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Caron AGM, van Huizen AM, Musters AAH, Gerbens LAA, Middelkamp Hup MA, Flohr C, Irvine AD, Vestergaard C, Peris K, Brandling-Bennett HA, Drucker AM, Spuls PI. International consensus on methotrexate dosing for patients with atopic dermatitis: An eDelphi study. J Eur Acad Dermatol Venereol 2024. [PMID: 39087636 DOI: 10.1111/jdv.20271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 07/05/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Despite the widespread off-label use of methotrexate (MTX) for the treatment of atopic dermatitis (AD), there is limited high-quality evidence on dosing regimens and existing guidelines do not provide clear recommendations regarding dosing strategies. OBJECTIVE The aim of this study was to achieve international consensus among AD experts to standardize the dosing regimen for MTX treatment in adults and children with AD. METHODS An electronic Delphi (eDelphi) study was conducted from October 2021 to September 2022. Recruitment was conducted through dermatology societies and AD interest groups. Participation was open to dermatologists and dermatology residents experienced in treating AD patients with MTX. The study consisted of three online rounds. The first round was informed by a systematic review of relevant literature, and subsequent rounds were adjusted based on the results of the previous round. Participants voted on 19 proposals using a 9-point scale (1-3 disagree, 4-6 neither agree nor disagree, 7-9 agree). Consensus was achieved when at least 70% of participants agreed, and less than 15% disagreed. Proposals that did not reach consensus in the first three rounds were discussed in a consensus meeting, where consensus was defined as less than 30% disagreement. RESULTS In total, 152 participants completed Round 1, 104 (68%) completed all survey rounds, and 43 (28%) joined the consensus meeting. Consensus was achieved on 7 proposals in Round 1, 4 in Round 2 and 6 in Round 3. The final 2 proposals reached consensus during the consensus meeting. Consensus topics include test dose, start dose, maximum dose, administration route, dosing schedule, management of stopping treatment, treatment duration and folic acid supplementation. CONCLUSIONS This eDelphi study achieved consensus on 19 proposals related to MTX dosing for adults and children with AD. These results aim to guide prescribing decisions and encourage a standardized global approach to MTX use in AD.
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Affiliation(s)
- Anouk G M Caron
- Dermatology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - Astrid M van Huizen
- Dermatology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - Annelie A H Musters
- Dermatology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - Louise A A Gerbens
- Dermatology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - Maritza A Middelkamp Hup
- Dermatology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - Carsten Flohr
- Department of Paediatric Dermatology, St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Alan D Irvine
- Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Ketty Peris
- Dipartimento di Scienze Mediche, Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCSUOC di Dermatologia, Rome, Italy
- Dipartimento di Medicina, Chirurgia Traslazionale, Università Cattolica del Sacro CuoreDermatologia, Rome, Italy
| | | | - Aaron M Drucker
- Division of Dermatology, Department of Medicine, University of Toronto and Women's College Hospital, and the Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Phyllis I Spuls
- Dermatology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
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Chavez-Alvarez S, Herz-Ruelas M, Villarreal-Martinez A, Ocampo-Candiani J, Garza-Garza R, Gomez-Flores M. Azathioprine: its uses in dermatology. An Bras Dermatol 2020; 95:731-736. [PMID: 33250113 PMCID: PMC7672387 DOI: 10.1016/j.abd.2020.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/19/2020] [Indexed: 01/19/2023] Open
Abstract
This is a narrative review of azathioprine. This medication is immunomodulatory and immunosuppressive, and it has been used widely through different medical specialties to modify disease. It has been proven useful for several dermatoses and it has encountered success when used as an off-label indication for other dermatologic diseases. Its mechanism of action is described thoroughly, as well as precautions for monitoring adequate levels in patients using it. Dermatologists should also be aware of the possible adverse events it may present. In dermatology it can be used in bullous and autoimmune diseases, and in other conditions, including intractable pruritus, atopic dermatitis, photodermatoses, psoriasis, and others. Azathioprine offers an alternative as a steroid-sparing agent and this review helps dermatologists prescribe it safely to all patients who require it.
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Affiliation(s)
- Sonia Chavez-Alvarez
- Department of Dermatology, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Nuevo León, Mexico
| | - Maira Herz-Ruelas
- Department of Dermatology, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Nuevo León, Mexico
| | - Alejandra Villarreal-Martinez
- Department of Dermatology, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Nuevo León, Mexico
| | - Jorge Ocampo-Candiani
- Department of Dermatology, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Nuevo León, Mexico
| | | | - Minerva Gomez-Flores
- Department of Dermatology, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Nuevo León, Mexico.
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Juul-Dam M, Sejersen H, Vestergaard C, Deleuran M, Hjortdal J. The impact of filaggrin genotype and atopic dermatitis on risk and severity of keratoconus. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.xjec.2020.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Quint T, Brunner PM, Sinz C, Steiner I, Ristl R, Vigl K, Kimeswenger S, Neubauer K, Pirkhammer D, Zikeli M, Hoetzenecker W, Reider N, Bangert C. Dupilumab for the Treatment of Atopic Dermatitis in an Austrian Cohort-Real-Life Data Shows Rosacea-Like Folliculitis. J Clin Med 2020; 9:jcm9041241. [PMID: 32344789 PMCID: PMC7230957 DOI: 10.3390/jcm9041241] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/18/2020] [Accepted: 04/22/2020] [Indexed: 12/18/2022] Open
Abstract
Dupilumab is the first biological treatment approved for moderate-to-severe atopic dermatitis (AD). Efficacy and safety have been demonstrated in clinical trials, but real-life data is still limited. The objective of this study was to retrospectively evaluate Dupilumab treatment in AD patients in a real-life clinical setting. Effectiveness and safety outcomes were collected at baseline and after 2, 6, 10, 24, 39, and 52 weeks by using clinical scores for disease activity, as well as serological markers. Ninety-four patients from five dermatological hospitals were included. After 24 weeks of treatment, the median Investigator Global Assessment (IGA) and Eczema Area and Severity Index (EASI) showed a significant reduction compared to baseline (3.9 ± 0.7 vs. 1.4 ± 0.8 and 26.5 ± 12.5 vs. 6.4 ± 6.5). Interestingly, we observed rosacea-like folliculitis as an unexpected side effect in 6.4% of patients. Dupilumab proves to be an effective and well-tolerated treatment under real-life conditions. The occurrence of rosacea-like folliculitis warrants further mechanistic investigation.
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Affiliation(s)
- Tamara Quint
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria; (T.Q.); (P.M.B.); (C.S.)
| | - Patrick M. Brunner
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria; (T.Q.); (P.M.B.); (C.S.)
| | - Christoph Sinz
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria; (T.Q.); (P.M.B.); (C.S.)
| | - Irene Steiner
- Institute of Medical Statistics, Medical University Vienna, 1090 Vienna, Austria; (I.S.); (R.R.)
| | - Robin Ristl
- Institute of Medical Statistics, Medical University Vienna, 1090 Vienna, Austria; (I.S.); (R.R.)
| | - Kornelia Vigl
- Department of Dermatology, Rudolfstiftung City Hospital, 1030 Vienna, Austria; (K.V.); (D.P.)
| | - Susanne Kimeswenger
- Department of Dermatology, Kepler University Hospital, 4020 Linz, Austria; (S.K.); (W.H.)
- Department of Soft Matter Physics, Institute for Experimental Physics, Johannes Kepler University, 4020 Linz, Austria
| | - Katharina Neubauer
- Department of Dermatology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (K.N.); (N.R.)
| | - Detlev Pirkhammer
- Department of Dermatology, Rudolfstiftung City Hospital, 1030 Vienna, Austria; (K.V.); (D.P.)
| | - Martin Zikeli
- Department of Dermatology, Wiener Neustadt Public Hospital, 2700 Wiener Neustadt, Austria;
| | - Wolfram Hoetzenecker
- Department of Dermatology, Kepler University Hospital, 4020 Linz, Austria; (S.K.); (W.H.)
| | - Norbert Reider
- Department of Dermatology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (K.N.); (N.R.)
| | - Christine Bangert
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria; (T.Q.); (P.M.B.); (C.S.)
- Correspondence: ; Tel.: +43-1-40400-77200
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Yu SH, Drucker AM, Lebwohl M, Silverberg JI. A systematic review of the safety and efficacy of systemic corticosteroids in atopic dermatitis. J Am Acad Dermatol 2018; 78:733-740.e11. [DOI: 10.1016/j.jaad.2017.09.074] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/27/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
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Rossi AB, Bacquey A, Nocera T, Thouvenin MD. Efficacy and Tolerability of a Medical Device Repairing Emollient Cream Associated with a Topical Corticosteroid in Adults with Atopic Dermatitis: An Open-label, Intra-individual Randomized Controlled Study. Dermatol Ther (Heidelb) 2018; 8:217-228. [PMID: 29511936 PMCID: PMC6002316 DOI: 10.1007/s13555-018-0228-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Indexed: 11/15/2022] Open
Abstract
Introduction Medical device repairing emollient creams (MDRECs) are designed to repair and protect the skin barrier. In this study, we examined the added clinical benefit and tolerability of a MDREC when used in association with a moderately potent topical corticosteroid (TCS) for adults with atopic dermatitis (AD). Methods This was an intra-individual randomized controlled trial in adults with moderate to severe AD (EudraCT no. 2014-002,194-10). Symmetrical lesions on each arm of the subjects were randomized to treatment for 10 days with twice-daily TCS (desonide) cream alone or with combined TCS + MDREC. Subjects were then included in a following 2-week maintenance phase if the AD on at least one test area had sufficiently improved so that the treatment was no longer needed. During the maintenance phase, treatment with the TCS cream was stopped, but twice-daily application of the MDREC was continued on the same test area previously assigned to receive it. The primary outcome measure was the change in local Scoring Atopic Dermatitis (SCORAD) index between day 1 and 3 based on investigators’ assessment. Secondary measures of lesion severity included changes in the local patient-oriented SCORAD index, pruritus intensity according to subjects’ assessments, and global assessments by subjects and investigators. Results The study included 54 subjects. The change in investigator-observed local SCORAD index between day 1 and 3 was − 14.4% with TCS alone and − 24.5% for TCS + MDREC (p = 0.0005). Between baseline and the end of the treatment phase, all secondary measures of lesion severity decreased more with the combined TCS + MDREC treatment than with the TCS cream alone. The MDREC also reduced the relapse of AD lesions during the maintenance phase. Tolerability was very good, and the product was well accepted by subjects. Conclusion These results support using the MDREC in association with TCS during AD flares and as a maintenance therapy after treatment with TCS has stopped. Funding Laboratoires Dermatologiques Ducray, Pierre Fabre.
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Affiliation(s)
- Ana Beatris Rossi
- Clinical Skin Research and Development Center, Pierre Fabre Dermo-Cosmétique, 2 Rue Viguerie, Hotel Dieu, Toulouse, France.,Department of Dermatology, University Hospital Toulouse, 24, chemin de Pouvourville TSA, 31059, Toulouse CEDEX 9, France
| | - Adeline Bacquey
- Clinical Skin Research and Development Center, Pierre Fabre Dermo-Cosmétique, 2 Rue Viguerie, Hotel Dieu, Toulouse, France
| | - Thérèse Nocera
- Clinical Skin Research and Development Center, Pierre Fabre Dermo-Cosmétique, 2 Rue Viguerie, Hotel Dieu, Toulouse, France.,Department of Dermatology, University Hospital Toulouse, 24, chemin de Pouvourville TSA, 31059, Toulouse CEDEX 9, France
| | - Marie-Dominique Thouvenin
- Clinical Skin Research and Development Center, Pierre Fabre Dermo-Cosmétique, 2 Rue Viguerie, Hotel Dieu, Toulouse, France.
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Weiss D, Schaschinger M, Ristl R, Gruber R, Kopp T, Stingl G, Bangert C. Ustekinumab treatment in severe atopic dermatitis: Down-regulation of T-helper 2/22 expression. J Am Acad Dermatol 2017; 76:91-97.e3. [DOI: 10.1016/j.jaad.2016.07.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 07/22/2016] [Accepted: 07/25/2016] [Indexed: 01/05/2023]
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Riis JL, Vestergaard C, Hjuler KF, Iversen L, Jakobsen L, Deleuran MS, Olsen M. Hospital-diagnosed atopic dermatitis and long-term risk of myocardial infarction: a population-based follow-up study. BMJ Open 2016; 6:e011870. [PMID: 27836869 PMCID: PMC5129053 DOI: 10.1136/bmjopen-2016-011870] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Atopic dermatitis (AD) is an inflammatory skin disorder with a childhood prevalence reaching 20%. An estimated 50% of patients have a life-long chronic course. The purpose of this study was to estimate the risk of first-time myocardial infarction (MI) in patients with AD compared with a general population cohort. DESIGN Cohort study. SETTING Denmark. PARTICIPANTS Using population-based medical registries, we identified individuals born in Denmark from 1947 to 1983 with at least two hospital-diagnoses of AD following inpatient admissions or hospital-based outpatient visits at any age from 1977 to 2013. Individuals with AD were matched with general population controls (10:1) for birth-year and gender. Unique personal identifiers permitted unambiguous data linkage. PRIMARY OUTCOME MEASURES Follow-up began on the date of AD diagnosis (index date for general population controls) and continued until death, emigration, MI or the year 2013. We computed the 15-year-cumulative incidence of MI following a diagnosis of AD. Comparing patients with AD with the general population cohort, we computed HRs of MI presented with 95% CIs and adjusted for history of diabetes mellitus, hypertension, hyperlipidaemia or stroke, educational level, birth-year and sex. RESULTS We identified 4814 patients diagnosed with AD. The cumulative incidence of MI was 0.6% for patients with AD and 0.4% for their matched controls. The corresponding adjusted HR was 1.74 (1.21 to 2.49). The HR for patients who were not in need of systemic treatment was 1.58 (1.02 to 2.45) and it was 2.40 (1.27 to 4.45) for those who were treated with azathioprine, methotrexate or cyclosporine. CONCLUSIONS Hospital-diagnosed AD was associated with increased risk of MI compared with the general population.
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Affiliation(s)
| | | | | | - Lars Iversen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Jakobsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mette S Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Andersen R, Thyssen J, Maibach H. Qualitative vs. quantitative atopic dermatitis criteria - in historical and present perspectives. J Eur Acad Dermatol Venereol 2015; 30:604-18. [DOI: 10.1111/jdv.13442] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 09/07/2015] [Indexed: 01/23/2023]
Affiliation(s)
- R.M. Andersen
- Department of Dermatology; University of California at San Francisco; San Francisco CA USA
- Department of Dermato-Allergology; National Allergy Research Centre; Copenhagen University Hospital; Gentofte Denmark
| | - J.P. Thyssen
- Department of Dermato-Allergology; National Allergy Research Centre; Copenhagen University Hospital; Gentofte Denmark
| | - H.I. Maibach
- Department of Dermatology; University of California at San Francisco; San Francisco CA USA
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Werfel T, Schwerk N, Hansen G, Kapp A. The diagnosis and graded therapy of atopic dermatitis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 111:509-20, i. [PMID: 25142076 PMCID: PMC4150028 DOI: 10.3238/arztebl.2014.0509] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 11/06/2013] [Accepted: 06/23/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Atopic dermatitis is the most common skin disease in children, with a prevalence of 10% to 15%, and is common in adults as well. Close coordination between primary care physicians and specialists is essential for the adequate treatment of chronically and severely affected patients. METHOD This article is a review of pertinent publications that were retrieved by a selective search in Pubmed, with additional consideration of the guidelines of the Association of Medical Scientific Societies in Germany (AWMF) and the European Dermatology Forum. RESULTS Trigger factors such as skin irritants, allergens, microbial pathogens, and psychological factors can affect the condition of the skin differently in individual patients and should be individually assessed. The use of skin moisturising creams or emollients along with avoidance of specific and unspecific irritants is of great importance, as these patients have an impaired cutaneous barrier. Topical anti-inflammatory treatment with glucocorticoids or calcineurin inhibitors is a central part of the management of atopic dermatitis; in exceptional cases, severely affected patients are treated with systemic anti-inflammatory drugs. Interdisciplinary patient education has been found to be an effective tool in the complex management of this disease. Chronically and severely affected patients present special challenges for diagnosis and treatment. CONCLUSION Recent advances in the understanding of the molecular basis of cutaneous barrier disorders and of congenital and acquired immune disorders have led to new approaches to the treatment of atopic dermatitis.
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Affiliation(s)
- Thomas Werfel
- Department of Dermatology and Allergology, Hannover Skin Cancer Center, Hannover Medical School
| | - Nicolaus Schwerk
- Clinic for Paediatric Pneumology and Neonatology, Hannover Medical School
| | - Gesine Hansen
- Clinic for Paediatric Pneumology and Neonatology, Hannover Medical School
| | - Alexander Kapp
- Department of Dermatology and Allergology, Hannover Skin Cancer Center, Hannover Medical School
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