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25th April 2023
Adolescent atopic eczema (AE) gives rise to a negative impact on patient’s quality of life. There is already good evidence to suggest that interleukin-13 (IL-13) creates inflammation in AE. Tralokinumab (TK) specifically neutralises IL-13 and therefore reduces inflammation. Previous work has demonstrated efficacy for the drug adults with moderate to severe AE. However, it remains uncertain whether TK is effective for adolescents with moderate to severe disease.
The current randomised, double-blinded, placebo-controlled enrolled adolescents (12 – 17 years) with moderate to severe AE. Individuals received monotherapy with TK either 150 or 300mg or matching placebo every two weeks for 16 weeks. The primary endpoint was an Investigator’s Global Assessment (IGA) score of 0 or 1 (clear/almost clear) at week 16. An alternative was a 75% or higher improvement in EASI (i.e., an EASI 75). Those meeting the primary outcome at week 16 continued in a maintenance phase until week 52.
Tralokinumab and atopic eczema outcomes
There were 289 participants with a median age of 15 years (51.6% male) and of whom, 97 and 98 had 150 and 300 mg of TK respectively.
At week 16, significantly more patients receiving TK had an IGA of 0 or 1 than placebo: 21.4% (150 mg) and 17.5% (300 mg) vs 4.3% for placebo (p < 0.01 and p = 0.002 respectively). In addition, 28.6% of TK 150 mg patients had an EASI75, 27.8% of the TK 300 mg group but only 6.4% of those in the placebo arm. Larger improvements were seen for both doses of the drug compared to placebo for itch and quality of life scores.
At week 52, 62.9% of all tralokinumab participants maintained their IGA score of 0 or 1 with doses administered either every 2 or 4 weeks. The drug was tolerable with a similar proportion of adverse events in all three arms.
Tralokinumab therefore appears effective for adolescents with moderate to severe AE.
Paller AS et al. Efficacy and Safety of Tralokinumab in Adolescents With Moderate to Severe Atopic Dermatitis: The Phase 3 ECZTRA 6 Randomized Clinical Trial. JAMA Dermatol 2023
27th August 2021
The prescription of opioid drugs to paediatric patients, defined as those aged 0 to 17 years, can lead to not only adverse effects in the short-term, but problems in the longer-term. For example, a study in children without severe pain, found that one of every 2611 acute opioid prescriptions were followed by an opioid-related adverse event. Moreover, persistent use of opioids has been observed in nearly 5% of adolescents after surgery and which could ultimately lead to dependence. There is currently limited data on the prescription of such drugs to paediatric patients but some information derived from insurance claims suggests that 1 in 10 adolescents filled at least one opioid prescription per year. In contrast, other insurance-based studies have revealed how opioid prescribing to children and adolescents has been steadily reducing since 2012.
In trying to gain further insight of opioid prescribing, a team from the Division of General Pediatrics, University of Michigan, US, set out to assess the prevalence and safety of opioid prescriptions given to children and young adults. The team used a comprehensive prescription database that contained records for every prescription dispensed from 92% of US retail pharmacies, 70% of mail-order pharmacies and 70% of pharmacies in long-term care facilities. The team looked specifically at opioid and benzodiazepine prescriptions, excluding opioid cough and cold remedies and buprenorphine, used for substance misuse. In an effort to determine whether such prescriptions could be deemed at high-risk, the team used 6 different metrics; the proportion of prescriptions for opioid naïve patients exceeding 3 and 7-day supplies; the proportion of prescriptions dispensed for children aged 0 to 11; the proportion of opioid prescriptions given to those aged 12 to 21 years with daily dosages of > 50 morphine milligram equivalents (MME) and finally, the proportion of opioid prescriptions for adolescents, which overlapped with a benzodiazepine prescription for > 1 day and each of these metrics was derived from best-practice guidance.
The database included 4,027,701 opioid prescriptions, of which 86.6% were for patients aged 0 to 21 years, of whom 80.7% were opioid naïve. The majority of prescriptions were issued by a dentist (38.2%), followed by a surgery (23.3%), physician assistant (7.2%) and emergency department (7.1%). Overall, 3.5% of children and young adults had >1 dispensed opioid prescription. The most commonly prescribed opioid was hydrocodone (52.7%), followed by oxycodone (21.3%), codeine (13.8%) and tramadol (9.8%).
Among 3,250,443 prescriptions written for opioid naïve patients, 41.8% and 3.8% exceeded the recommended 3- and 7-day course respectively. Similarly, among 3,487,263 prescriptions for adolescents and young adults, 11.5% had a daily MME > 50 and 4.6% were co-prescribed with a benzodiazepine. In fact, 45.6% of all prescriptions were classed as being high-risk by more than one metric.
Commenting on their findings, the authors noted that the majority of prescriptions were issued by dentists and likely to have been for dental extractions although alternatives to opioid prescriptions such as non-steroidal anti-inflammatory drugs provide a similar level of pain relief. They concluded that broad-based initiatives are needed to address high-risk prescribing.
Chua KP et al. Prescribing to US children and young adults in 2019. Pediatrics. 2021