Omalizumab en el tratamiento de la dermatitis atópica

doi:10.1016/j.ad.2011.07.013

Actas Dermo-Sifiliográficas

Volume 103, Issue 7, September 2012, Pages 624-628

https://doi.org/10.1016/j.ad.2011.07.013 Get rights and content

Resumen

La atopia se acompaña de forma casi constante de una producción elevada de inmunoglobulina E (IgE). Omalizumab es un anticuerpo monoclonal anti-IgE, que actualmente está indicado en pacientes con asma que cumplen determinados criterios. Se han publicado algunos estudios sobre la utilidad del omalizumab en el tratamiento de la dermatitis atópica (DA), con resultados variables.

Presentamos nuestra experiencia en 9 pacientes con dermatitis atópica grave, refractaria al menos a dos fármacos sistémicos. Todos los pacientes tratados referían una disminución del prurito y una mejoría en su calidad de vida. Los que presentaban asma consiguieron un buen control desde el punto de vista respiratorio, sin precisar otros tratamientos adicionales. En dos casos se consiguió un buen control en monoterapia, apreciándose una discreta mejoría de las lesiones de eccema en 4 de ellos.

El omalizumab es un fármaco bien tolerado y seguro. Puede ser útil en el tratamiento de pacientes con DA grave, refractaria a otros tratamientos sistémicos. Este anticuerpo monoclonal anti-IgE abre la puerta a los tratamientos inmunomoduladores sistémicos para el manejo de la DA, lo que supone un gran avance terapéutico.

Abstract

Atopy is almost always associated with an elevated immunoglobulin (Ig) E production. Omalizumab is a monoclonal anti-IgE antibody that is currently indicated for the treatment of cases of asthma that satisfy certain criteria. A number of studies have been published on the usefulness of omalizumab in the treatment of atopic dermatitis, and the results have been variable. We present our experience in the treatment of 9 patients with severe atopic dermatitis refractory to at least 2 systemic drugs. All patients reported a decrease in pruritus and an improvement in quality of life. Good control of the skin disease was achieved with omalizumab in monotherapy in 2 patients, and there was a slight improvement in the eczematous lesions in 4 patients. Those patients who also had asthma achieved good control of their respiratory symptoms and did not require additional therapy. Omalizumab is a well-tolerated and safe drug that can be useful for the treatment of severe atopic dermatitis refractory to other systemic therapies. This monoclonal anti-IgE antibody is a major therapeutic advance as it opens the door to the management of atopic dermatitis using systemic immunomodulating therapies.

Section snippets

Introducción

La atopia se define como un conjunto de enfermedades crónicas con un fuerte componente hereditario (asma, rinoconjuntivitis, eccema), basadas en una hipersensibilidad cutánea y/o de mucosas frente a determinadas sustancias ambientales, junto a una producción elevada de inmunoglobulina E (IgE) y/o una reactividad inespecífica alterada¹. (tabla 1).

Omalizumab es un anticuerpo monoclonal quimérico, humanizado, constituido en un 95% por IgG1 humana, siendo el 5% un epítopo específico de la IgE

Casos clínicos

Presentamos 9 pacientes con dermatitis atópica (DA) grave tratados con omalizumab en nuestro centro desde enero de 2007 hasta octubre de 2009. Todos los pacientes eran mayores de 18 años de edad y presentaban DA grave y refractaria, al menos a dos fármacos sistémicos. Omalizumab fue pautado como tratamiento de uso compasivo. Los pacientes fueron informados con detalle de las opciones terapéuticas disponibles y firmaron el correspondiente consentimiento informado.

De los 9 pacientes 5 eran

Discusión

La inmunopatología de la DA varía en función del momento evolutivo de la enfermedad (fig. 1). El mecanismo de acción de omalizumab en la atopia es multifactorial y se traduce en una inmunomodulación global. En primer lugar disminuye la IgE y la degranulación de los mastocitos y los macrófagos, así como una gran cantidad de mediadores de la inflamación implicados en la DA (IL-13, IL-5, IL-8, TFN-α, leucotrienos, prostaglandinas). Además bloquea la cascada de eventos TH2, punto clave en la

Conflicto de intereses

Los autores declaran no tener ningún conflicto de intereses.

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There are more references available in the full text version of this article.

Cited by (32)

Targeting immunoglobulin E in atopic dermatitis: A review of the existing evidence
2021, World Allergy Organization Journal
Citation Excerpt :
They can also identify responses and outcomes in special patient populations such as pregnant women, the elderly, children, and patients with comorbidities such as cancer, human immunodeficiency virus, or other chronic diseases. The use of omalizumab in patients with AD has been presented in multiple case series and case reports.42,44–77 Details on these cases are summarised in Table 1.
Immunoglobulin E (IgE) plays an essential role in many allergic diseases. This review highlights the role of IgE in atopic dermatitis (AD), a common, chronic, and complex skin inflammation, and the available therapeutic approaches that target IgE in AD. We examine the existing data showing the use of omalizumab, the only biologic anti-IgE therapy available in clinical use, plasma apheresis, and a combination of both therapeutic approaches for the treatment of AD. Existing data on the efficacy of omalizumab in AD are inconclusive. A limited number of randomised controlled studies, few uncontrolled prospective and retrospective reports, as well as multiple case series and case reports observed varying degrees of the efficacy of omalizumab in AD. Omalizumab displays a trend of higher efficacy in AD patients with low IgE levels compared with those with very high-to-extremely high serum IgE concentrations. Plasma apheresis and its combination with omalizumab show good efficacy, even in patients with unusually high serum IgE concentrations. Combining apheresis and anti-IgE treatment may serve as a comprehensive therapeutic approach for patients with elevated levels of IgE. Dedicated clinical studies with robust study designs are needed to establish the therapeutic efficacy of omalizumab in AD.
Medicinal potential of Panax ginseng and its ginsenosides in atopic dermatitis treatment
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Citation Excerpt :
However, special irradiation devices, which are only available in specialist centers, are needed for this type of treatment [30], and depending on the patient, unwanted side effects such as erythema, blistering, hyperpigmentation, and eczema, among others, might appear [31]. In addition, specific AD mediator's inhibition treatments have been developed such as cyclosporine A [32] and azathioprine [33] (Tcell inhibitors), infliximab [34] (TNF-α inhibitor), omalizumab [35] (IgE inhibitor), mepolizumab (IL-5 inhibitor) [11], and dupilumab (IL-4 and IL-13 inhibitors) [36]. Exempting dupilumab, which is currently on medical trial, all remaining treatments have proved to have either low efficacy on AD's treatment or undesired secondary effects (Table 1).
Atopic dermatitis (AD) is a chronic and relapsing inflammatory disease that affects 1%–20% of people worldwide. Despite affecting many people, AD current treatments, such as corticosteroids and calcineurin inhibitors, have not only harmful secondary effects but are also often ineffective. Therefore, natural nontoxic compounds are on high demand for developing new effective AD treatments. Panax ginseng Meyer has been used traditionally for its promising healing and restorative properties to treat many diseases including skin disorders, reason why in this review we want to explore the research performed with AD and P. ginseng as well as determining its potential for new drug development. Previous researches have shown that P. ginseng has positive effects in AD patients such as lower eczema area and severity index, transepidermal water loss, and immunoglobulin E levels and better quality of sleep. In vivo animal models, as well, have shown positive results to P. ginseng and derived ginsenosides, such as the decrease of transepidermal water loss, immunoglobulin E levels in serum, allergy-related cytokines, and downregulation of NF-κB, MAPK, and Ikaros pathways. All of these previous data suggest that P. ginseng and its derived ginsenosides are undoubtedly a nontoxic effective option to treat AD.
Efficacy of omalizumab in patients with atopic dermatitis: A systematic review and meta-analysis
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Omalizumab for severe atopic dermatitis associated with hyper IgE
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The Efficacy and Effectiveness of the Biological Treatment of Pruritus in the Course of Atopic Dermatitis
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Biological medication in atopic dermatitis
2022, Expert Opinion on Biological Therapy

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Caso clínicoOmalizumab en el tratamiento de la dermatitis atópicaOmalizumab for the Treatment of Atopic Dermatitis

Resumen

Abstract

Section snippets

Introducción

Casos clínicos

Discusión

Conflicto de intereses

J Am Acad Dermatol

J Invest Dermatol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Am Acad Dermatol

J Am Acad Dermatol

Off-label use of omalizumab in non-asthma conditions: new opportunities

Expert Rev Respir Med

Caso clínico
Omalizumab en el tratamiento de la dermatitis atópicaOmalizumab for the Treatment of Atopic Dermatitis