Crisaborole and atopic dermatitis skin biomarkers: An intrapatient randomized trial

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:144

Article

Bissonnette, Robert¹  Pavel, Ana B.^2,3  Diaz, Aisleen^2,3,4  Werth, John L.⁵  Zang, Chuanbo⁵  Vranic, Ivana⁶  Purohit, Vivek S.⁷  Zielinski, Michael A.⁵  Vlahos, Bonnie⁵  Estrada, Yeriel D.^2,3  Proulx, Etienne Saint-Cyr¹  Ports, William C.⁷  Guttman-Yassky, Emma^2,3 

[1] Innovaderm Res, Montreal, PQ, Canada

[2] Icahn Sch Med Mt Sinai, Dept Dermatol, 5 East 98th St, New York, NY 10029 USA

[3] Icahn Sch Med Mt Sinai, Lab Inflammatory Skin Dis, 5 East 98th St, New York, NY 10029 USA

[4] Ponce Hlth Sci Univ, Sch Med, Ponce, PR USA

[5] Pfizer, Collegeville, PA USA

[6] Pfizer, Surrey, England

[7] Pfizer, Groton, CT USA

关键词: Atopic dermatitis;    crisaborole;    phosphodiesterase 4;    pruritus;    transcriptome;    gene expression;    inflammation;    biomarker;    transepidermal water loss;   

DOI  :  10.1016/j.jaci.2019.06.047

来源: Elsevier

【 摘 要 】

Background: Crisaborole ointment 2% is a nonsteroidal phosphodiesterase 4 inhibitor for the treatment of mild-to-moderate atopic dermatitis (AD). The mechanism of action of crisaborole and its effects on lesional measures of disease severity are not yet well defined. Objective: This phase 2a, single-center, vehicle-controlled, intrapatient study was designed to further characterize the mechanism of action of crisaborole through evaluation of clinical efficacy and changes in skin biomarkers in adults (n = 40) with mild-to-moderate AD. Methods: Two target lesions were randomized in an intrapatient (14) manner to double-blind crisaborole/vehicle applied twice daily for 14 days. Patients then applied crisaborole (open-label) to all affected areas for 28 days. Punch biopsy specimens were collected for biomarker analysis at baseline, day 8 (optional), and day 15. Results: Crisaborole treatment resulted in early improvement in lesional signs/symptoms versus vehicle, with improvement in pruritus (pruritus numeric rating scale) observed as early as 24 hours after the first application. Crisaborole-treated lesions showed significant percentage improvement from baseline in lesional transcriptomic profile compared with vehicle at day 8 (91.15% vs 36.02%, P < 10(-15)) that was sustained until day 15 (92.90% vs 49.59%, P < 10(-15)). Crisaborole significantly modulated key AD biomarkers versus vehicle, including T(H)2 and T(H)17/T(H)22 pathways and epidermal hyperplasia/proliferation. Molecular profiles and epidermal pathology normalized toward nonlesional skin and correlated with clinical changes in lesion severity and barrier function. Conclusion: Crisaborole reversed biomarker profiles of skin inflammation and barrier function, with associated improvements in clinical efficacy measures, highlighting the therapeutic utility of targeting phosphodiesterase 4 in patients with AD.

【 授权许可】

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