Oleh Admin Kalbe Medical pada June 09, 2017 07:30

Dupilumab Bermanfaat Meredakan Gejala Dermatitis Atopi Sedang-Berat

Dermatitis atopi adalah penyakit peradangan kronik pada kulit dengan gejala utama berupa rasa gatal yang sangat menganggu serta lesi kulit yang khas. Penyakit ini biasanya dimulai sejak bayi atau balita, dan pada sebagian kecil kasus akan berlanjut sampai dewasa. Pada penyakit ini, terjadi peningkatan kadar imunoglobulin E (IgE). Dermatitis atopi adalah satu dari 4 penyakit hipersensitivitas, dengan 3 yang lainnya antara lain rinitis alergi, asma, dan alergi makanan. Gejala utama dari dermatitis atopi adalah gatal. Kemudian pada lokasi-lokasi tertentu di kulit akan muncul lesi-lesi yang khas berbentuk plak, hiperpigmentasi, serta kulit kering bersisik. Lokasi yang terlibat biasanya adalah kulit pada bagian tubuh fleksor, seperti lipat siku dan lipat lutut, meskipun lokasi dapat bervariasi bergantung dari usia.

Pengobatan dermatitis atopi biasanya mengandalkan obat-obatan topikal seperti salep kortikosteroid. Pada dermatitis atopi ringan, pengobatan secara topikal dapat bermanfaat untuk meredakan gejala secara memuaskan, tetapi pada dermatitis atopi sedang dan berat, seringkali pengobatan topikal belum bisa meredakan gejala secara memuaskan. Dupilumab adalah obat monoclonal antibody yang bekerja dengan cara menghambat interleukin-4 dan interleukin-13. Diduga dupilumab dapat bermanfaat untuk meredakan gejala dermatitis atopi.


Oleh karena itu, dr. Blauvelt dan tim dari USA melakukan sebuah uji klinik yang diterbitkan di jurnal Lancet tahun 2017. Pada uji klinik ini, sebanyak 740 pasien dermatitis atopi sedang-berat yang tidak terkontrol menggunakan kortikosteroid topikal diacak untuk mendapatkan tambahan pengobatan berupa dupilumab 300 mg subkutan sekali seminggu, dupilumab 300 mg setiap 2 minggu, atau plasebo. Parameter yang dievaluasi adalah respons perbaikan gejala diukur menggunakan skor IGA (Investigator's Global Assessment) dan skor EASI75 (Eczema Area and Severity Index 75%).


Hasilnya, pada minggu ke-16 didapatkan bahwa kelompok yang mendapatkan dupilumab lebih banyak yang mengalami perbaikan gejala dibandingkan dengan kelompok plasebo, baik menurut skor IGA: 39% [dupilumab q1w], 39% [dupilumab q2w] dan 12% [plasebo] (p<0•0001); maupun skor EASI75: (64% [dupilumab q1w] and 69% [dupilumab q2w] vs 23% [plasebo] (p<0•0001). Kejadian tidak diinginkan dilaporkan serupa pada 3 kelompok, yaitu: 83% (dupilumab q1w), 88% (dupilumab q2w), dan 84% (plasebo).


Kesimpulan:
Penggunaan dupilumab (monoclonal antibody penghambat interleukin-4 dan interleukin-13) bermanfaat untuk meredakan gejala dermatitis atopi sedang-berat yang tidak berespons dengan pengobatan kortikosteroid topikal. (NNO)

Image : Ilustrasi
Referensi:
1.Atopic dermatitis: Practice essentials, background, pathophysiology [Internet]. 2017 Apr 6. Available from:http://emedicine.medscape.com/article/1049085-overview?pa=RQkCsSgTFpaaKC6zY1IS1AWJTd9%2B%2BP%2Fv%2BxLpLVbHhm5xkhahyn029%2BEmxu5YY2g%2FveO3iTErSoOyjZHIWECxQ8UpYh9Cqy2pnXDanvdYOKo%3D
2.Blauvelt A, de Bruin-Weller M, Gooderham M, Cather JC, Weisman J, Pariser D, et al. Long-term management of moderate-to-severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS): A 1-year, randomised, double-blinded, placebo-controlled, phase 3 trial. Lancet Lond Engl. 2017 May 4;

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