When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council - 14/09/17
Doi : 10.1016/j.jaad.2017.06.042
Eric L. Simpson, MD, MCR a, ⁎ 
, Marjolein Bruin-Weller, MD, PhD b, Carsten Flohr, MD, PhD, MSc c, Michael R. Ardern-Jones, DPhil(PhD), FRCP(MD) d, Sebastien Barbarot, MD, PhD e, Mette Deleuran, MD, DMSc f, Thomas Bieber, MD, PhD, MDRA g, h, Christian Vestergaard, MD, PhD, DMSc i, Sara J. Brown, MD, FRCPE j, k, Michael J. Cork, PhD, FRCP l, Aaron M. Drucker, MD, FRCPC m, Lawrence F. Eichenfield, MD n, o, p, Regina Foelster-Holst, MD q, Emma Guttman-Yassky, MD, PhD r, Audrey Nosbaum, MD, PhD s, Nick J. Reynolds, MD, FRCP t, u, Jonathan I. Silverberg, MD, PhD, MPH v, w, x, Jochen Schmitt, MD, MPH y, Marieke M.B. Seyger, MD, PhD z, Phyllis I. Spuls, MD, PhD aa, Jean-Francois Stalder, MD e, John C. Su, MD, MEpi, MA, MSt bb, cc, Roberto Takaoka, MD dd, Claudia Traidl-Hoffmann, MD ee, ff, Jacob P. Thyssen, MD, PhD, DmSci gg, Jorien van der Schaft, MD, PhD hh, Andreas Wollenberg, MD, DrMed, DrHC ii, Alan D. Irvine, MD, DSc jj, ⁎ , Amy S. Paller, MSc, MD v, kk, ll, ⁎
, Marjolein Bruin-Weller, MD, PhD b, Carsten Flohr, MD, PhD, MSc c, Michael R. Ardern-Jones, DPhil(PhD), FRCP(MD) d, Sebastien Barbarot, MD, PhD e, Mette Deleuran, MD, DMSc f, Thomas Bieber, MD, PhD, MDRA g, h, Christian Vestergaard, MD, PhD, DMSc i, Sara J. Brown, MD, FRCPE j, k, Michael J. Cork, PhD, FRCP l, Aaron M. Drucker, MD, FRCPC m, Lawrence F. Eichenfield, MD n, o, p, Regina Foelster-Holst, MD q, Emma Guttman-Yassky, MD, PhD r, Audrey Nosbaum, MD, PhD s, Nick J. Reynolds, MD, FRCP t, u, Jonathan I. Silverberg, MD, PhD, MPH v, w, x, Jochen Schmitt, MD, MPH y, Marieke M.B. Seyger, MD, PhD z, Phyllis I. Spuls, MD, PhD aa, Jean-Francois Stalder, MD e, John C. Su, MD, MEpi, MA, MSt bb, cc, Roberto Takaoka, MD dd, Claudia Traidl-Hoffmann, MD ee, ff, Jacob P. Thyssen, MD, PhD, DmSci gg, Jorien van der Schaft, MD, PhD hh, Andreas Wollenberg, MD, DrMed, DrHC ii, Alan D. Irvine, MD, DSc jj, ⁎ , Amy S. Paller, MSc, MD v, kk, ll, ⁎ a Department of Dermatology, Oregon Health and Science University, Portland, Oregon
b National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
c Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' National Health Service Foundation Trust and King's College London, London, United Kingdom
d Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
e Department of Dermatology, Nantes University Hospital, Nantes, France
f Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
g Department of Dermatology and Allergy, University of Bonn, Bonn, Germany
h Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
i Department of Dermatology Aarhus University Hospital, Aarhus, Denmark
j Skin Research Group, School of Medicine, University of Dundee, Dundee, United Kingdom
k Department of Dermatology, Ninewells Hospital and Medical School, Dundee, United Kingdom
l Sheffield Dermatology Research Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
m Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island
n Department of Dermatology, University of California, San Diego, California
o Department of Pediatrics, University of California, San Diego, California
p Rady Children's Hospital, San Diego, California
q Dermatology, Venereology and Allergology, University of Schleswig-Holstein, Kiel, Germany
r Icahn School of Medicine at Mount Sinai Medical Center, New York, New York
s Department of Allergy and Clinical Immunology, University Hospital Lyon Sud, Hospices Civiles de Lyon, Lyon, France
t Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
u Newcastle Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
v Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
w Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
x Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
kk Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
y Center for Evidence-Based Healthcare, Technische Universität Dresden, Dresden, Germany
z Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
aa Department of Dermatology, Academic Medical Centre, Amsterdam, The Netherlands
bb Department of Dermatology, Monash University, Eastern Health and Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
cc Department of Paediatrics, Monash University, Eastern Health and Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
dd Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
ee Institute of Environmental Medicine, UNIKA-T, Technical University of Munich and Helmholtz Zentrum München–German Research Center for Environmental Health (GmbH), Munich, Germany
ff CK CARE, Christine-Kühne-Center for Allergy Research and Education, Davos, Switzerland
gg Department of Dermatology and Allergy, Herlev-Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
hh Department of Dermatology and Allergology, University Medical Centre Utrech, Utrecht, Germany
ii Department of Dermatology and Allergy, Ludwig-Maximilian-University Munich, Munich, Germany
jj Trinity College Dublin, National Children's Research Centre, Paediatric Dermatology Our Lady's Children's Hospital, Dublin, United Kingdom
ll Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
∗Correspondence to: Eric L. Simpson, MD, MCR, Department of Dermatology, Oregon Health and Science University, Portland, OR.Department of DermatologyOregon Health and Science UniversityPortlandOR∗∗Alan D. Irvine, MD, DSc, Trinity College Dublin, National Children's Research Centre, Paediatric Dermatology, Our Lady's Children's Hospital, Dublin, United Kingdom.Trinity College DublinNational Children's Research CentrePaediatric DermatologyOur Lady's Children's HospitalDublinUnited Kingdom∗∗∗Amy S. Paller, MSc, MD, Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N St Clair, Suite 1600, Chicago, IL 60611.Department of DermatologyNorthwestern University Feinberg School of Medicine676 N St Clair, Suite 1600ChicagoIL60611
Abstract |
Background |
Although most patients with atopic dermatitis (AD) are effectively managed with topical medication, a significant minority require systemic therapy. Guidelines for decision making about advancement to systemic therapy are lacking.
Objective |
To guide those considering use of systemic therapy in AD and provide a framework for evaluation before making this therapeutic decision with the patient.
Methods |
A subgroup of the International Eczema Council determined aspects to consider before prescribing systemic therapy. Topics were assigned to expert reviewers who performed a topic-specific literature review, referred to guidelines when available, and provided interpretation and expert opinion.
Results |
We recommend a systematic and holistic approach to assess patients with severe signs and symptoms of AD and impact on quality of life before systemic therapy. Steps taken before commencing systemic therapy include considering alternate or concomitant diagnoses, avoiding trigger factors, optimizing topical therapy, ensuring adequate patient/caregiver education, treating coexistent infection, assessing the impact on quality of life, and considering phototherapy.
Limitations |
Our work is a consensus statement, not a systematic review.
Conclusion |
The decision to start systemic medication should include assessment of severity and quality of life while considering the individual's general health status, psychologic needs, and personal attitudes toward systemic therapies.
Le texte complet de cet article est disponible en PDF.Key words : atopic dermatitis, azathioprine, biologic, consensus statement, cyclosporine, eczema, methotrexate, quality of life, systemic therapy
Abbreviations used : AD, IEC, NB-UVB, QoL, SCORAD, TCI, TCS
Plan
| Drs Irvine and Paller contributed equally to this article. |
|
| Corporate sponsorship was provided to the International Eczema Council by Abbvie, Amgen, Celgene, Chugai, Galderma, GlaxoSmithKline/Stiefel, the Leo Foundation, Leo Pharma, Lilly, MedImmune/Astrazeneca, Pfizer, Sanofi, Genzyme and Regeneron Pharmaceuticals, and Valeant. The sponsors had no influence on the content and viewpoints in this article. The cost of publication was covered by the International Eczema Council. |
|
| Disclosure: Dr Simpson is an investigator for GlaxoSmithKline, Novartis, Regeneron, Vanda, and Tioga and a consultant with honorarium for Celgene, Galderma, Dermira, Genentech, GlaxoSmithKline, Pfizer, Regeneron, and Sanofi. Dr Bruin-Weller is an investigator for Roche and an investigator and consultant for Abbvie and Regeneron/Sanofi, with all fees paid to her institution. Dr Flohr is a consultant with honorarium for Roche/Genentech and Sanofi/Regeneron. Dr Barbarot is a consultant with honorarium for Pierre Fabre Laboratory and Sanofi-Genzyme, a speaker/educator with honorarium for Bioderma, and an investigator with Pierre Fabre Laboratory. Dr Deleuran is an investigator for AbbVie and Sanofi Genzyme and a consultant with honorarium for CKCare Foundation, La Roche Posay, Leo Pharma, Meda Pharma, Pierre Fabre, Regeneron, and Sanofi Genzyme. Dr Bieber is an investigator or consultant or lecturer for Sanofi, Regeneron, Novartis, Roche, Astellas, Galderma, Pfizer/Anacor, GlaxoSmithKline, Lilly, and L′Oréal. Dr Cork is a consultant with honorarium and investigator for Regeneron and Sanofi. Dr Drucker is a consultant with honorarium for Astellas Canada, Prime Inc, Sanofi, and Spire Learning and an investigator for Sanofi and Regeneron. Dr Eichenfield is a consultant with honorarium for Anacor/Pfizer, Galderma, Genentech, Lilly, Regeneron/Sanofi, and Valeant and an investigator for Regeneron/Sanofi. Dr Foelster-Holst is an investigator (with fees paid to her institution) for Astellas, Novartis Pharma, Phamanet, Pierre Fabre, and Regeneron and a consultant with honoraria for ALK/Abbott, Ardeypharm, Astellas, Johnson and Johnson, La Roche Posay, and Neubourg Skin care GMBH and Co. Dr Guttman is a consultant with honorarium for AbbVie, Allergan, Amgen, Anacor, Bristol-Myers Squibb, Celgene, Celsus Therapeutics, Dermira, Drais, Eli Lilly, Escalier, Galderma, Genentech, Glenmark, LEO Pharma, Mitsubushi Tanabe, Novartis, Pfizer, Regeneron, Sanofi, Stiefel/GlaxoSmithKline, and Vitae and principal investigator for Bristol-Myers Squibb, Celgene, Dermira, Janssen Biotech, LEO Pharma, Merck, Novartis, and Regeneron. Dr Nosbaum is a consultant with honorarium for Sanofi. Dr Reynolds is an investigator for BBSRC Case with AstraZeneca, Stiefel/GlaxoSmithKline, Bristol Myers Squib, Genentech, Innovate UK with Stiefel/GlaxoSmithKline, and Wellcome Trust/GlaxoSmithKline and a consultant with honorarium for Genentech. Dr Schmitt is an investigator for ALK, Merck Sharp and Dohme, Novartis, Pfizer, and Sanofi and a consultant with honorarium for Novartis and Roche. Dr Spuls is a consultant with honorarium for AbbVie, Anacor, Leo Pharma, and Novartis and an investigator for Leopharma and Schering Plough; she reports also having been involved in performing clinical trials with many pharmaceutical industries that manufacture drugs used for the treatment of psoriasis and atopic dermatitis. Dr Thyssen is a consultant with honorarium for Leo Pharma, Roche, and Sanofi-Genzyme. Dr Wollenberg is a consultant with honorium for Almiral, Anacor, Astellas, Bioderma, Celgene, Chugai (travel grant), Galderma, Hans Karrer, Leo Pharma, L'Oreal, MEDA, MedImmune, Merck Sharp and Dohme, Novartis, Pierre Fabre, Pfizer, Regeneron, and Sanofi-Adventis and he received research funding from Beiersdorf and Leo Pharma. Dr Irvine is a consultant with honorarium for AbbVie, Anacor, Chugai Pharma, Genentech, and Sanofi Regeneron. Dr Paller is a consultant with honorarium Anacor, Eli Lilly, Galderma, GlaxoSmithKline/Stiefel, Pierre Fabre, Puricore, Regeneron/Sanofi, Roivant, and Valeant and an investigator for Astellas and Pfizer. Drs Ardern-Jones, Vestergaard, Brown, Silverberg, Seyger, Stalder, Su, Takaoka, Traidl-Hoffmann, and Van der Schaft have no conflicts of interest to declare. |
|
| Reprints not available from the authors. |
© 2017
American Academy of Dermatology, Inc. Tous droits réservés.
Vol 77 - N° 4
P. 623-633 - octobre 2017 Retour au numéro
Article précédent
- CME examination
- Variations in risk of asthma and seasonal allergies between early- and late-onset pediatric atopic dermatitis: A cohort study
- Joy Wan, Nandita Mitra, Ole J. Hoffstad, Joel M. Gelfand, Albert C. Yan, David J. Margolis
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?