Effect of dupilumab on sleep disturbances in adult patients with severe atopic dermatitis.

BACKGROUND Sleep disturbances are common in patients with atopic dermatitis (AD). Considering their relevant burden on health, routine screening of sleep disturbances seems to be very useful in AD adults management. However, few studies have evaluated the association between sleep disturbances and AD in adults and real-life data are lacking. The aim is to assess the effect of treatment with dupilumab on sleep disturbances in adult patients with severe atopic dermatitis. METHODS Retrospective, multicenter study including patients (age≥18 yr.s) with severe atopic dermatitis who were treated with dupilumab for at least 8 months from January 2019 to January 2020. Patients were evaluated three times: at treatment initiation (T0) and at 4 (T4) and 8 months (T8) from the start of treatment. At each visit disease activity was assessed by severity score (Eczema Area and Severity Index, EASI), patient-reported outcomes (Pruritus Numerical Rating Scale, NRS, Dermatology Life Quality Index,DLQI, and Pittsburgh Sleep Quality Index, PSQI). Kolmogorov-Smirnov test was performed to evaluate the normality distribution, Bartlett's test for homoscedasticity. Since the assumptions were met, ANOVA for repeated measures was performed to evaluate the mean difference of PSQI, EASI, DLQI and Pruritus NRS between baseline, 4th month and 8th month. In addition, Chi-square for Trend test was performed to evaluate the increasing/decreasing prevalence of poor sleepers. RESULTS A total of 36 patients (15 females and 21 males) with a mean age of 42.5±14.3 (range 20-67) were included in the study. The mean score for PSQI at TO was 9.0 ±3.6. At week 16 (T4) the mean score for PSQI was 4.92±2.99 and at week 32 (T8), the mean score for PSQI was 4.3± 3.0. EASI, NRS pruritus and DLQI significantly improved during follow up (p<0.001) whereas PSQI improved significantly at 16 weeks (T4) but no significant further improvement was observed at 32 weeks. Of the 31 patients (86%) with baseline PSQI≥5, 17 (54%)experienced sleep quality improvement during treatment. Overall, we observed a total of 22 patients (61.1%) having a PSQI <5 at 32 weeks CONCLUSIONS: Our data show effectiveness of Dupilumab in improving sleep disturbances in adult patients with severe AD. However, further studies are required to uPnSdQeIr sctoaunld isf erve as useful evaluating tool.