among children with AD, the impulsivity/hyperactivity score was significantly higher in those with vs without PN (5.5 ± 4.2 vs 2.9 ± 2.9; P = .038); no significant differences were observed in Eczema Area Severity Index scores, itch numeric rating scale scores, or other AD outcomes in children with vs without PN (P > .05).

Study details: This cross-sectional study included 39 children with AD who did (n = 21) or did not (n = 18) have PN.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Kim Y, Lee J, Shin K, et al. Association between prurigo nodularis and behavioural patterns of attention-deficit/hyperactivity disorder in children with atopic dermatitis: A cross-sectional study. J Eur Acad Dermatol Venereol. 2024(Mar 27). doi: 10.1111/jdv.19967  Source

Key clinical point: Specific behavioral patterns of attention-deficit/hyperactivity disorder, such as impulsivity and hyperactivity, were associated with the development of prurigo nodularis (PN) in children with atopic dermatitis (AD), regardless of AD severity.

Major finding: Among children with AD, the impulsivity/hyperactivity score was significantly higher in those with vs without PN (5.5 ± 4.2 vs 2.9 ± 2.9; P = .038); no significant differences were observed in Eczema Area Severity Index scores, itch numeric rating scale scores, or other AD outcomes in children with vs without PN (P > .05).

Study details: This cross-sectional study included 39 children with AD who did (n = 21) or did not (n = 18) have PN.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Kim Y, Lee J, Shin K, et al. Association between prurigo nodularis and behavioural patterns of attention-deficit/hyperactivity disorder in children with atopic dermatitis: A cross-sectional study. J Eur Acad Dermatol Venereol. 2024(Mar 27). doi: 10.1111/jdv.19967  Source

Key clinical point: Upadacitinib treatment rapidly and sustainably improved multiple patient-reported outcomes, including itch, in adults and adolescents with moderate to severe atopic dermatitis (AD).

Major finding: At week 1, more than 10% and 15% of patients receiving 15 and 30 mg upadacitinib, respectively, experienced improvements in itch; thereafter, response rates increased steadily and sustainably through week 52. Similar improvements were observed for pain and other skin symptoms.

Study details: This pooled analysis included 1609 adults and adolescents with moderate to severe AD from the phase 3 Measure Up 1 and Measure Up 2 studies who had received upadacitinib (15 mg n = 557; 30 mg n = 567) or placebo (followed by upadacitinib 15 or 30 mg after 16 weeks; n = 485).

Disclosures: This study was funded by AbbVie, Inc. Eight authors declared being employees of or holding stock or stock options in AbbVie. The other authors declared serving as speakers for, receiving consulting fees, or having other ties with various sources, including AbbVie.

Source: Silverberg JI, Gooderham MJ, Paller AS, et al. Early and sustained improvements in symptoms and quality of life with upadacitinib in adults and adolescents with moderate-to-severe atopic dermatitis: 52-week results from two phase III randomized clinical trials (Measure Up 1 and Measure Up 2). Am J Clin Dermatol. 2024 (Mar 25). doi: 10.1007/s40257-024-00853-4 Source

Key clinical point: Upadacitinib treatment rapidly and sustainably improved multiple patient-reported outcomes, including itch, in adults and adolescents with moderate to severe atopic dermatitis (AD).

Major finding: At week 1, more than 10% and 15% of patients receiving 15 and 30 mg upadacitinib, respectively, experienced improvements in itch; thereafter, response rates increased steadily and sustainably through week 52. Similar improvements were observed for pain and other skin symptoms.

Study details: This pooled analysis included 1609 adults and adolescents with moderate to severe AD from the phase 3 Measure Up 1 and Measure Up 2 studies who had received upadacitinib (15 mg n = 557; 30 mg n = 567) or placebo (followed by upadacitinib 15 or 30 mg after 16 weeks; n = 485).

Disclosures: This study was funded by AbbVie, Inc. Eight authors declared being employees of or holding stock or stock options in AbbVie. The other authors declared serving as speakers for, receiving consulting fees, or having other ties with various sources, including AbbVie.

Source: Silverberg JI, Gooderham MJ, Paller AS, et al. Early and sustained improvements in symptoms and quality of life with upadacitinib in adults and adolescents with moderate-to-severe atopic dermatitis: 52-week results from two phase III randomized clinical trials (Measure Up 1 and Measure Up 2). Am J Clin Dermatol. 2024 (Mar 25). doi: 10.1007/s40257-024-00853-4 Source

Key clinical point: Upadacitinib treatment rapidly and sustainably improved multiple patient-reported outcomes, including itch, in adults and adolescents with moderate to severe atopic dermatitis (AD).

Major finding: At week 1, more than 10% and 15% of patients receiving 15 and 30 mg upadacitinib, respectively, experienced improvements in itch; thereafter, response rates increased steadily and sustainably through week 52. Similar improvements were observed for pain and other skin symptoms.

Study details: This pooled analysis included 1609 adults and adolescents with moderate to severe AD from the phase 3 Measure Up 1 and Measure Up 2 studies who had received upadacitinib (15 mg n = 557; 30 mg n = 567) or placebo (followed by upadacitinib 15 or 30 mg after 16 weeks; n = 485).

Disclosures: This study was funded by AbbVie, Inc. Eight authors declared being employees of or holding stock or stock options in AbbVie. The other authors declared serving as speakers for, receiving consulting fees, or having other ties with various sources, including AbbVie.

Source: Silverberg JI, Gooderham MJ, Paller AS, et al. Early and sustained improvements in symptoms and quality of life with upadacitinib in adults and adolescents with moderate-to-severe atopic dermatitis: 52-week results from two phase III randomized clinical trials (Measure Up 1 and Measure Up 2). Am J Clin Dermatol. 2024 (Mar 25). doi: 10.1007/s40257-024-00853-4 Source

Key clinical point: Patients with atopic dermatitis (AD) treated with dupilumab have an increased risk for cutaneous T-cell lymphoma (CTCL) compared with those not treated with dupilumab.

Major finding: Patients with AD who did vs did not receive dupilumab had a significantly higher risk of developing CTCL (odds ratio [OR] 4.1003; 95% CI 2.055-8.192). The risk for CTCL persisted in those with no prior exposure to disease-modifying antirheumatic drugs (OR 3.202; 95% CI 1.573-6.514).

Study details: This retrospective cohort study included patients with AD who did (n = 22,888) or did not (n = 22,871) receive dupilumab treatment and did not have a preexisting diagnosis for CTCL, Hodgkin lymphoma, non-Hodgkin lymphoma, nonfollicular lymphoma, leukemia, malignant melanoma, squamous cell carcinoma, or basal cell carcinoma.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Hasan I, Parsons L, Duran S, Zinn Z. Dupilumab therapy for atopic dermatitis is associated with increased risk of cutaneous T cell lymphoma: A retrospective cohort study. J Am Acad Dermatol. 2024 (Apr 6). doi: 10.1016/j.jaad.2024.03.039 Source

Key clinical point: Patients with atopic dermatitis (AD) treated with dupilumab have an increased risk for cutaneous T-cell lymphoma (CTCL) compared with those not treated with dupilumab.

Major finding: Patients with AD who did vs did not receive dupilumab had a significantly higher risk of developing CTCL (odds ratio [OR] 4.1003; 95% CI 2.055-8.192). The risk for CTCL persisted in those with no prior exposure to disease-modifying antirheumatic drugs (OR 3.202; 95% CI 1.573-6.514).

Study details: This retrospective cohort study included patients with AD who did (n = 22,888) or did not (n = 22,871) receive dupilumab treatment and did not have a preexisting diagnosis for CTCL, Hodgkin lymphoma, non-Hodgkin lymphoma, nonfollicular lymphoma, leukemia, malignant melanoma, squamous cell carcinoma, or basal cell carcinoma.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Hasan I, Parsons L, Duran S, Zinn Z. Dupilumab therapy for atopic dermatitis is associated with increased risk of cutaneous T cell lymphoma: A retrospective cohort study. J Am Acad Dermatol. 2024 (Apr 6). doi: 10.1016/j.jaad.2024.03.039 Source

Key clinical point: Patients with atopic dermatitis (AD) treated with dupilumab have an increased risk for cutaneous T-cell lymphoma (CTCL) compared with those not treated with dupilumab.

Major finding: Patients with AD who did vs did not receive dupilumab had a significantly higher risk of developing CTCL (odds ratio [OR] 4.1003; 95% CI 2.055-8.192). The risk for CTCL persisted in those with no prior exposure to disease-modifying antirheumatic drugs (OR 3.202; 95% CI 1.573-6.514).

Study details: This retrospective cohort study included patients with AD who did (n = 22,888) or did not (n = 22,871) receive dupilumab treatment and did not have a preexisting diagnosis for CTCL, Hodgkin lymphoma, non-Hodgkin lymphoma, nonfollicular lymphoma, leukemia, malignant melanoma, squamous cell carcinoma, or basal cell carcinoma.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Hasan I, Parsons L, Duran S, Zinn Z. Dupilumab therapy for atopic dermatitis is associated with increased risk of cutaneous T cell lymphoma: A retrospective cohort study. J Am Acad Dermatol. 2024 (Apr 6). doi: 10.1016/j.jaad.2024.03.039 Source

Key clinical point: Established and new atopic dermatitis (AD)-associated filaggrin loss-of-function variants are associated with increased risks for clinical AD outcomes and disruption of skin barrier integrity in lesional and nonlesional skin of children with AD.

Major finding: Twenty variants were identified, including one novel variant. The presence of one or more variants was associated with a higher risk for moderate or severe AD vs mild AD (odds ratio 2.00; corrected P = .0394), a higher Scoring AD score (corrected P = .0394), and transepidermal water loss in both lesional (P = .018) and nonlesional (P = .015) skin.

Study details: This study included 438 children with AD (age ≤ 2 years; gestation period ≥ 36 weeks) from the early-life Mechanisms of Progression of Atopic Dermatitis to Asthma in Children cohort without a comorbid lung condition or dependence on immunosuppression or oral steroids for a condition except asthma.

Disclosures: This study was funded by the US National Institutes of Health. Matthew S. Hestand declared being an employee and shareholder of Pacific Biosciences. The other authors declared no conflicts of interest.

Source: Virolainen SJ, Satish L, Biagini JM, et al. Filaggrin loss-of-function variants are associated with atopic dermatitis phenotypes in a diverse, early life prospective cohort. JCI Insight. 2024 (Apr 2). doi: 10.1172/jci.insight.178258 Source

Key clinical point: Established and new atopic dermatitis (AD)-associated filaggrin loss-of-function variants are associated with increased risks for clinical AD outcomes and disruption of skin barrier integrity in lesional and nonlesional skin of children with AD.

Major finding: Twenty variants were identified, including one novel variant. The presence of one or more variants was associated with a higher risk for moderate or severe AD vs mild AD (odds ratio 2.00; corrected P = .0394), a higher Scoring AD score (corrected P = .0394), and transepidermal water loss in both lesional (P = .018) and nonlesional (P = .015) skin.

Study details: This study included 438 children with AD (age ≤ 2 years; gestation period ≥ 36 weeks) from the early-life Mechanisms of Progression of Atopic Dermatitis to Asthma in Children cohort without a comorbid lung condition or dependence on immunosuppression or oral steroids for a condition except asthma.

Disclosures: This study was funded by the US National Institutes of Health. Matthew S. Hestand declared being an employee and shareholder of Pacific Biosciences. The other authors declared no conflicts of interest.

Source: Virolainen SJ, Satish L, Biagini JM, et al. Filaggrin loss-of-function variants are associated with atopic dermatitis phenotypes in a diverse, early life prospective cohort. JCI Insight. 2024 (Apr 2). doi: 10.1172/jci.insight.178258 Source

Key clinical point: Established and new atopic dermatitis (AD)-associated filaggrin loss-of-function variants are associated with increased risks for clinical AD outcomes and disruption of skin barrier integrity in lesional and nonlesional skin of children with AD.

Major finding: Twenty variants were identified, including one novel variant. The presence of one or more variants was associated with a higher risk for moderate or severe AD vs mild AD (odds ratio 2.00; corrected P = .0394), a higher Scoring AD score (corrected P = .0394), and transepidermal water loss in both lesional (P = .018) and nonlesional (P = .015) skin.

Study details: This study included 438 children with AD (age ≤ 2 years; gestation period ≥ 36 weeks) from the early-life Mechanisms of Progression of Atopic Dermatitis to Asthma in Children cohort without a comorbid lung condition or dependence on immunosuppression or oral steroids for a condition except asthma.

Disclosures: This study was funded by the US National Institutes of Health. Matthew S. Hestand declared being an employee and shareholder of Pacific Biosciences. The other authors declared no conflicts of interest.

Source: Virolainen SJ, Satish L, Biagini JM, et al. Filaggrin loss-of-function variants are associated with atopic dermatitis phenotypes in a diverse, early life prospective cohort. JCI Insight. 2024 (Apr 2). doi: 10.1172/jci.insight.178258 Source

Key clinical point: Baricitinib treatment was effective and well-tolerated in patients with moderate to severe atopic dermatitis (AD) who were followed-up for 3 months in real-world settings.

Major finding: Baricitinib led to a significant reduction in the Eczema Area Severity Index (21.5 ± 13.2 vs 9.3 ± 9.0) and objective Scoring AD (45.9 ± 12.3 vs 28.2 ± 15.5) scores at 3 months vs start visit (both P < .001). The treatment discontinuation rate was 16.7%, with two patients discontinuing baricitinib due to adverse events.

Study details: This was an interim analysis of the TREATgermany registry that included 81 adult patients with moderate to severe AD who received baricitinib and concomitant topical treatment, of whom 49 had initiated baricitinib at a registry visit; 26 of these did not switch from a previous systemic drug and had their first follow-up visit at 3 months.

Disclosures: TREATgermany is supported by AbbVie Deutschland GmbH & Co. KG, Galderma S.A., and others. Six authors declared serving as consultants, lecturers, etc., for or having other ties with various organizations, including the sponsors of TREATgermany. The other authors declared no conflicts of interest.

Source: Traidl S, Heinrich L, Siegels D, et al, and the TREATgermany study group. Treatment of moderate-to-severe atopic dermatitis with baricitinib: Results from an interim analysis of the TREATgermany registry. J Eur Acad Dermatol Venereol. 2024 (Mar 28). doi: 10.1111/jdv.19979 Source

Key clinical point: Baricitinib treatment was effective and well-tolerated in patients with moderate to severe atopic dermatitis (AD) who were followed-up for 3 months in real-world settings.

Major finding: Baricitinib led to a significant reduction in the Eczema Area Severity Index (21.5 ± 13.2 vs 9.3 ± 9.0) and objective Scoring AD (45.9 ± 12.3 vs 28.2 ± 15.5) scores at 3 months vs start visit (both P < .001). The treatment discontinuation rate was 16.7%, with two patients discontinuing baricitinib due to adverse events.

Study details: This was an interim analysis of the TREATgermany registry that included 81 adult patients with moderate to severe AD who received baricitinib and concomitant topical treatment, of whom 49 had initiated baricitinib at a registry visit; 26 of these did not switch from a previous systemic drug and had their first follow-up visit at 3 months.

Disclosures: TREATgermany is supported by AbbVie Deutschland GmbH & Co. KG, Galderma S.A., and others. Six authors declared serving as consultants, lecturers, etc., for or having other ties with various organizations, including the sponsors of TREATgermany. The other authors declared no conflicts of interest.

Source: Traidl S, Heinrich L, Siegels D, et al, and the TREATgermany study group. Treatment of moderate-to-severe atopic dermatitis with baricitinib: Results from an interim analysis of the TREATgermany registry. J Eur Acad Dermatol Venereol. 2024 (Mar 28). doi: 10.1111/jdv.19979 Source

Key clinical point: Baricitinib treatment was effective and well-tolerated in patients with moderate to severe atopic dermatitis (AD) who were followed-up for 3 months in real-world settings.

Major finding: Baricitinib led to a significant reduction in the Eczema Area Severity Index (21.5 ± 13.2 vs 9.3 ± 9.0) and objective Scoring AD (45.9 ± 12.3 vs 28.2 ± 15.5) scores at 3 months vs start visit (both P < .001). The treatment discontinuation rate was 16.7%, with two patients discontinuing baricitinib due to adverse events.

Study details: This was an interim analysis of the TREATgermany registry that included 81 adult patients with moderate to severe AD who received baricitinib and concomitant topical treatment, of whom 49 had initiated baricitinib at a registry visit; 26 of these did not switch from a previous systemic drug and had their first follow-up visit at 3 months.

Disclosures: TREATgermany is supported by AbbVie Deutschland GmbH & Co. KG, Galderma S.A., and others. Six authors declared serving as consultants, lecturers, etc., for or having other ties with various organizations, including the sponsors of TREATgermany. The other authors declared no conflicts of interest.

Source: Traidl S, Heinrich L, Siegels D, et al, and the TREATgermany study group. Treatment of moderate-to-severe atopic dermatitis with baricitinib: Results from an interim analysis of the TREATgermany registry. J Eur Acad Dermatol Venereol. 2024 (Mar 28). doi: 10.1111/jdv.19979 Source

Key clinical point: Patients with atopic dermatitis (AD) have a significantly increased risk of developing lymphoma.

Major finding: Patients with AD vs control individuals showed a significantly increased likelihood of developing noncutaneous T-cell lymphoma (odds ratio [OR] 2.52; 95% CI 1.37-4.62), with similar outcomes for the peripheral T-cell lymphoma subtype (OR 4.00; 95% CI 1.50-10.66).

Study details: Findings are from a nested case-control study including 6425 adult patients with AD and 25,700 matched control individuals without AD from electronic health records.

Disclosures: This study did not receive any funding. Benjamin Ungar reported being an employee of Mount Sinai and receiving research funds from and serving as a consultant for various organizations.

Source: Powers CM, Piontkowski AJ, Orloff J, et al. Risk of lymphoma in patients with atopic dermatitis: A case-control study in the All of Us database. J Am Acad Dermatol. 2024 (Apr 4). doi: 10.1016/j.jaad.2024.03.038 Source

Key clinical point: Patients with atopic dermatitis (AD) have a significantly increased risk of developing lymphoma.

Major finding: Patients with AD vs control individuals showed a significantly increased likelihood of developing noncutaneous T-cell lymphoma (odds ratio [OR] 2.52; 95% CI 1.37-4.62), with similar outcomes for the peripheral T-cell lymphoma subtype (OR 4.00; 95% CI 1.50-10.66).

Study details: Findings are from a nested case-control study including 6425 adult patients with AD and 25,700 matched control individuals without AD from electronic health records.

Disclosures: This study did not receive any funding. Benjamin Ungar reported being an employee of Mount Sinai and receiving research funds from and serving as a consultant for various organizations.

Source: Powers CM, Piontkowski AJ, Orloff J, et al. Risk of lymphoma in patients with atopic dermatitis: A case-control study in the All of Us database. J Am Acad Dermatol. 2024 (Apr 4). doi: 10.1016/j.jaad.2024.03.038 Source

Key clinical point: Patients with atopic dermatitis (AD) have a significantly increased risk of developing lymphoma.

Major finding: Patients with AD vs control individuals showed a significantly increased likelihood of developing noncutaneous T-cell lymphoma (odds ratio [OR] 2.52; 95% CI 1.37-4.62), with similar outcomes for the peripheral T-cell lymphoma subtype (OR 4.00; 95% CI 1.50-10.66).

Study details: Findings are from a nested case-control study including 6425 adult patients with AD and 25,700 matched control individuals without AD from electronic health records.

Disclosures: This study did not receive any funding. Benjamin Ungar reported being an employee of Mount Sinai and receiving research funds from and serving as a consultant for various organizations.

Source: Powers CM, Piontkowski AJ, Orloff J, et al. Risk of lymphoma in patients with atopic dermatitis: A case-control study in the All of Us database. J Am Acad Dermatol. 2024 (Apr 4). doi: 10.1016/j.jaad.2024.03.038 Source

Key clinical point: Passive smoking during pregnancy is associated with an increased risk for atopic dermatitis (AD) in offspring; however, the association between active smoking during pregnancy and AD in offspring remains unestablished.

Major finding: Passive smoking during pregnancy led to a higher risk for AD in offspring (odds ratio [OR] 1.52; 95% CI 1.36-1.70); however, active smoking during pregnancy did not increase the risk for AD in offspring (OR 0.96; 95% CI 0.86-1.07).

Study details: This meta-analysis of 15 observational studies included children or mother-child pairs who underwent either questionnaire-based or physician assessment for AD diagnosis and questionnaire-based assessment or cotinine level measurement for evaluating exposure to active or passive smoking.

Disclosures: This study was supported by the Key Scientific and Technological Research Projects of Henan Province and the Key Scientific Research Projects in Universities of Henan Province, China. The authors declared no conflicts of interest.

Source: Chao L, Liang W, Zhao X, et al. Maternal tobacco exposure during pregnancy and atopic dermatitis in offspring: A systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2024 (Ma 14). doi: 10.1111/jdv.19958 Source

Key clinical point: Passive smoking during pregnancy is associated with an increased risk for atopic dermatitis (AD) in offspring; however, the association between active smoking during pregnancy and AD in offspring remains unestablished.

Major finding: Passive smoking during pregnancy led to a higher risk for AD in offspring (odds ratio [OR] 1.52; 95% CI 1.36-1.70); however, active smoking during pregnancy did not increase the risk for AD in offspring (OR 0.96; 95% CI 0.86-1.07).

Study details: This meta-analysis of 15 observational studies included children or mother-child pairs who underwent either questionnaire-based or physician assessment for AD diagnosis and questionnaire-based assessment or cotinine level measurement for evaluating exposure to active or passive smoking.

Disclosures: This study was supported by the Key Scientific and Technological Research Projects of Henan Province and the Key Scientific Research Projects in Universities of Henan Province, China. The authors declared no conflicts of interest.

Source: Chao L, Liang W, Zhao X, et al. Maternal tobacco exposure during pregnancy and atopic dermatitis in offspring: A systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2024 (Ma 14). doi: 10.1111/jdv.19958 Source

Key clinical point: Passive smoking during pregnancy is associated with an increased risk for atopic dermatitis (AD) in offspring; however, the association between active smoking during pregnancy and AD in offspring remains unestablished.

Major finding: Passive smoking during pregnancy led to a higher risk for AD in offspring (odds ratio [OR] 1.52; 95% CI 1.36-1.70); however, active smoking during pregnancy did not increase the risk for AD in offspring (OR 0.96; 95% CI 0.86-1.07).

Study details: This meta-analysis of 15 observational studies included children or mother-child pairs who underwent either questionnaire-based or physician assessment for AD diagnosis and questionnaire-based assessment or cotinine level measurement for evaluating exposure to active or passive smoking.

Disclosures: This study was supported by the Key Scientific and Technological Research Projects of Henan Province and the Key Scientific Research Projects in Universities of Henan Province, China. The authors declared no conflicts of interest.

Source: Chao L, Liang W, Zhao X, et al. Maternal tobacco exposure during pregnancy and atopic dermatitis in offspring: A systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2024 (Ma 14). doi: 10.1111/jdv.19958 Source

Key clinical point: In children with atopic dermatitis (AD), weekly vitamin D3 (VD3) supplementation vs placebo for 6 weeks failed to decrease the clinical severity of AD or alter type 2 immunity biomarkers.

Major finding: At 6 weeks, the change in the Severity Scoring of AD (SCORAD) index was similar in the VD3 (−5.3 ± 11.6) and placebo (−5.5 ± 9.9; P = .91) groups. No significant between-group differences were observed for change in type 2 immunity blood biomarkers, such as eosinophil counts, total immunoglobulin E (IgE), and specific IgE against staphylococcal enterotoxin A and B (all P > .05).

Study details: This randomized controlled trial included 101 children with AD (age 2-17 years) who were randomly assigned to receive weekly oral VD3 (8000, 12,000, and 16,000 IU for ages 2-5.9, 6-11.9, and 12-17.9 years, respectively; n = 53) or placebo (n = 48) for 6 weeks.

Disclosures: This study was funded by Fondo de Desarrollo Científico y Tecnológico, Chile. The authors declared no conflicts of interest.

Source: Borzutzky A, Iturriaga C, Pérez-Mateluna G, et al. Effect of weekly vitamin D supplementation on the severity of atopic dermatitis and type 2 immunity biomarkers in children: A randomized controlled trial. J Eur Acad Dermatol Venereol. 2024 (Mar 14). doi: 10.1111/jdv.19959 Source

Key clinical point: In children with atopic dermatitis (AD), weekly vitamin D3 (VD3) supplementation vs placebo for 6 weeks failed to decrease the clinical severity of AD or alter type 2 immunity biomarkers.

Major finding: At 6 weeks, the change in the Severity Scoring of AD (SCORAD) index was similar in the VD3 (−5.3 ± 11.6) and placebo (−5.5 ± 9.9; P = .91) groups. No significant between-group differences were observed for change in type 2 immunity blood biomarkers, such as eosinophil counts, total immunoglobulin E (IgE), and specific IgE against staphylococcal enterotoxin A and B (all P > .05).

Study details: This randomized controlled trial included 101 children with AD (age 2-17 years) who were randomly assigned to receive weekly oral VD3 (8000, 12,000, and 16,000 IU for ages 2-5.9, 6-11.9, and 12-17.9 years, respectively; n = 53) or placebo (n = 48) for 6 weeks.

Disclosures: This study was funded by Fondo de Desarrollo Científico y Tecnológico, Chile. The authors declared no conflicts of interest.

Source: Borzutzky A, Iturriaga C, Pérez-Mateluna G, et al. Effect of weekly vitamin D supplementation on the severity of atopic dermatitis and type 2 immunity biomarkers in children: A randomized controlled trial. J Eur Acad Dermatol Venereol. 2024 (Mar 14). doi: 10.1111/jdv.19959 Source

Key clinical point: In children with atopic dermatitis (AD), weekly vitamin D3 (VD3) supplementation vs placebo for 6 weeks failed to decrease the clinical severity of AD or alter type 2 immunity biomarkers.

Major finding: At 6 weeks, the change in the Severity Scoring of AD (SCORAD) index was similar in the VD3 (−5.3 ± 11.6) and placebo (−5.5 ± 9.9; P = .91) groups. No significant between-group differences were observed for change in type 2 immunity blood biomarkers, such as eosinophil counts, total immunoglobulin E (IgE), and specific IgE against staphylococcal enterotoxin A and B (all P > .05).

Study details: This randomized controlled trial included 101 children with AD (age 2-17 years) who were randomly assigned to receive weekly oral VD3 (8000, 12,000, and 16,000 IU for ages 2-5.9, 6-11.9, and 12-17.9 years, respectively; n = 53) or placebo (n = 48) for 6 weeks.

Disclosures: This study was funded by Fondo de Desarrollo Científico y Tecnológico, Chile. The authors declared no conflicts of interest.

Source: Borzutzky A, Iturriaga C, Pérez-Mateluna G, et al. Effect of weekly vitamin D supplementation on the severity of atopic dermatitis and type 2 immunity biomarkers in children: A randomized controlled trial. J Eur Acad Dermatol Venereol. 2024 (Mar 14). doi: 10.1111/jdv.19959 Source

Key clinical point: Tralokinumab-mediated inhibition of interleukin (IL)-13 improved epidermal pathology and reduced the expression of key atopic dermatitis (AD) biomarkers in the serum of patients with moderate to severe AD.

Major finding: At week 16, tralokinumab vs placebo led to a significantly greater decrease from baseline in serum levels of type 2 biomarkers (CCL17/TARC, periostin, immunoglobulin E, and IL-22; all P < .05), a greater mean percentage change in the Eczema Area Severity Index score (−55.6 vs −36.7), and improved expression of genes dysregulated in AD (46.6% vs 16.4%; P < .001).

Study details: This study involved the collection of blood samples from 802 patients with moderate to severe AD randomized in the ECZTRA 1 and ECZTEND trials, followed by the selection of a subset of 299 patients with relevant samples available who had received tralokinumab (n = 223) or placebo (n = 76).

Disclosures: LEO Pharma A/S funded both ECZTRA 1 and the ongoing ECZTEND trial. Six authors declared being employees or shareholders of LEO Pharma. Several authors declared receiving research grants from or having other ties with various sources, including LEO Pharma.

Source: Guttman-Yassky E, Kabashima K, Staumont-Salle D, et al. Targeting IL-13 with tralokinumab normalizes type 2 inflammation in atopic dermatitis both early and at 2 years. Allergy. 2024 (Apr 2). doi: 10.1111/all.16108 Source

Key clinical point: Tralokinumab-mediated inhibition of interleukin (IL)-13 improved epidermal pathology and reduced the expression of key atopic dermatitis (AD) biomarkers in the serum of patients with moderate to severe AD.

Major finding: At week 16, tralokinumab vs placebo led to a significantly greater decrease from baseline in serum levels of type 2 biomarkers (CCL17/TARC, periostin, immunoglobulin E, and IL-22; all P < .05), a greater mean percentage change in the Eczema Area Severity Index score (−55.6 vs −36.7), and improved expression of genes dysregulated in AD (46.6% vs 16.4%; P < .001).

Study details: This study involved the collection of blood samples from 802 patients with moderate to severe AD randomized in the ECZTRA 1 and ECZTEND trials, followed by the selection of a subset of 299 patients with relevant samples available who had received tralokinumab (n = 223) or placebo (n = 76).

Disclosures: LEO Pharma A/S funded both ECZTRA 1 and the ongoing ECZTEND trial. Six authors declared being employees or shareholders of LEO Pharma. Several authors declared receiving research grants from or having other ties with various sources, including LEO Pharma.

Source: Guttman-Yassky E, Kabashima K, Staumont-Salle D, et al. Targeting IL-13 with tralokinumab normalizes type 2 inflammation in atopic dermatitis both early and at 2 years. Allergy. 2024 (Apr 2). doi: 10.1111/all.16108 Source

Key clinical point: Tralokinumab-mediated inhibition of interleukin (IL)-13 improved epidermal pathology and reduced the expression of key atopic dermatitis (AD) biomarkers in the serum of patients with moderate to severe AD.

Major finding: At week 16, tralokinumab vs placebo led to a significantly greater decrease from baseline in serum levels of type 2 biomarkers (CCL17/TARC, periostin, immunoglobulin E, and IL-22; all P < .05), a greater mean percentage change in the Eczema Area Severity Index score (−55.6 vs −36.7), and improved expression of genes dysregulated in AD (46.6% vs 16.4%; P < .001).

Study details: This study involved the collection of blood samples from 802 patients with moderate to severe AD randomized in the ECZTRA 1 and ECZTEND trials, followed by the selection of a subset of 299 patients with relevant samples available who had received tralokinumab (n = 223) or placebo (n = 76).

Disclosures: LEO Pharma A/S funded both ECZTRA 1 and the ongoing ECZTEND trial. Six authors declared being employees or shareholders of LEO Pharma. Several authors declared receiving research grants from or having other ties with various sources, including LEO Pharma.

Source: Guttman-Yassky E, Kabashima K, Staumont-Salle D, et al. Targeting IL-13 with tralokinumab normalizes type 2 inflammation in atopic dermatitis both early and at 2 years. Allergy. 2024 (Apr 2). doi: 10.1111/all.16108 Source