Systemic Treatment of Atopic Dermatitis – European Guidelines and Current State of Art
Authors:
N. Benáková 1,2
Authors‘ workplace:
Dermatovenerologická klinika 1. LF UK, Praha, přednosta prof. MUDr. Jiří Štork, CSc.
1; Dermato-alergologická ordinace Immuno Flow Praha, vedoucí lékař MUDr. Martin Fuchs
2
Published in:
Čes-slov Derm, 94, 2019, No. 6, p. 223-231
Category:
Reviews (Continuing Medical Education)
Overview
Patients with severe atopic dermatitis and their physicians have been waiting for new systemic drugs for a long time. The use of conventional immunosuppressants (corticosteroids, cyclosporine A and off label use of methotrexate, mycophenolate mofetil and azathioprine) is limited due to their long-term low efficacy, cumulative toxicity and side effects. Phototherapy doesn´t represent a long-term therapy option either and moreover, it isn´t as effective as systemic treatment in atopic dermatitis. The need for long-term effective and safe drugs is evident. Biologics, small molecules and other new drugs seem to be promising candidates. As a positive side effect of new drug introduction, the existing systemic drugs are being revisited. This article deals with the conclusions of the European guidelines, clinical profile comparison of methotrexate and cyclosporine A, dupilumab characteristics and perspectives in systemic therapy of atopic dermatitis.
Keywords:
atopic dermatitis – systemic therapy – European guidelines – current situation
Sources
1. BENÁKOVÁ, N. Atopická dermatitida v roce 2009. Čs Derm, 2009, 84(2), p. 65–68.
2. BENÁKOVÁ, N. Terapeutická edukace. Čs Derm, 2015, 90(1), p. 4–10.
3. EICHENFELD, L. F., AHLUWALIA, J., WALDMANN, A. et al. Current guidelines for the evaluation and management of atopic dermatitis: a comparison of the Joint Task Force practice parameter and American Academy of Dermatology guidelines. JAACI, 2017, 139(4), p. 49–57.
4. ELMARIAH, S. B., LERNER, E. A. The missing link between itch and inflammation in atopic dermatitis. Cell, 2013, 155(2), p. 267–269.
5. GARRITSEN, F. M., van den HEUVEL, J. M., BRUINZEEL-KOOMEN, C. A. F. M. et al. Use of oral immunosuppressive drugs in the treatment of AD in Netherlands. JEADV, 2018, 32(8), p. 1336–1342.
6. GERBENS, L. A. A., HAMANN, S. A. S., BROUWER, M.W.D. et al. Methotrexate and azathioprin for severe atopic dermatitis. Br J Dermatol, 2018, 178(6), p. 1288–1296.
7. GOUJON, C., VIGUIER, M., STAUMONT-SALLÉ, D. et al. Methotrexate versus cyclosporine A in adults with moderate-to-severe atopic dermatitis: a phase III randomized noninferiority trial. J Allergy Clin Immunol Pract, 2018, 6(2), p. 562–589.
8. CHOPRA, R.,VAKHARIA, P. P., SIMPSON, E.L. et al. Severity assessment for inclusion criteria and baseline severity evaluation of atopic dermatitis clinical trials: a systematic review. JEADV, 2017, 31(11), p. 1890–1899.
9. IRVINE, A. D., BEATTLE, J. P., BARON, S. et al. A randomized controlled trial protokol assesing the effectiveness, safety and cost-effectiveness of methotrexate vs. ciclosporin in the treatment of severe atopic eczema in children. Br J Dermatol, 2018, 179(6), p. 1297–1306.
10. LAW PING MAN, S., BOUZILLÉ, G., BENETON, N. et al. Drug survival and postdrug survival of first line immunosuppressive treatments for atopic dermatitis: comparison between methotrexate and cyclosporine. JEADV, 2018, 32(8), p. 1327–1335.
11. PALER, A.S., JAWORSKI, J. C., SIMPSON, E. L. et al. Major comorbidities of atopic dermatitis: beyond allergic disorders. Am J Clin Dermatol, 2018, 19(6), p. 821–838.
12. PALER, A. S., KONG, H. H., SEED, P. et al. The microbiome in patients with atopic dermatitis. JAACI, 2019, 143(1), p. 26–35.
13. ROEKEVISCH, E., SPULS, P. I., KUESTER, D. et al. Efficacy and safety of systemic treatments for moderate-to-severe atopic dermatitis: a systematic review. J Allergy Clin Immunol, 2014, 133(2), p. 429–438.
14. SHAFT, van der, J., POLITIEK, K., REEK van den, JMPA. et al. Drug survival for ciclosporin A in a long--term daily practice cohort of adult patients with atopic dermatitis. Br J Dermatol, 2015,172(6), p. 1621–1627.
15. SIMPSON, E. L. et al. When does AD warrant systemic therapy ? JAAD, 2017, 77(4), p. 623–633.
16. VANGIPURAM, R., TYRING, S.K. Dupilumab for Moderate-to-Severe Atopic Dermatitis. Skin Therapy Letter, 2017, 22(6), p. 1–4.
17. WEIDINGER, S., NOVAK, N. Atopic Dermatitis. Lancet, 2016, 387(1023), p. 1109–1122.
18. WOLLENBERG, A. BARBAROT, S., BIEBER, T. et al. Consensus-based European guidelines for treatment of atopic eczema (dermatitis) in adults and children: part I. JEADV, 2018, 32(5), p. 657–682.
19. WOLLENBERG, A., BARBAROT, S., BIEBER, T. et al. Consensus-based European guidelines for treatment of atopic eczema (dermatitis) in adults and children: part II. JEADV, 2018, 32(5), p. 850–878.
20. WOLLENBERG, A. et al. Conjunctivitis occurring in atopic dermatitis patients treated with dupilumab – clinical characteristics and treatment. J Allergy Clin Immunol Pract, 2018, 6(5), p. 1778–1780.
21. Souhrn údajů o léku (SPC) Dupixent. Dostupné na www: www.sukl.cz.
Labels
Dermatology & STDs Paediatric dermatology & STDsArticle was published in
Czech-Slovak Dermatology
2019 Issue 6
Most read in this issue
- Svědění konečníku
- Spitz Tumors – Diagnostically Difficult Situations. A Series of Cases
- Systemic Treatment of Atopic Dermatitis – European Guidelines and Current State of Art
- Clinical Case: Pink Papule on the Calf