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Sequential combined therapy with Omalizumab and Rituximab: A new approach to severe atopic dermatitis

Abstract:

Background: Atopic dermatitis (AD) is a common chronic skin disease, and a signifi cant percentage of AD patients have severe forms. Infl ammation based on type 2 helper T cells (TH2), autoantibodies, and CD8+ T cells could play a relevant role in this disease. When the patient requires systemic immunosuppressors for disease control, side effects are frequent. We propose a sequential therapeutic strategy with 2 monoclonal antibodies, omalizumab (anti-immunoglobulin [Ig] E) and rituximab (anti-CD20), which might induce clinical benefi t with few side effects in selected individuals with AD. Methods: We report 6 cases of severe AD refractory to conventional therapy. The patients underwent sequential switch therapy with omalizumab and rituximab. Clinical response was assessed by means of the decrease in body surface affected. Immunological parameters and side effects were also monitored. Results: Four patients received omalizumab before a high-dose cycle of rituximab. In the case of recurrences, either low-dose cycles of rituximab or omalizumab were administered. A long-term clinical benefi t was observed in 3 out of 4 patients. Two patients fi rst received high-dose rituximab followed by either low-dose rituximab or omalizumab, and one of them achieved a response at 17 months. No severe side effects were recorded. Serum IgE level and B-cell counts decreased with therapy, the latter returning to baseline levels 10 to 11 months after treatment. Specifi c antibody responses remained protective during the study. Conclusions: With our proposed switch therapy, 4 out of 6 patients achieved a dramatic clinical improvement. This novel strategy targets different arms of the immune response and might be a good alternative for patients with severe AD. © 2013 Esmon Publicidad.