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Relative efficacy of systemic treatments for atopic dermatitis - 14/01/19

Doi : 10.1016/j.jaad.2018.09.053 
Edward W. Seger, MS a, Todd Wechter, BS a, Lindsay Strowd, MD a, Steven R. Feldman, MD, PhD a, b, c,
a Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina 
b Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina 
c Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina 

Correspondence to: Steven R. Feldman, MD, PhD, Department of Dermatology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157-1071.Department of DermatologyWake Forest School of MedicineMedical Center BlvdWinston-SalemNC27157-1071

Abstract

Background

Systemic medications are often required for severe atopic dermatitis (AD) refractory to topical therapies. Biologic medications are a recent advancement in the field and a comparison with standard systemic approaches would be beneficial.

Objective

To compare efficacies of systemic therapies for the treatment of AD.

Methods

A systematic literature review was performed using Medline, Ovid, and Embase. Randomized controlled trials looking at the efficacy of systemic treatments for AD in adults and children were included.

Results

A total of 41 studies met criteria and were included in our final analysis. Consistent improvements in Eczema Area and Severity Index and Scoring Atopic Dermatitis were reported with dupilumab and cyclosporine. Phase 2 clinical trials for lebrikizumab and tralokinumab were effective and would benefit from phase 3 trials. No study reported efficacy of biologic medications in pediatric patients; however, cyclosporine improved clinical severity by the greatest amount in this group.

Limitations

A lack of well controlled comparison studies make direct comparisons between the treatments difficult.

Conclusion

For treatment of severe AD, the strongest evidence currently exists for dupilumab and cyclosporine at improving clinical disease severity. Further research is required to determine long-term safety and efficacy of biologic medications.

Le texte complet de cet article est disponible en PDF.

Key words : adults, atopic dermatitis, biologic treatment, children, cyclosporine, dupilumab, efficacy, lebrikizumab, systemic treatment, tralokinumab

Abbreviations used : AD, DLQI, EASI, IL, RCT, SASSAD, SCORAD


Plan


 Funding sources: None.
 Conflicts of interest: Dr Feldman has received research, speaking, or consulting support from a variety of companies including Galderma, GSK/Stiefel, Almirall, Leo Pharma, Baxter, Boeringer Ingelheim, Mylan, Celgene, Pfizer, Valeant, Taro, Abbvie, Cosmederm, Anacor, Astellas, Janssen, Lilly, Merck, Merz, Novartis, Regeneron, Sanofi, Novan, Parion, Qurient, National Biological Corporation, Caremark, Advance Medical, Sun Pharma, Suncare Research, Informa, UpToDate, and National Psoriasis Foundation. He is founder and majority owner of www.DrScore.com and founder and part owner of Causa Research, a company dedicated to enhancing patients' adherence to treatment. Dr Strowd has received research, speaking, or consulting support from Pfizer, Sanofi, Regeneron, and Novartis. Mr Seger and Mr Wechter have no conflicts to disclose.
 Reprints not available from the authors.


© 2018  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 80 - N° 2

P. 411 - février 2019 Retour au numéro
Article précédent Article précédent
  • Association between atopic dermatitis, depression, and suicidal ideation: A systematic review and meta-analysis
  • Kevin R. Patel, Supriya Immaneni, Vivek Singam, Supriya Rastogi, Jonathan I. Silverberg
| Article suivant Article suivant
  • Guideline-based medicine grading on the basis of the guidelines of care for ambulatory atopic dermatitis treatment in the United States
  • Alan B. Fleischer

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