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<p>PsEma is an inflammatory skin condition with overlapping clinical and molecular features of atopic dermatitis and psoriasis involving Th1/Th22/Th17 pathways, and patients often respond suboptimally to single targeted therapy. We aimed to characterize the clinical response to dual biologic therapy targeting IL-4Rα and IL-23. We conducted a retrospective review of 28 patients with a clinical diagnosis of PsEma treated between January 2014 and June 2024 who either initiated dupilumab or an anti–IL-23 agent and later transitioned to dual therapy or who began combination therapy directly. Outcomes assessed included Body Surface Area (BSA), Investigator Global Assessment (IGA), and Eczema Area and Severity Index (EASI), with pairwise t-tests comparing changes on dual therapy versus monotherapy. Among 28 patients treated with combination therapy for a mean of 61 ± 59 weeks, clinical improvements were substantial, including BSA reduction of 32% ± 24%, IGA improvement of 2 points, and EASI reduction of 24 ± 18. These improvements exceeded those observed with dupilumab monotherapy (BSA 13% ± 16%, IGA 1 point, EASI 12 ± 11) or anti-IL-23 monotherapy (BSA 8% ± 26%, IGA 0–1 points, EASI 7 ± 13). Dual IL-4Rα/IL-23 blockade produced greater clinical improvement than either monotherapy alone, supporting its potential role in managing PsEma and highlighting the need for prospective evaluation.</p>

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The use of dual therapy targeting IL-4Rα and IL-23 in the treatment of PsEma, a psoriasis and eczema overlap condition

  • 期刊论文

  • 发表日期：

    2026年7月17日

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  • Joseph A. Largen,
  • Brandon R. Block,
  • Kelly Hawkins,
  • Sabrina Ghalili,
  • Sophie Guenin,
  • Akbobek Amangeldiyeva,
  • Joel Correa da Rosa,
  • Ester Del Duca,
  • Nicholas Gulati,
  • Benjamin Ungar,
  • Emma Guttman-Yassky

摘要

PsEma is an inflammatory skin condition with overlapping clinical and molecular features of atopic dermatitis and psoriasis involving Th1/Th22/Th17 pathways, and patients often respond suboptimally to single targeted therapy. We aimed to characterize the clinical response to dual biologic therapy targeting IL-4Rα and IL-23. We conducted a retrospective review of 28 patients with a clinical diagnosis of PsEma treated between January 2014 and June 2024 who either initiated dupilumab or an anti–IL-23 agent and later transitioned to dual therapy or who began combination therapy directly. Outcomes assessed included Body Surface Area (BSA), Investigator Global Assessment (IGA), and Eczema Area and Severity Index (EASI), with pairwise t-tests comparing changes on dual therapy versus monotherapy. Among 28 patients treated with combination therapy for a mean of 61 ± 59 weeks, clinical improvements were substantial, including BSA reduction of 32% ± 24%, IGA improvement of 2 points, and EASI reduction of 24 ± 18. These improvements exceeded those observed with dupilumab monotherapy (BSA 13% ± 16%, IGA 1 point, EASI 12 ± 11) or anti-IL-23 monotherapy (BSA 8% ± 26%, IGA 0–1 points, EASI 7 ± 13). Dual IL-4Rα/IL-23 blockade produced greater clinical improvement than either monotherapy alone, supporting its potential role in managing PsEma and highlighting the need for prospective evaluation.