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Chang-Chieh L, Shen-Han C, Yu-Han F, Chi-Ta H. Eczema herpeticum in an immunocompetent man. Diagn Microbiol Infect Dis 2024; 110:116304. [PMID: 38879925 DOI: 10.1016/j.diagmicrobio.2024.116304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Eczema herpeticum is a rapidly progressing skin complication related to the herpes simplex virus, particularly in individuals with compromised immune systems or atopic dermatitis. Eczema herpeticum is characterized by cutaneous pain, scaling, and the presence of vesicular lesions, often accompanied by secondary infection. Dissemination of the infection can lead to severe morbidity and mortality in patients without appropriate antiviral and antibiotic therapy. CASE REPORT We presented a case of ankylosing spondylitis in a relatively young patient who did not receive immunosuppressive therapy and had no history of Human Immunodeficiency Virus, herpes zoster infection or atopic dermatitis. The patient's symptoms improved following a course of antiviral and antibiotic treatments. INTRODUCTION The incidence of eczema herpeticum has been on the rise in recent decades, primarily due to an increased number of individuals with compromised immune systems. This increase can be attributed to various factors, including the higher prevalence of Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome, the more extensive use of immunosuppressive therapy, and what seems to be a growing incidence of atopic dermatitis.[1] This disease can be initially mistaken for Stevens-Johnson syndrome because of the rapid advancement of skin lesions, however, the atypical target lesions, flaccid bullae and prominent mucosal involvement found in Stevens-Johnson syndrome are absent in cases of eczema herpeticum. Other differential diagnoses include impetigo, disseminated herpes zoster, acute generalized exanthematous pustulosis, dermatitis herpetiformis.
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Affiliation(s)
- Liao Chang-Chieh
- Post-graduate Year Training (PGY), Department of Medical Education, Tungs' Taichung Metro Harbor Hospital, Taichung City, Taiwan, R.O.C
| | - Cheng Shen-Han
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Tungs' Taichung Metro Harbor Hospital, Taichung City, Taiwan, R.O.C
| | - Fang Yu-Han
- Division of Dermatology, Tungs' Taichung Metro Harbor Hospital, Taichung City, Taiwan, R.O.C
| | - Hsieh Chi-Ta
- Division of Nephrology, Department of Internal Medicine, Tungs' Taichung Metro Harbor Hospital, Taichung City, Taiwan, R.O.C.
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Yokose M, Hirosawa T, Tsunashima K, Shimizu T. A Typical Case of Atypical Disease: "Three Noes" Infective Endocarditis. Cureus 2024; 16:e65325. [PMID: 39184702 PMCID: PMC11344238 DOI: 10.7759/cureus.65325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2024] [Indexed: 08/27/2024] Open
Abstract
Recognizing typical presentations of atypical cases is essential to reduce diagnostic errors and achieve better diagnoses. To better understand this, we report a typical case of "three noes" infective endocarditis (no left-sided, no intravenous drug use, and no intracardiac devices) with some different characteristics from well-known infective endocarditis. A 16-year-old boy with a history of atopic dermatitis presented with a one-month history of intermittent fever and shaking chills. The patient became afebrile with oral antibiotics, and initial investigations did not detect any evidence of bacterial infection, including heart murmurs and peripheral embolic manifestations. However, his symptoms relapsed one week after the cessation of antibiotics. A repeated workup revealed tricuspid valve infective endocarditis due to methicillin-susceptible Staphylococcus aureus. The relationship between atopic dermatitis and infective dermatitis has been reported in some literature, and clinicians should consider three noes infective endocarditis in patients with atopic dermatitis presenting with fever and unremarkable physical examination.
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Affiliation(s)
- Masashi Yokose
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Mibu, JPN
| | - Takanobu Hirosawa
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Mibu, JPN
| | - Keita Tsunashima
- Department of Emergency and General Medicine, Dokkyo Medical University Nikko Medical Center, Nikko, JPN
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Mibu, JPN
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3
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Guglielmo A, Deotto ML, Naldi L, Stinco G, Pileri A, Piraccini BM, Fortina AB, Sechi A. Biologics and small molecules treatment for moderate-to-severe atopic dermatitis patients with comorbid conditions and special populations: an Italian perspective. Dermatol Reports 2024; 16:9839. [PMID: 38957642 PMCID: PMC11216152 DOI: 10.4081/dr.2023.9839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 07/04/2024] Open
Abstract
This comprehensive review offers a detailed look at atopic dermatitis (AD) treatment in Italy, focusing primarily on the use of biologics and small molecules. In response to advancing knowledge of AD's causes and treatments, there's a global need for updated guidelines to provide physicians with a more comprehensive clinical perspective, facilitating personalized treatment strategies. Dupilumab, a groundbreaking biologic, gained approval as a significant milestone. Clinical trials demonstrated its ability to significantly reduce AD severity scores, with an impressive 37% of patients achieving clear or nearly clear skin within just 16 weeks of treatment. Real-world studies further support its efficacy across various age groups, including the elderly, with a safety profile akin to that of younger adults. Tralokinumab, a more recent approval, shows promise in clinical trials, particularly among younger populations. However, its real-world application, especially in older individuals, lacks comprehensive data. Janus Kinases inhibitors like Upadacitinib, Baricitinib, and Abrocitinib hold substantial potential for AD treatment. Nevertheless, data remains limited for patients over 75, with older adults perceived to carry a higher risk profile. Integrated safety analyses revealed individuals aged 60 and above experiencing major adverse cardiovascular events and malignancies, underscoring the need for cautious consideration. While these therapies offer promise, especially among younger patients, further research is essential to determine their safety and efficacy in various populations, including pediatric, geriatric, and those with comorbidities. Biologics and small molecules are improving AD treatment, as shown in this review.
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Affiliation(s)
- Alba Guglielmo
- Dermatology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Bologna
- Institute of Dermatology, Azienda Sanitaria Universitaria Friuli Centrale, Udine
| | | | - Luigi Naldi
- Dermatology Unit, San Bortolo Hospital, Vicenza
| | - Giuseppe Stinco
- Institute of Dermatology, Azienda Sanitaria Universitaria Friuli Centrale, Udine
- Department of Medicine, University of Udine, Italy
| | - Alessandro Pileri
- Dermatology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Bologna
| | - Bianca Maria Piraccini
- Dermatology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Bologna
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Kim B, Rothenberg ME, Sun X, Bachert C, Artis D, Zaheer R, Deniz Y, Rowe P, Cyr S. Neuroimmune interplay during type 2 inflammation: Symptoms, mechanisms, and therapeutic targets in atopic diseases. J Allergy Clin Immunol 2024; 153:879-893. [PMID: 37634890 PMCID: PMC11215634 DOI: 10.1016/j.jaci.2023.08.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/17/2023] [Accepted: 08/22/2023] [Indexed: 08/29/2023]
Abstract
Type 2 inflammation is characterized by overexpression and heightened activity of type 2 cytokines, mediators, and cells that drive neuroimmune activation and sensitization to previously subthreshold stimuli. The consequences of altered neuroimmune activity differ by tissue type and disease; they include skin inflammation, sensitization to pruritogens, and itch amplification in atopic dermatitis and prurigo nodularis; airway inflammation and/or hyperresponsiveness, loss of expiratory volume, airflow obstruction and increased mucus production in asthma; loss of sense of smell in chronic rhinosinusitis with nasal polyps; and dysphagia in eosinophilic esophagitis. We describe the neuroimmune interactions that underlie the various sensory and autonomic pathologies in type 2 inflammatory diseases and present recent advances in targeted treatment approaches to reduce type 2 inflammation and its associated symptoms in these diseases. Further research is needed to better understand the neuroimmune mechanisms that underlie chronic, sustained inflammation and its related sensory pathologies in diseases associated with type 2 inflammation.
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Affiliation(s)
- Brian Kim
- Kimberly and Eric J. Waldman Department of Dermatology, Mark Lebwohl Center for Neuroinflammation and Sensation, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Marc E Rothenberg
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Xin Sun
- Department of Pediatrics, University of California, San Diego, Calif
| | - Claus Bachert
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Muenster, Muenster, Germany; First Affiliated Hospital, Sun Yat-Sen University, International Airway Research Center, Guangzhou, China
| | - David Artis
- Jill Roberts Institute for Research in Inflammatory Bowel Disease, Friedman Center for Nutrition and Inflammation, Joan and Sanford I. Weill Department of Medicine, Department of Microbiology and Immunology, Weill Cornell Medicine, Cornell University, New York, NY
| | | | - Yamo Deniz
- Regeneron Pharmaceuticals, Tarrytown, NY
| | | | - Sonya Cyr
- Regeneron Pharmaceuticals, Tarrytown, NY
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Samynathan A, Silverberg JI. Navigating the atopic dermatitis toolbox: Challenging scenarios and shared decision-making. Ann Allergy Asthma Immunol 2024; 132:337-343. [PMID: 38145707 DOI: 10.1016/j.anai.2023.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/27/2023]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory disease with a complex pathogenesis and heterogeneous clinical presentation. Recently, multiple advanced therapies were approved for the treatment of moderate-severe AD, including the biologics dupilumab, tralokinumab, and lebrikizumab and oral Janus kinase inhibitors abrocitinib, upadacitinib, and baricitinib. These treatments have different efficacy, safety, and tolerability profiles and monitoring requirements. The availability of multiple recently approved therapies poses a clinical challenge for health care providers and patients on how to select the best treatment for patients. This article aims to highlight clinical considerations and patient perspectives to guide shared decision-making for biologic and oral systemic therapy, particularly Janus kinase inhibitors, in AD. Important aspects to consider include treatment goals, medical history, symptom severity, physician assessments, safety profile of drugs, and the risk predispositions in patients.
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Affiliation(s)
- Archana Samynathan
- Department of Dermatology, George Washington University, Washington, District of Columbia
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University, Washington, District of Columbia.
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Momin RI, Baer SL, Waller JL, Young L, Tran S, Taskar V, Bollag WB. Atopic Dermatitis and the Risk of Infection in End-Stage Renal Disease. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2145. [PMID: 38138248 PMCID: PMC10744789 DOI: 10.3390/medicina59122145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/24/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Atopic dermatitis (AD), also known as eczema, is a common chronic inflammatory skin condition affecting 16.5 million adults in the United States. AD is characterized by an impaired epidermal barrier that can predispose individuals to infection. End-stage renal disease (ESRD) is also commonly complicated by infections due to chronic vascular access and immune-system dysfunction, possibly related to uremia. Multiple studies have reported that renal disease is a common comorbidity in adults with atopic dermatitis. The aim of this study was to determine whether AD is a risk factor for certain infections in patients with ESRD. Materials and Methods: Using the United States Renal Data System, a retrospective cohort analysis was conducted on adult ESRD patients initiating dialysis between 2004 and 2019 to investigate associations between infections and AD in this population. Results: Of 1,526,266 patients, 2290 were identified with AD (0.2%). Infectious outcomes of interest were bacteremia, septicemia, cellulitis, herpes zoster, and conjunctivitis. In all infectious outcomes except for conjunctivitis, patients with the infectious outcomes were more likely to carry a diagnosis of AD. After controlling for demographic and clinical covariates, AD was associated with an increased risk of cellulitis (adjusted relative risk (aRR) = 1.39, 95% confidence interval (CI) = 1.31-1.47) and herpes zoster (aRR = 1.67, CI = 1.44-1.94), but not with bacteremia (aRR = 0.96, CI = 0.89-1.05), septicemia (aRR = 1.02, CI = 0.98-1.08), or conjunctivitis (aRR = 0.97, CI = 0.740-1.34). Conclusions: Overall, after controlling for demographic and clinical covariates and adjusting for person-years-at-risk, AD was associated with an increased risk for some, but not all, infections within the population of patients with ESRD.
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Affiliation(s)
- Rushan I. Momin
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (R.I.M.); (S.L.B.); (J.L.W.); (S.T.); (V.T.)
| | - Stephanie L. Baer
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (R.I.M.); (S.L.B.); (J.L.W.); (S.T.); (V.T.)
- Charlie Norwood Department, Veterans Affairs Medical Center, Augusta, GA 30904, USA
| | - Jennifer L. Waller
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (R.I.M.); (S.L.B.); (J.L.W.); (S.T.); (V.T.)
| | - Lufei Young
- School of Nursing at UNC Charlotte, University of North Carolina Charlotte, Charlotte, NC 28223, USA
| | - Sarah Tran
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (R.I.M.); (S.L.B.); (J.L.W.); (S.T.); (V.T.)
| | - Varsha Taskar
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (R.I.M.); (S.L.B.); (J.L.W.); (S.T.); (V.T.)
| | - Wendy B. Bollag
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (R.I.M.); (S.L.B.); (J.L.W.); (S.T.); (V.T.)
- Charlie Norwood Department, Veterans Affairs Medical Center, Augusta, GA 30904, USA
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7
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Bieber T, Katoh N, Simpson EL, de Bruin-Weller M, Thaçi D, Torrelo A, Sontag A, Grond S, Issa M, Lu X, Cardillo T, Holzwarth K, Thyssen JP. Safety of baricitinib for the treatment of atopic dermatitis over a median of 1.6 years and up to 3.9 years of treatment: an updated integrated analysis of eight clinical trials. J DERMATOL TREAT 2023; 34:2161812. [PMID: 36546346 DOI: 10.1080/09546634.2022.2161812] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Baricitinib, a selective Janus kinase (JAK)1/JAK2 inhibitor, is approved for treatment of moderate-to-severe atopic dermatitis (AD) in adults. OBJECTIVES We report integrated baricitinib safety data in patients with up to 3.9-years exposure. METHODS Three datasets from the integrated AD clinical trial program were analyzed: placebo-controlled, 2-mg-4-mg extended, and All-bari. Data cutoffs were up to 21-December-2021 for long-term extension studies. Proportions of patients with events and incidence rates (IR)/100 patient years (PY) at risk were calculated. RESULTS 2636 patients received baricitinib for 4628.4 PY. Discontinuation due to adverse events was low (IR = 3.4). IRs in All-bari were: serious adverse events, 5.2; infection, 67.2 (any infection), 6.7 (herpes simplex), 2.8 (herpes zoster), and 0.3 (opportunistic infections). Adverse events of special interest in All-bari included seven patients with positively adjudicated major adverse cardiovascular events (MACE) (IR = 0.15), three pulmonary emboli (PE) (IR = 0.06), 14 malignancies excluding nonmelanoma skin cancer (IR = 0.3), one gastrointestinal perforation (IR = 0.02), and four deaths (IR = 0.1). No deep vein thromboses (DVT) or tuberculosis were reported. CONCLUSION In this analysis, baricitinib maintained a similar safety profile to earlier analyses with no new safety signals. Rates of MACE, DVT/PE, malignancies, and serious infections were within ranges of background rates in patients with AD. CLINICALTRIALS.GOV NCT02576938 (JAHG), NCT03334396 (JAHL; BREEZE-AD1), NCT03334422 (JAHM; BREEZE-AD2), NCT03334435 (JAHN; BREEZE-AD3), NCT03428100 (JAIN; BREEZE-AD4), NCT03435081 (JAIW; BREEZE-AD5), NCT03559270 (JAIX; BREEZE-AD6), NCT03733301 (JAIY; BREEZE-AD7).
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Affiliation(s)
- Thomas Bieber
- Department of Dermatology and Allergy, University Hospital of Bonn, Bonn, Germany.,Christine Kühne - Center for Allergy Research and Education, Davos, Switzerland
| | - Norito Katoh
- Department of Dermatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eric L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | - Marjolein de Bruin-Weller
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Diamant Thaçi
- Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - Antonio Torrelo
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | | | - Maher Issa
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Xiaoyu Lu
- TechData Service Company, King of Prussia, PA, USA
| | | | | | - Jacob P Thyssen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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Rouhani DS, Singh NK, Chao JJ, Almutairi A, Badowski-Platz R, Seradj MH, Mofid MM. Silk Bioprotein as a Novel Surgical-Site Wound Dressing: A Prospective, Randomized, Single-Blinded, Superiority Clinical Trial. Aesthet Surg J Open Forum 2023; 5:ojad071. [PMID: 37899912 PMCID: PMC10603584 DOI: 10.1093/asjof/ojad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Background Medical adhesive-related skin injuries (MARSIs) affect about 1.5 million patients annually in the United States. Complications include allergic contact dermatitis, skin blistering, skin tears, and surgical-site infections (SSIs). The authors hypothesize that a natural hypoallergenic silk bioprotein wound dressing will decrease the incidence of MARSI in comparison to a synthetic alternative. Objectives This study aimed to assess the efficacy and safety of a silk bioprotein wound dressing compared to the Dermabond Prineo (Ethicon, Inc., Somerville, NJ) skin closure system. Methods This prospective, randomized, single-blinded trial studied 25 patients who were dressed with Dermabond Prineo on one side of their body and on the contralateral side with the silk bioprotein dressing after undergoing abdominoplasty or reduction mammaplasty procedures. Data were collected over 5 postoperative visits using photographs and an investigator administered questionnaire to track rash, itch, discomfort, erythema, edema, SSIs, need for pharmaceutical intervention, mechanical injury, removal time, and bathing routines. Results Sixty-four percent (16/25) of patients characterized the severity of discomfort as a score of 4 out of 10 or greater on the Dermabond Prineo control side and only 4% (1/25) for the silk-dressing side (P < .001). Fifty-two percent (13/25) had a visible rash of 4 or higher on the Dermabond Prineo side of their incision and 0% (0/25) had a rash on the silk side (P < .001). Fifty-two percent (13/25) required steroids or antibiotics to treat MARSI to Dermabond Prineo and 0% (0/25) required pharmaceutical intervention on the silk side (P < .001). Conclusions The use of a silk bioprotein wound dressing significantly reduces the incidence of MARSI throughout the postoperative period. Level of Evidence 2
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Affiliation(s)
| | | | | | | | | | | | - Mehrdad Mark Mofid
- Corresponding Author: Dr Mehrdad Mark Mofid, 4150 Regents Park Row STE 300, La Jolla, CA 92037, USA. E-mail:
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Williams RC, Brako MYO, Guo W, Usmani H, Na S, Clark RAF. The uni-directional association of atopic dermatitis and rheumatoid arthritis: a systematic review and meta-analysis. Arch Dermatol Res 2023; 315:2261-2269. [PMID: 37043009 DOI: 10.1007/s00403-023-02619-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/02/2023] [Accepted: 03/30/2023] [Indexed: 04/13/2023]
Abstract
Atopic dermatitis (AD) is a highly pruritic, inflammatory skin disease with a strong immune component. Rheumatoid arthritis (RA) is a systemic autoimmune disease that causes synovitis and destruction of small joints. Researchers have attempted to quantify an association between both diseases with mixed conclusions. This systematic review and meta-analysis will study the association between AD and RA. Additionally, we conducted a systematic review between AD and other arthritic conditions including osteoarthritis (OA), psoriatic arthritis (PsA), and juvenile idiopathic arthritis (JIA). Medline, Web of Science, Cochrane, and EMBASE databases were searched for relevant studies from inception to March 2021. Observational studies examining relationships between AD and arthritic conditions were selected. 2539 studies were screened; nine were found suitable for quantitative analysis, all of which examined AD and RA. All studies had low risk of bias as determined by the Newcastle-Ottawa Scale. Patients with RA did not have significantly increased odds of comorbid AD. These findings were consistent across multiple study designs. However, patients with AD had significantly increased odds of comorbid RA. There were not enough studies identified to perform quantitative analysis between AD and other arthritic conditions. Two studies, one on JIA and one PsA, found no association with AD. Two studies on AD and OA had conflicting results. The present study provides definitive evidence of increased odds of comorbid RA in AD patients. There were no such increased odds of comorbid AD in RA patients. No such association was found between AD and PsA, OA or JIA.
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Affiliation(s)
- Ryan C Williams
- Department of Dermatology, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, 11727, USA.
| | - Maame Yaa O Brako
- Department of Dermatology, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, 11727, USA
| | - William Guo
- Department of Dermatology, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, 11727, USA
| | - Hunya Usmani
- Department of Dermatology, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, 11727, USA
| | - Sean Na
- Department of Dermatology, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, 11727, USA
| | - Richard A F Clark
- Department of Dermatology, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, 11727, USA
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10
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Narla S, Silverberg JI. Safety of Oral Janus Kinase Inhibitors in the Treatment of Moderate-to-Severe Atopic Dermatitis. Dermatitis 2023; 34:366-386. [PMID: 36800199 DOI: 10.1089/derm.2022.29004.sna] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Multiple Janus Kinase (JAK) inhibitors were developed as potential treatments for moderate-to-severe atopic dermatitis (AD). There is a substantial amount of safety data from recent trials of oral JAK inhibitors in patients with AD. However, the vast majority of safety data for oral JAK inhibitors is derived from patients with rheumatoid arthritis and other immune-mediated disorders, and is primarily derived from tofacitinib, a pan-selective JAK inhibitor. This narrative review examines safety data for oral JAK inhibitors from studies in AD and other indications. The available data do demonstrate that rare but serious and life-threatening adverse events can occur with oral JAK inhibitor treatment and should be carefully considered in therapeutic shared decision making.
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Affiliation(s)
- Shanthi Narla
- From the Department of Dermatology, St. Luke's University Health Network, Easton, Pennsylvania, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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11
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Kiiski V, Ukkola-Vuoti L, Vikkula J, Ranta M, Lassenius MI, Kopra J. Effect of Disease Severity on Comorbid Conditions in Atopic Dermatitis: Nationwide Registry-Based Investigation in Finnish Adults. Acta Derm Venereol 2023; 103:adv00882. [PMID: 36883876 PMCID: PMC10010184 DOI: 10.2340/actadv.v103.4447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/07/2022] [Indexed: 03/09/2023] Open
Abstract
The majority of registry studies on atopic dermatitis include only patients and diagnoses from specialized healthcare. The aim of this retrospective, real-world cohort study was to evaluate the effect of atopic dermatitis severity on comorbidities and total morbidity, with comprehensive data from both primary and specialty healthcare registries covering the entire Finnish adult population. In total, 124,038 patients were identified (median age 46 years; 68% female) and stratified by disease severity. All regression analyses (median follow-up 7.0 years) were adjusted at a minimum for age, sex, obesity, and educational level. Compared with mild atopic dermatitis, severe atopic dermatitis was significantly associated with multiple morbidities, including neurotic, stress-related and somatoform disorders, abscesses, erysipelas/cellulitis, impetigo, herpes zoster, extragenital herpes, bacterial conjunctivitis, septicaemia, lymphomas, alopecia areata, urticaria, other dermatitis, contact allergy, osteoporosis, and intervertebral disc disorders (p < 0.001). In addition, there were significant associations with alcohol dependence, depression, condylomas, rosacea, migraine, sleep apnoea, hypertension, enthesopathies, atherosclerosis, and drug-induced cataract (p < 0.05). Odds ratios were modest and mostly were between 1.10 and 2.75. Furthermore, patients with severe atopic dermatitis had lower incidences of prostate cancer, cystitis, and anogenital herpes than patients with mild atopic dermatitis (p < 0.05). These results suggest that severe atopic dermatitis results in significant overall morbidity.
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12
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Rios-Duarte JA, Silverberg JI. Association of Adult Atopic Dermatitis Severity With Bacterial, Viral, and Fungal Skin Infections. Dermatitis 2023; 34:120-126. [PMID: 36917529 DOI: 10.1089/derm.2022.29006.jrd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: Little is known about the relationship of atopic dermatitis (AD) severity, phenotype, and persistence on different types of skin infections. Objective: To evaluate the relationship of AD characteristics and skin infections over time in adults. Methods: We performed a prospective dermatology practice-based study (n = 559). History of infection was assessed using questionnaires. AD severity was evaluated using Scoring Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI), Investigator's Global Assessment (IGA), and Patient-reported Global Assessment (PtGA). Results: At baseline, 160 (21.4%) patients reported history of ≥1 skin infection, including 14.3% with bacterial infections. In multivariable repeated measures logistic regression models, ≥1 cutaneous infection was associated with moderate (adjusted odds ratio [95% confidence interval]: 2.67 [1.67-4.28]) and severe (6.35 [3.36-12.01]) versus mild SCORAD; as well as severe SCORAD-itch; moderate and severe versus clear-mild EASI; moderate and severe versus clear-mild PtGA; mild, moderate, and severe versus clear-almost clear IGA. Cutaneous infections were not associated with ichthyosis, palmar hyperlinearity, nummular eczema, cheilitis, or hand eczema. Specific infections varied by AD severity and body site. Persistent moderate-severe disease was associated with higher odds of skin infection. Conclusion: Skin infections were associated with AD severity but not phenotype, and may be mitigated by improved AD severity.
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Affiliation(s)
| | - Jonathan I Silverberg
- †Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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13
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Gentry CA, Whitman CM, Kliewer BS, Williams RJ, Thind SK. Propensity-matched analysis of the protective effect of ticagrelor versus clopidogrel on the risk of developing Staphylococcus aureus bacteremia. Int J Antimicrob Agents 2023; 61:106752. [PMID: 36773940 DOI: 10.1016/j.ijantimicag.2023.106752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/24/2023] [Accepted: 02/04/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVE Recent data indicate that ticagrelor, used in acute coronary syndromes (ACS), has antibacterial effects against Staphylococcus sp. and other effects that may help management of infection. The primary objective of this study was to evaluate the protective effect of ticagrelor in patients who have had an ACS event and the risk of developing Staphylococcus aureus bacteremia (SAB) compared to a propensity-matched cohort receiving clopidogrel. METHODS This study was a retrospective, nationwide analysis of all patients presenting to any percutaneous coronary intervention-performing Veterans Affairs Medical Center with an ACS episode and resultant prescription for clopidogrel or ticagrelor. The primary outcome was the comparative rate of SAB in patients receiving ticagrelor vs. clopidogrel. RESULTS Analysis involved 24 456 patients on ticagrelor and 277 277 patients on clopidogrel. There was a statistically significant difference in the number of patients developing SAB between the propensity-matched groups (32 [0.13%] of 24 456 for ticagrelor vs. 71 [0.29%] of 24 456 for clopidogrel; odds ratio (OR), 0.43; 95% confidence interval (CI), 0.28-0.65; P<0.0001). Multivariate logistic regression showed that receipt of clopidogrel, comorbid dermatologic condition, comorbid hematologic condition, and baseline anemia were independently associated with the development of SAB. CONCLUSIONS The study findings align with recent reports that ticagrelor may have a beneficial role in the prevention of SAB.
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Affiliation(s)
- Chris A Gentry
- Pharmacy Service, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma, USA.
| | - Charles M Whitman
- Pharmacy Service, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma, USA
| | - Brian S Kliewer
- Section of Internal Medicine, Medical Service, Oklahoma City Veterans Affairs Health Care System, and Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Riley J Williams
- Pharmacy Service, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma, USA
| | - Sharanjeet K Thind
- Section of Infectious Diseases, Medical Service, Oklahoma City Veterans Affairs Health Care System, and Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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14
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Thyssen JP, Halling AS, Schmid-Grendelmeier P, Guttman-Yassky E, Silverberg JI. Comorbidities of atopic dermatitis-what does the evidence say? J Allergy Clin Immunol 2023; 151:1155-1162. [PMID: 36621338 DOI: 10.1016/j.jaci.2022.12.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 01/07/2023]
Abstract
Atopic dermatitis (AD) is a common disease that is associated with atopic and nonatopic comorbidities. There has been a growing interest in this area of AD, because presence or risk of comorbidities can in many ways impact the management of patients with AD. Thus, some treatments for AD may improve its comorbidities as well, whereas others may increase their risk. In this review article, we discuss various comorbidities of AD mostly on the basis of the results of recent multiple systematic reviews and meta-analyses to update readers about this rapidly developing area of dermatology. We emphasize the important information provided by studies presenting both relative risk and absolute risk, and show that AD is associated with, among others, atopic comorbidities such as asthma, rhinitis, and food allergy, nonatopic comorbidities such as ocular, psychiatric, infectious, endocrine, autoimmune, and cardiovascular diseases, and certain cancers. Clinicians need to be aware of these and be cognizant about positive and negative effects of existing and new treatments for AD.
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Affiliation(s)
- Jacob P Thyssen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Anne-Sofie Halling
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Emma Guttman-Yassky
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
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15
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Blauvelt A, Wollenberg A, Eichenfield LF, Zhang H, Sierka D, Khokhar FA, Vakil J, Shabbir A, Marco AR, Cyr SL. No Increased Risk of Overall Infection in Adults with Moderate-to-Severe Atopic Dermatitis Treated for up to 4 Years with Dupilumab. Adv Ther 2023; 40:367-380. [PMID: 36318387 PMCID: PMC9628338 DOI: 10.1007/s12325-022-02322-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/14/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Patients with atopic dermatitis (AD) have an increased risk for infections. This open-label extension study, LIBERTY AD OLE, reports the incidence of infections in adults with moderate-to-severe AD treated with dupilumab for up to 4 years. METHODS We evaluated infections in adults with moderate-to-severe AD treated with dupilumab 300 mg weekly (qw) or every 2 weeks (q2w; approved regimen) for up to 4 years. Topical corticosteroids (TCS) and calcineurin inhibitors (TCI) were permitted. Exposure-adjusted incidence rates (number of patients with at least one event per 100 patient-years [nP/100 PY]) are reported. RESULTS Overall, 2677 patients were enrolled and treated with dupilumab: 352 (13.1%) completed up to week 204; 226 patients (8.4%) switched from qw to q2w during the trial. Rates of overall infections (71.27 nP/100 PY), serious and/or severe infections (1.39 nP/100 PY), and infections leading to discontinuation (0.34 nP/100 PY) were consistent with a previous 3-year analysis of this study and low compared with 1-year results in adults with AD treated with placebo + TCS. The cumulative number of patients with treatment-emergent serious or severe infections, non-herpetic or herpetic infections, and total skin infections decreased year-over-year. Limitations included open-label study design with no placebo arm; decreasing sample size at later time points due to sponsor decision to close sites following regulatory approval; qw dosing differs from approved q2w dosing; and patients could use TCS/TCI throughout the study, which may have impacted infection rates. CONCLUSIONS Continuous long-term dupilumab treatment in adults with moderate-to-severe AD is not associated with an increased risk of overall systemic or cutaneous infections. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01949311. Video Abstract INFOGRAPHIC.
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Affiliation(s)
- Andrew Blauvelt
- grid.477719.bOregon Medical Research Center, Portland, OR USA
| | - Andreas Wollenberg
- grid.5252.00000 0004 1936 973XDepartment of Dermatology and Allergy, University Hospital, Ludwig-Maximilian University, Munich, Germany ,grid.411326.30000 0004 0626 3362Department of Dermatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Lawrence F. Eichenfield
- grid.266100.30000 0001 2107 4242Departments of Dermatology and Pediatrics, University of California San Diego, San Diego, CA USA ,grid.286440.c0000 0004 0383 2910Division of Pediatric and Adolescent Dermatology, Rady Children’s Hospital, San Diego, CA USA
| | - Haixin Zhang
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals Inc., 777 Old Saw Mill River Rd, Tarrytown, NY 10591 USA
| | - Debra Sierka
- grid.417555.70000 0000 8814 392XSanofi, Cambridge, MA USA
| | - Faisal A. Khokhar
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals Inc., 777 Old Saw Mill River Rd, Tarrytown, NY 10591 USA
| | - Jignesh Vakil
- grid.417555.70000 0000 8814 392XSanofi, Cambridge, MA USA
| | - Arsalan Shabbir
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals Inc., 777 Old Saw Mill River Rd, Tarrytown, NY 10591 USA
| | | | - Sonya L. Cyr
- grid.418961.30000 0004 0472 2713Regeneron Pharmaceuticals Inc., 777 Old Saw Mill River Rd, Tarrytown, NY 10591 USA
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16
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Toyoshima Y, Tanaka T, Matsuhisa H. A case of infective endocarditis in an 8-year-old boy 3 months after transcatheter atrial septal defect closure using Figulla Flex II occluder. Cardiol Young 2022; 33:1-3. [PMID: 36366794 DOI: 10.1017/s104795112200347x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Infective endocarditis is a rare complication of atrial septal defect closure using transcatheter procedure. We report about infective endocarditis in an 8-year-old boy 3 months after transcatheter closure using a Figulla Flex II atrial septal defect occluder. Transesophageal echocardiography showed vegetation attached to the left atrium side of the device. Device removal and atrial septal defect closure were performed. The device was less endothelialized on the left than on the right atrium side. Therefore, insufficient endothelialization may cause infective endocarditis.
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Affiliation(s)
- Yuka Toyoshima
- Department of Cardiology, Kobe Children's Hospital, Kobe, Japan
| | | | - Hironori Matsuhisa
- Department of Cardiovascular Surgery, Kobe Children's Hospital, Kobe, Japan
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17
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Umar BU, Rahman S, Dutta S, Islam T, Nusrat N, Chowdhury K, Binti Wan Ahmad Fakuradzi WFS, Haque M. Management of Atopic Dermatitis: The Role of Tacrolimus. Cureus 2022; 14:e28130. [PMID: 35990561 PMCID: PMC9387362 DOI: 10.7759/cureus.28130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Atopic dermatitis (AD) is a long-lasting inflammatory dermatological condition characterized by itchy, eczematous, sparsely tiny blisters that hold a clear watery substance. Additionally, the diseased skin can suppurate, occasionally with weeping with thickening of the affected skin. This is considered one of the top skin disorders involving both children and adult populations globally. The principal therapeutic intervention for AD is long-standing topical glucocorticoids, which have been used for several decades. Corticosteroid therapy brings several adverse drug effects (ADRs), including irreversible skin atrophy. Tacrolimus belongs to the class of calcineurin inhibitors, which is a type of immunomodulator possessing promising efficacy in treating AD. Topical tacrolimus is an effective and safe non-corticosteroid substitute treatment for AD. We reviewed the available literature to compare and institute the safety, efficacy, and effectiveness of tacrolimus when equated to corticosteroid therapy in managing AD.
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18
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Weiss A, Delavenne E, Matias C, Lagler H, Simon D, Li P, Hansen JU, Dos Santos TP, Jana B, Priemel P, Bangert C, Bauer M, Eberl S, Nussbaumer-Pröll A, Anne Österreicher Z, Matzneller P, Quint T, Weber M, Nielsen HM, Rades T, Johansen HK, Westh H, Kim W, Mylonakis E, Friis C, Guardabassi L, Pace J, Lundberg CV, M'Zali F, Butty P, Sørensen N, Nielsen HB, Toft-Kehler R, Guttman-Yassky E, Stingl G, Zeitlinger M, Sommer M. Topical niclosamide (ATx201) reduces Staphylococcus aureus colonization and increases Shannon diversity of the skin microbiome in atopic dermatitis patients in a randomized, double-blind, placebo-controlled Phase 2 trial. Clin Transl Med 2022; 12:e790. [PMID: 35522900 PMCID: PMC9076020 DOI: 10.1002/ctm2.790] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 12/12/2022] Open
Abstract
Background In patients with atopic dermatitis (AD), Staphylococcus aureus frequently colonizes lesions and is hypothesized to be linked to disease severity and progression. Treatments that reduce S. aureus colonization without significantly affecting the skin commensal microbiota are needed. Methods and findings In this study, we tested ATx201 (niclosamide), a small molecule, on its efficacy to reduce S. aureus and propensity to evolve resistance in vitro. Various cutaneous formulations were then tested in a superficial skin infection model. Finally, a Phase 2 randomized, double‐blind and placebo‐controlled trial was performed to investigate the impact of ATx201 OINTMENT 2% on S. aureus colonization and skin microbiome composition in patients with mild‐to‐severe AD (EudraCT:2016‐003501‐33). ATx201 has a narrow minimal inhibitory concentration distribution (.125–.5 μg/ml) consistent with its mode of action – targeting the proton motive force effectively stopping cell growth. In murine models, ATx201 can effectively treat superficial skin infections of methicillin‐resistant S. aureus. In a Phase 2 trial in patients with mild‐to‐severe AD (N = 36), twice‐daily treatment with ATx201 OINTMENT 2% effectively reduces S. aureus colonization in quantitative colony forming unit (CFU) analysis (primary endpoint: 94.4% active vs. 38.9% vehicle success rate, p = .0016) and increases the Shannon diversity of the skin microbiome at day 7 significantly compared to vehicle. Conclusion These results suggest that ATx201 could become a new treatment modality as a decolonizing agent.
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Affiliation(s)
- Anne Weiss
- UNION Therapeutics, Hellerup, Denmark.,Novo Nordisk Foundation for Biosustainability, Technical University of Denmark, Lyngby, Denmark
| | | | | | - Heimo Lagler
- Department of Medicine 1, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Wien, Austria
| | | | - Ping Li
- UNION Therapeutics, Hellerup, Denmark
| | - Jon U Hansen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Teresa Pires Dos Santos
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Bimal Jana
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Petra Priemel
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Christine Bangert
- Department of Dermatology, Medical University of Vienna, Wien, Austria
| | - Martin Bauer
- Department of Clinical Pharmacology, Medical University of Vienna, Wien, Austria
| | - Sabine Eberl
- Department of Clinical Pharmacology, Medical University of Vienna, Wien, Austria
| | | | | | - Peter Matzneller
- Department of Clinical Pharmacology, Medical University of Vienna, Wien, Austria
| | - Tamara Quint
- Department of Dermatology, Medical University of Vienna, Wien, Austria
| | - Maria Weber
- Department of Clinical Pharmacology, Medical University of Vienna, Wien, Austria
| | | | - Thomas Rades
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Helle Krogh Johansen
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Wooseong Kim
- Warren Alpert Medical School of Brown University, Division of Infectious Diseases, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Eleftherios Mylonakis
- Warren Alpert Medical School of Brown University, Division of Infectious Diseases, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Christian Friis
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Luca Guardabassi
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - John Pace
- UNION Therapeutics, Hellerup, Denmark
| | | | | | | | | | | | | | | | - Georg Stingl
- Department of Dermatology, Medical University of Vienna, Wien, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Wien, Austria
| | - Morten Sommer
- UNION Therapeutics, Hellerup, Denmark.,Novo Nordisk Foundation for Biosustainability, Technical University of Denmark, Lyngby, Denmark
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19
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Silverberg JI, Rubini NPM, Pires MC, Rossi AB, Zhang A, Chen Z, Levit NA, Chao J, Shumel B, Bégo-Le Bagousse G. Dupilumab Treatment Reduces Hospitalizations in Adults With Moderate-to-Severe Atopic Dermatitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1279-1285.e1. [PMID: 35032695 DOI: 10.1016/j.jaip.2021.11.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Refractory disease, flares, or infections in atopic dermatitis (AD) can lead to hospitalizations. OBJECTIVE To compare hospitalization rates among adults with moderate-to-severe AD treated with dupilumab versus control. METHODS Data from 7 randomized, placebo-controlled trials of dupilumab (300 mg every 2 weeks [q2w] and/or weekly [qw]; with or without topical corticosteroids) were analyzed. RESULTS Patients in the dupilumab 300 mg q2w, qw, and combined dupilumab (q2w and qw; n = 1,841) groups compared with patients in the control group (n = 1,091) had lower rates of all-cause hospitalizations (5.8, 2.7, and 3.8 events, respectively, vs 9.0 events per 100 patient-years [PY]; all P < .05 [49%, 71%, and 62% risk reduction, respectively]); AD-related hospitalizations (2.0, 0.4, 1.0 events vs 4.1 events per 100 PY; P < .05 for qw and dupilumab combined [91% and 79% risk reduction, respectively]); as well as reduced overall duration of AD-related hospitalization (10.9, 7.3, and 8.6 d vs 38.9 d per 100 PY). CONCLUSIONS Among adults with moderate-to-severe AD, treatment with dupilumab versus control was associated with significant reductions in all-cause and AD-related hospitalization rates, and shorter duration of AD-related hospitalization.
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Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Norma P M Rubini
- School of Medicine and Surgery, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Mario C Pires
- Dermatology Service, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
| | | | | | - Zhen Chen
- Regeneron Pharmaceutical, Inc., Tarrytown, NY
| | | | | | - Brad Shumel
- Regeneron Pharmaceutical, Inc., Tarrytown, NY
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20
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Paller AS, Beck LA, Blauvelt A, Siegfried EC, Cork MJ, Wollenberg A, Chen Z, Khokhar FA, Vakil J, Zhang A, Bansal A, Cyr SL. Infections in children and adolescents treated with dupilumab in pediatric clinical trials for atopic dermatitis-A pooled analysis of trial data. Pediatr Dermatol 2022; 39:187-196. [PMID: 35083774 PMCID: PMC9302614 DOI: 10.1111/pde.14909] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/19/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND/OBJECTIVE Patients with moderate-to-severe atopic dermatitis (AD) have increased risk of cutaneous and extracutaneous infections. Dupilumab has previously been associated with reduced risk of serious/severe infections and non-herpetic skin infections in adults with moderate-to-severe AD. This analysis assessed infection rates with dupilumab versus placebo in pediatric patients with moderate-to-severe and severe AD participating in clinical trials. METHODS This is a pooled analysis from two 16-week, randomized, placebo-controlled, phase 3 clinical trials of dupilumab: monotherapy in adolescents aged 12-17 years with moderate-to-severe AD (LIBERTY AD ADOL, NCT03054428) and with concomitant topical corticosteroids in children aged 6-11 years with severe AD (LIBERTY AD PEDS, NCT03345914). Data were pooled according to treatment received: placebo/approved dupilumab doses/other studied dupilumab doses/all dupilumab doses. Exposure-adjusted rates (patients with ≥1 event per 100 patient-years [nP/100 PY]) were used to compare treatment groups. RESULTS Overall, 612 patients were included: 205 received placebo and 407 received dupilumab (261 received approved dupilumab doses and 146 received other studied dupilumab doses). Overall infection rates were numerically lower with dupilumab versus placebo (nP/100 PY: placebo, 227; approved dupilumab, 173; other dupilumab, 206; all dupilumab, 184). Total skin infections were numerically less frequent in all dupilumab-treated groups versus placebo (nP/100 PY: placebo, 67; approved dupilumab, 30; other dupilumab, 46; all dupilumab, 36). CONCLUSIONS These data suggest that dupilumab treatment in children and adolescents with AD does not increase infection risk overall and is associated with lower rates of skin infections compared with placebo.
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Affiliation(s)
- Amy S. Paller
- Departments of Dermatology and PediatricsNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of PediatricsNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Lisa A. Beck
- University of Rochester Medical CenterRochesterNew YorkUSA
| | | | - Elaine C. Siegfried
- Departments of Pediatrics and DermatologySaint Louis University School of MedicineSt. LouisMissouriUSA
| | - Michael J. Cork
- Sheffield Dermatology ResearchUniversity of SheffieldSheffieldUK
| | - Andreas Wollenberg
- Department of Dermatology and AllergyUniversity HospitalLudwig‐Maximilian UniversityMunichGermany
| | - Zhen Chen
- Regeneron Pharmaceuticals IncTarrytownNew YorkUSA
| | | | | | | | | | - Sonya L. Cyr
- Regeneron Pharmaceuticals IncTarrytownNew YorkUSA
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21
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Bosma AL, Ascott A, Iskandar R, Farquhar K, Matthewman J, Langendam MW, Mulick A, Abuabara K, Williams HC, Spuls PI, Langan SM, Middelkamp-Hup MA. Classifying atopic dermatitis: a systematic review of phenotypes and associated characteristics. J Eur Acad Dermatol Venereol 2022; 36:807-819. [PMID: 35170821 PMCID: PMC9307020 DOI: 10.1111/jdv.18008] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/10/2021] [Accepted: 01/18/2022] [Indexed: 11/28/2022]
Abstract
Atopic dermatitis is a heterogeneous disease, accompanied by a wide variation in disease presentation and the potential to identify many phenotypes that may be relevant for prognosis and treatment. We aimed to systematically review previously reported phenotypes of atopic dermatitis and any characteristics associated with them. Ovid EMBASE, Ovid MEDLINE and Web of Science were searched from inception till the 12th of February 2021 for studies attempting to classify atopic dermatitis. Primary outcomes are atopic dermatitis phenotypes and characteristics associated with them in subsequent analyses. A secondary outcome is the methodological approach used to derive them. In total, 8,511 records were found. By focusing only on certain clinical phenotypes, 186 studies were eligible for inclusion. The majority of studies were hospital-based (59%, 109/186) and cross-sectional (76%, 141/186). The number of included patients ranged from seven to 526,808. Data-driven approaches to identify phenotypes were only used in a minority of studies (7%, 13/186). Ninety-one studies (49%) investigated a phenotype based on disease severity. A phenotype based on disease trajectory, morphology and eczema herpeticum was investigated in 56 (30%), 22 (12%) and 11 (6%) studies, respectively. Thirty-six studies (19%) investigated morphological characteristics in other phenotypes. Investigated associated characteristics differed between studies. In conclusion, we present an overview of phenotype definitions used in literature for severity, trajectory, morphology and eczema herpeticum, including associated characteristics. There is a lack of uniform and consistent use of atopic dermatitis phenotypes across studies.
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Affiliation(s)
- A L Bosma
- Department of Dermatology, UMC, location Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, The Netherlands
| | - A Ascott
- Department of Dermatology, University Hospitals Sussex NHS Foundation Trust, Worthing, United Kingdom
| | - R Iskandar
- Faculty of Epidemiology and Population Health, School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - J Matthewman
- Department of Non-communicable disease epidemiology, School of Hygiene and Tropical Medicine, London, United Kingdom
| | - M W Langendam
- Department of Epidemiology and Data Science, UMC, location Amsterdam Medical Center, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - A Mulick
- Faculty of Epidemiology and Population Health, School of Hygiene and Tropical Medicine, London, United Kingdom
| | - K Abuabara
- Department of Dermatology, University of California San Francisco, United States
| | - H C Williams
- Centre of Evidence-Based Dermatology, University of Nottingham, United Kingdom
| | - P I Spuls
- Department of Dermatology, UMC, location Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, The Netherlands
| | - S M Langan
- Department of Dermatology, UMC, location Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, The Netherlands.,Faculty of Epidemiology and Population Health, School of Hygiene and Tropical Medicine, London, United Kingdom
| | - M A Middelkamp-Hup
- Department of Dermatology, UMC, location Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, The Netherlands
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22
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Voillot P, Riche B, Portafax M, Foulquié P, Gedik A, Barbarot S, Misery L, Héas S, Mebarki A, Texier N, Schück S. Social Media Platforms Listening Study on Atopic Dermatitis: Quantitative and Qualitative Findings. J Med Internet Res 2022; 24:e31140. [PMID: 35089160 PMCID: PMC8838596 DOI: 10.2196/31140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/04/2021] [Accepted: 11/30/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic, pruritic, inflammatory disease that occurs most frequently in children but also affects many adults. Social media have become key tools for finding and disseminating medical information. OBJECTIVE The aims of this study were to identify the main themes of discussion, the difficulties encountered by patients with respect to AD, the impact of the pathology on quality of life (QoL; physical, psychological, social, or financial), and to study the perception of patients regarding their treatment. METHODS A retrospective study was carried out by collecting social media posts in French language written by internet users mentioning their experience with AD, their QoL, and their treatments. Messages related to AD discomfort posted between July 1, 2010, and October 23, 2020, were extracted from French-speaking publicly available online forums. Automatic and manual extractions were implemented to create a general corpus and 2 subcorpuses depending on the level of control of the disease. RESULTS A total of 33,115 messages associated with AD were included in the analysis corpus after extraction and cleaning. These messages were posted by 15,857 separate web users, most of them being women younger than 40 years. Tips to manage AD and everyday hygiene/treatments were among the most discussed topics for controlled AD subcorpus, while baby-related topics and therapeutic failure were among the most discussed topics for insufficiently controlled AD subcorpus. QoL was discussed in both subcorpuses with a higher proportion in the controlled AD subcorpus. Treatments and their perception were also discussed by web users. CONCLUSIONS More than just emotional or peer support, patients with AD turn to online forums to discuss their health. Our findings show the need for an intersection between social media and health care and the importance of developing new approaches such as the Atopic Dermatitis Control Tool, which is a patient-related disease severity assessment tool focused on patients with AD.
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Affiliation(s)
| | | | | | | | | | | | - Laurent Misery
- Centre Hospitalier Universitaire de Brest, Brest, France
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AAD Guidelines: awareness of comorbidities associated with atopic dermatitis in adults. J Am Acad Dermatol 2022; 86:1335-1336.e18. [DOI: 10.1016/j.jaad.2022.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/21/2022]
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24
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A Review of Safety Outcomes from Clinical Trials of Baricitinib in Rheumatology, Dermatology and COVID-19. Adv Ther 2022; 39:4910-4960. [PMID: 36063279 PMCID: PMC9443639 DOI: 10.1007/s12325-022-02281-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/21/2022] [Indexed: 01/30/2023]
Abstract
Baricitinib is an oral, selective inhibitor of Janus kinase (JAK)1/JAK2 that transiently and reversibly inhibits many proinflammatory cytokines. This mechanism is a key mediator in a number of chronic inflammatory diseases; accordingly, baricitinib has been studied and approved for the treatment of several rheumatological and dermatological disorders, as well as COVID-19. This narrative review summarises and discusses the safety profile of baricitinib across these diseases, with special focus on adverse events of special interest (AESI) for JAK inhibitors, using integrated safety data sets of clinical trial data, and puts findings into context with the underlying risk in the respective disease populations, using supporting literature. We show that rates of infection with baricitinib generally reflected the inherent risk of the disease populations being treated, with serious infections and herpes zoster being more frequent in rheumatic diseases than in dermatological disorders, and herpes simplex being reported particularly in atopic dermatitis. Similarly, rates of major adverse cardiovascular events (MACE), venous thromboembolism (VTE) and malignancies were generally within or below the ranges reported for the respective disease populations, thereby reflecting the underlying risk; these events were therefore more frequent in patients with rheumatic diseases than in those with dermatological disorders, the latter of whom generally had low absolute risk. AESI were usually more common in patients with risk factors specific for each event. When a population similar to that of ORAL Surveillance was considered, the incidence rate of MACE with baricitinib was numerically lower than that reported with tofacitinib and similar to that of tumour necrosis factor inhibitors. No safety concerns were observed in hospitalised patients with COVID-19 who received baricitinib for up to 14 days. Identifying the patterns and likelihoods of AEs that occur during treatment in large groups of patients with different diseases can help the physician and patient better contextualise the benefit-to-risk ratio for the individual patient.
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Park HJ, Choi M. Association of Childhood Atopic Dermatitis with Extracutaneous Infections Based on the Nationwide Cross-Sectional Study in Korea. Ann Dermatol 2022; 34:315-317. [PMID: 35948338 PMCID: PMC9365646 DOI: 10.5021/ad.20.249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/07/2020] [Accepted: 12/28/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Hee Jae Park
- Department of Dermatology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Mira Choi
- Department of Dermatology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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26
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Association of herpes zoster and chronic inflammatory skin disease in US inpatients. J Am Acad Dermatol 2021; 85:1437-1445. [PMID: 31958523 PMCID: PMC10148648 DOI: 10.1016/j.jaad.2019.12.073] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/29/2019] [Accepted: 12/31/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Patients with chronic inflammatory skin disease (CISD) have potential risk factors for herpes zoster (HZ). However, little is known about HZ risk in CISD. OBJECTIVE To determine whether CISD is associated with HZ. METHODS Data were analyzed from the 2002 to 2012 Nationwide Inpatient Sample, a representative cohort of US hospitalizations (N = 68,088,221 children and adults). RESULTS In multivariable logistic regression models including age, sex, race/ethnicity, insurance, household income, and long-term systemic corticosteroid use, hospitalization for HZ was associated with atopic dermatitis (adjusted odds ratio [95% confidence interval], 1.38 [1.14-1.68]), psoriasis (4.78 [2.83-8.08]), pemphigus (1.77 [1.01-3.12]), bullous pemphigoid (1.77 [1.01-3.12]), mycosis fungoides (3.79 [2.55-5.65]), dermatomyositis (7.31 [5.27-10.12]), systemic sclerosis (1.92 [1.47-2.53]), cutaneous lupus erythematosus (1.94 [1.10-3.44]), vitiligo (2.00 [1.04-3.85]), and sarcoidosis (1.52 [1.22-1.90]). Only lichen planus (crude odds ratio [95% confidence interval], 3.01 [1.36-6.67]), Sézary syndrome (12.14 [5.20-28.31]), morphea (2.74 [1.36-5.51]), and pyoderma gangrenosum (2.44 [1.16-5.13]) showed increased odds in bivariable models. Sensitivity analyses among those younger than 60 and younger than 50 years showed similar results. Predictors of HZ in CISD included female sex, fewer chronic conditions, and long-term systemic corticosteroid use. LIMITATIONS Cross-sectional study. CONCLUSIONS Many CISDs are associated with increased hospitalization for HZ, even below the ages recommended for HZ vaccination. Additional studies are needed to establish CISD-specific vaccination guidelines.
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Narla S, Silverberg JI. Dermatology for the internist: optimal diagnosis and management of atopic dermatitis. Ann Med 2021; 53:2165-2177. [PMID: 34787024 PMCID: PMC8604464 DOI: 10.1080/07853890.2021.2004322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/02/2021] [Indexed: 11/29/2022] Open
Abstract
Internists are front-line health care providers that commonly provide the first encounter to patients for dermatological conditions, especially atopic dermatitis (AD). Internists need to be comfortable with managing mild-moderate AD in their practices. Criteria and guidelines established in dermatology literature are available to help the general practitioner diagnose and treat AD. AD is a systemic disease associated with multiple cutaneous and extra-cutaneous comorbidities that warrant screening by internists, especially mental health conditions. Environmental factors may play a role in the development or worsening of AD; however, there is currently no strong evidence to guide specific population- or clinic-based interventions for their avoidance. While food allergies are common in AD patients, the role of food allergens as an exacerbating factor for AD is controversial. Before starting any dietary modifications, careful evaluation should be performed by an allergist. If the patient is not well-controlled despite adequate topical therapies or is experiencing severe/worsening disease, early referral to dermatology is warranted to rule out confounding diagnoses and/or escalation to systemic therapies. Finally, it is important to recognise the racial disparities present in AD and address these when formulating treatment plans.Key messages:Confounding dermatoses, either instead of or in addition to AD, should be considered in treatment-refractory AD, and the appropriate workup may be initiated while awaiting dermatology referral.AD patients have multiple cutaneous and extra-cutaneous comorbidities that warrant screening by internists, especially mental health conditions.
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Affiliation(s)
- Shanthi Narla
- Department of Dermatology, St. Luke’s University Health Network, Easton, PA, USA
| | - Jonathan I. Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Real-world comorbidities of atopic dermatitis in the U.S. adult ambulatory population. J Am Acad Dermatol 2021; 86:835-845. [PMID: 34800600 DOI: 10.1016/j.jaad.2021.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 11/04/2021] [Accepted: 11/10/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is a pruritic inflammatory skin disease associated with various comorbidities. However, comprehensive analyses of real-world comorbidities in adult AD patients are limited. OBJECTIVE To characterize the real-world comorbidities associated with adult AD in an ambulatory population. METHODS We queried the MarketScan Commercial Claims and Encounters database from January 1, 2017 to December 31, 2017. Multivariable logistic regressions were performed to compare comorbidities in adult AD patients vs. age- and sex-matched controls. RESULTS A total of 39,779 AD patients and 353,743 controls were identified. Increased odds of psychiatric conditions including anxiety (OR 1.44) and mood disorders (OR 1.31) were observed in AD. AD patients had higher likelihood of autoimmune diseases including vitiligo (OR 4.44) and alopecia areata (OR 6.01). Adult AD was also associated with infections including impetigo (OR 9.72), MRSA (OR 3.92), and cellulitis (OR 2.52). AD patients were more likely to have systemic conditions including lymphoid/hematopoietic malignancy (OR 1.91), atherosclerosis (OR 1.69), and metabolic syndrome (OR 1.47). For all the above, p<0.001. LIMITATIONS Retrospective analysis of healthcare claims data CONCLUSIONS: Adult AD is associated with various psychiatric and systemic comorbidities, emphasizing the systemic nature of AD and the need for collaborative management of these patients.
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DESCRIBE-AD: A novel classification framework for atopic dermatitis. J Am Acad Dermatol 2021; 87:541-550. [PMID: 34774658 PMCID: PMC10119387 DOI: 10.1016/j.jaad.2021.10.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/27/2021] [Accepted: 10/29/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic, inflammatory skin disease associated with heterogeneous morphology, distribution, symptoms, severity, extent, longitudinal courses, quality of life burden, comorbidities, and treatment responses. This heterogeneity contributes to challenges in diagnosis, the characterization of disease activity, and therapeutic stratification. OBJECTIVE To develop a framework to standardize AD assessment. METHODS We propose a novel framework to assess AD based on a literature review and clinical experience. RESULTS DESCRIBE-AD is a framework that can effectively capture the clinical domains contributing to AD heterogeneity and includes both patient- and clinician-reported perspectives. DESCRIBE-AD includes assessments of Dermatitis morphology and phenotype, Evolution of disease, Symptom severity, Comorbid health disorders, Response to therapy, Intensity of lesions, Burden of disease, and Extent of lesions. Rather than placing the focus on any single, specific aspect of AD, DESCRIBE-AD allows for a comprehensive approach to the assessment and clinical management of AD. CONCLUSIONS DESCRIBE-AD is a novel framework that can be used to better describe the heterogeneity of AD and guide treatment decisions.
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Wan J, Shin DB, Syed MN, Abuabara K, Lemeshow AR, Gelfand JM. Risk of herpesvirus, serious, and opportunistic infections in atopic dermatitis: a population-based cohort study. Br J Dermatol 2021; 186:664-672. [PMID: 34748650 DOI: 10.1111/bjd.20887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Staphylococcal and herpes simplex virus (HSV) infections are commonly recognized in atopic dermatitis (AD) but less is known about other types of infections. OBJECTIVES To determine the risk of herpesvirus infections, serious infections, and opportunistic infections in patients with AD. METHODS We conducted a population-based cohort study using UK-based electronic medical records data. Patients with AD were each matched to up to 5 unaffected patients on age, practice, and index date. AD severity was defined using treatments. The outcomes were incident herpesvirus infections (cytomegalovirus [CMV], Epstein-Barr virus [EBV], HSV, or varicella zoster virus [VZV]), serious infections, and opportunistic infections. RESULTS 409,431 children and 625,083 adults with AD were matched to 1,809,029 children and 2,678,888 adults without AD, respectively. In adjusted Cox regression models, children and adults with AD had 50-52% greater risk of HSV and 18-33% greater risk of VZV, with risk increasing in parallel with AD severity. CMV risk was elevated among children with AD (HR 2.50 [1.38-4.54]) and adults with severe AD (4.45 [1.76-11.25]). Patients with AD had 26-40% increase in risk of serious infections, with severe AD carrying greatest risk. Although rare, opportunistic infections were not associated with AD in children but were associated with all severities of AD in adults (overall HR 1.31 [1.20-1.42]). All estimates remained consistent after excluding patients receiving immunosuppressive treatments for AD. CONCLUSIONS AD is significantly associated with herpesvirus infections, serious infections, and opportunistic infections in a dose-responsive manner with severity. AD may increase susceptibility to infections exclusive of immunosuppressive medications.
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Affiliation(s)
- J Wan
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - D B Shin
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - M N Syed
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - K Abuabara
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | | | - J M Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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31
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Abstract
Atopic dermatitis is a complex, chronic inflammatory skin disorder with significant morbidity. It is often a frustrating condition for both children and parents due to chronic and relapsing course. There is now an increasing understanding of the disease pathogenesis resulting in discovery of much wanted newer therapeutics and targeted therapies after a long time. Whether these interventions will result in sustained benefits or long term cure remains to be seen.
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Affiliation(s)
- Shweta Saini
- Division of Allergy and Immunology, Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Pediatric Specialty Center, Suite # 4018, 3950 Beaubien Boulevard, Detroit, MI 48201, USA
| | - Milind Pansare
- Division of Allergy and Immunology, Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Pediatric Specialty Center, Suite # 4018, 3950 Beaubien Boulevard, Detroit, MI 48201, USA.
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Yousaf M, Ayasse M, Ahmed A, Gwillim E, Janmohamed SR, Yousaf A, Patel KR, Thyssen JP, Silverberg JI. Association between Atopic Dermatitis and Hypertension: A Systematic Review and Meta-Analysis. Br J Dermatol 2021; 186:227-235. [PMID: 34319589 DOI: 10.1111/bjd.20661] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies found conflicting results about the association of atopic dermatitis (AD) with hypertension. OBJECTIVES Determine whether AD and AD severity are associated with hypertension. METHODS A systematic review was performed of published studies in MEDLINE, EMBASE, Scopus, Web of Science, and GREAT databases. At least 2 reviewers conducted title/abstract, full-text review, and data extraction. Quality of evidence was assessed using the Newcastle-Ottawa Scale. RESULTS Fifty-one studies met inclusion criteria; 19 had sufficient data for meta-analysis. AD was associated with higher odds of hypertension compared to healthy controls (increased in 9 of 16 studies; pooled prevalence: 16.4% vs 13.8%; random-effects regression, pooled unadjusted odds ratio [OR][95% confidence interval <CI95>]: 1.16 [1.04-1.30]), but lower odds of hypertension compared to psoriasis (decreased in 5 of 8 studies; 15.4% vs 24.8%; 0.53 [0.37-0.76]). In particular, moderate-severe AD were associated with hypertension compared to healthy controls (increased in 4 of 6 studies; 24.9% vs 14.7%; 2.33 [1.10-4.94]). Hypertension was commonly reported as an adverse-event secondary to AD treatments, particularly systemic cyclosporine A. Limitations include lack of longitudinal studies or individual-level data and potential confounding. CONCLUSIONS AD, particularly moderate-to-severe disease, was associated with increased hypertension compared to healthy controls, but lower odds than psoriasis.
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Affiliation(s)
- M Yousaf
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - M Ayasse
- Department of Dermatology, George Washington University School of Medicine, Washington, DC, USA
| | - A Ahmed
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - E Gwillim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - S R Janmohamed
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Dermatology, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - A Yousaf
- Department of Dermatology, West Virginia University School of Medicine, Morgantown
| | - K R Patel
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - J P Thyssen
- Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark
| | - J I Silverberg
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Hu Y, Jiang F, Tan J, Liu S, Li S, Wu M, Yan C, Yu G, Hu Y, Yin Y, Tong S. Environmental Exposure and Childhood Atopic Dermatitis in Shanghai: A Season-Stratified Time-Series Analysis. Dermatology 2021; 238:101-108. [PMID: 34082421 DOI: 10.1159/000514685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Childhood atopic dermatitis (AD) is an inflammatory skin disease which sometimes predisposes to allergies. Environmental factors (low humidity, irritants, etc.) are prominent causative triggers of AD. OBJECTIVES This study aims to explore the effects of both meteorological factors and air pollutants on childhood AD, and the modification effects by season in Shanghai, China. METHODS Quasi-Poisson generalized linear regression model, combined with a distributed lag nonlinear model was used to examine the nonlinear and lagged effects of environmental factors on childhood AD from 2009 to 2017 in Shanghai. We also performed a season-stratified analysis to determine the modification effects of environmental exposure by season on childhood AD. RESULTS There were 1,043,240 outpatient visits for childhood AD in total, at 3 major pediatric hospitals. Low temperature and relative humidity (RH), and high daily temperature difference (DTD) and air pollutants (i.e., NO2) increased the relative risks (RRs) of outpatient visits for childhood AD in the whole year. In the cold season, an increased risk of outpatient visits for childhood AD was associated with low RH (RR 2.26, 95% CI 1.69-3.02) and high NO2 (1.11, 95% CI 1.06-1.17). In the warm season, outpatient visits for childhood AD were associated with low temperature (3.49, 95% CI 3.22-3.77), low RH (1.89, 95% CI 1.74-2.06), high DTD (1.41, 95% CI 1.31-1.53), and high NO2 (1.05, 95% CI 1.03-1.06). CONCLUSIONS This study suggests that environmental exposure may be a key trigger for outpatient visits for childhood AD with apparent seasonal effects. Tailored preventive strategies to avoid environmental triggers of childhood AD should be developed.
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Affiliation(s)
- Yabin Hu
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fan Jiang
- Department of Developmental and Behavioral Pediatrics, Pediatric Translational Medicine Institution, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianguo Tan
- Shanghai Key Laboratory of Meteorology and Health (Shanghai Meteorological Service), Shanghai, China
| | - Shijian Liu
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shenghui Li
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Meiqin Wu
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chonghuai Yan
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guangjun Yu
- Center for Biomedical Informatics, Shanghai Children's Hospital, Shanghai, China
| | - Yi Hu
- Center for Biomedical Informatics, Shanghai Children's Hospital, Shanghai, China
| | - Yong Yin
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shilu Tong
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,School of Public Health, Institute of Environment and Population Health, Anhui Medical University, Hefei, China.,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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34
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Management of atopic dermatitis in the inpatient setting. CURRENT DERMATOLOGY REPORTS 2021. [DOI: 10.1007/s13671-021-00332-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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Extended Safety Analysis of Baricitinib 2 mg in Adult Patients with Atopic Dermatitis: An Integrated Analysis from Eight Randomized Clinical Trials. Am J Clin Dermatol 2021; 22:395-405. [PMID: 33826132 PMCID: PMC8068648 DOI: 10.1007/s40257-021-00602-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Baricitinib, a selective Janus kinase 1/Janus kinase 2 inhibitor, is indicated in the European Union and Japan for the treatment of moderate-to-severe atopic dermatitis (AD) in adults who are candidates for systemic therapy. OBJECTIVE The objective of this study was to evaluate the safety of baricitinib 2 mg in the AD clinical program. METHODS Six double-blind, randomized, placebo-controlled studies, and two long-term extension studies were summarized in two datasets. Placebo comparison was based on six 16-week studies with baricitinib 2 mg. All-bari-2-mg-AD included patients who received baricitinib 2 mg at any time during the eight studies. RESULTS In total, 1598 patients received once-daily baricitinib 2 mg for 1434.2 patient-years of exposure (median 330 days/maximum 2.4 years). Treatment-emergent adverse events were higher for baricitinib 2 mg (57.9%) vs placebo (51.6%). Serious adverse events, serious infections, and opportunistic infections were low in frequency and similar between baricitinib 2 mg and placebo. There were no malignancies, gastrointestinal perforations, or major adverse cardiovascular events with baricitinib 2 mg in the placebo-controlled period. Herpes simplex (cluster) was higher for baricitinib 2 mg (3.8%) vs placebo (2.8%); rates decreased with extended 2 mg exposure. In All-bari-2-mg-AD, there were five malignancies other than non-melanoma skin cancer, two major adverse cardiovascular events, one peripheral venous thrombosis, one arterial thrombosis, and no pulmonary embolisms, deep vein thromboses, or deaths. CONCLUSIONS This integrated analysis in patients with moderate-to-severe AD confirms the established safety profile of baricitinib 2 mg. Longer exposure to treatment is required to evaluate risks of malignancies and major adverse cardiovascular events. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifiers: NCT02576938 (first posted 15 October, 2015); NCT03334396 (7 November, 2017); NCT03334422 (7 November, 2017); NCT03428100 (9 February, 2018); NCT03435081 (15 February, 2018); NCT03733301 (7 November, 2018); NCT03334435 (7 November, 2017); NCT03559270 (18 June, 2018).
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Mu Z, Zhang Y, Li L, Han X. Mapping knowledge structures and theme trends of atopic dermatitis: a co-word biclustering and quantitative analysis of the publication between 2015 and 2019. J DERMATOL TREAT 2021; 33:2024-2033. [PMID: 33761805 DOI: 10.1080/09546634.2021.1905769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) has been a hot research direction of dermatologists for a long time. However, the knowledge structures and theme trends for AD have not yet been studied bibliometrically. OBJECTIVE To investigate the distribution pattern and knowledge structure of AD related literatures in PubMed. METHODS Bibliographic information was generated by the Bibliographic Item Co-Occurrence Matrix Builder (BICOMB). A visual matrix was created by the gCLUTO software. GraphPad Prism 5 software was used to construct a Strategic diagram analysis. Ucinet 6.0 software and NetDraw 2.084 software were used to generate a social network analysis (SNA). RESULTS Among all the extracted MeSH terms and subheadings, 77 MeSH terms/MeSH subheadings with a high-frequency were identified, and hot topics were gathered together into 6 groups. In the strategic diagram, immunology, microbiology, and drug therapy of AD were fully developed. In contrast, prevention, pathology, genetics, metabolism, administration, cost of illness, quality of life therapeutic paradigm, and immunosuppressive agents of AD were considerably immature offering prospective scope for further research. CONCLUSIONS The results may potentially aid in describing an all-round grasp of the current research areas and furnish guidelines for the researchers for beginning new projects.
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Affiliation(s)
- Zhenzhen Mu
- Department of Dermatology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yue Zhang
- Department of Dermatology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Lin Li
- Department of Dermatology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiuping Han
- Department of Dermatology, Shengjing Hospital of China Medical University, Shenyang, China
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Sutaria N, Choi J, Roh YS, Alphonse MP, Adawi W, Lai J, Pollock JR, Fontecilla Biles N, Gabriel S, Chavda R, Kwatra SG. Association of prurigo nodularis and infectious disease hospitalizations: a national cross-sectional study. Clin Exp Dermatol 2021; 46:1236-1242. [PMID: 33763852 DOI: 10.1111/ced.14652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/07/2021] [Accepted: 03/16/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Prurigo nodularis (PN) is associated with a variety of systemic comorbidities, including infectious diseases such as HIV and viral hepatitis. There are limited data on other infectious disease comorbidities in patients with PN. AIM To characterize infectious disease hospitalizations among patients with PN and the associated cost burden. METHODS We searched the 2016-2017 National Inpatient Sample, a cross-sectional sample of 20% of all US hospitalizations, for infectious disease hospitalizations among patients with PN. Associations of PN with infections and related costs were determined using multivariable logistic and linear regression, adjusting for age, race, sex and insurance type. RESULTS PN was associated with any infection overall (OR = 2.98, 95% CI 2.49-3.56), and with HIV, cutaneous, hepatobiliary, central nervous system, bacterial, viral and fungal/parasitic infections and for sepsis. Patients with PN had a higher mean cost of care (US$11 667 vs. US$8893, P < 0.001) and length of stay (5.5 vs. 4.2 days, P < 0.001) for any infection overall and for 7 of 13 other infections. Adjusting for age, race, sex and insurance coverage, PN was associated with higher cost (+30%, 95% CI +17 to +44%) and higher length of stay (+30%, 95% CI +18 to +44%) for any infection overall, and for several specific infections. These associations remained with alternate regression models adjusting for severity of illness. CONCLUSION There is a high infectious disease burden among patients with PN, corresponding to higher healthcare utilization and spending. Clinicians must be aware of these associations when treating these patients with immunomodulatory drugs.
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Affiliation(s)
- N Sutaria
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J Choi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Y S Roh
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - M P Alphonse
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - W Adawi
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - J Lai
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J R Pollock
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Dermatology, Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | - N Fontecilla Biles
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S Gabriel
- Galderma SA, Prescription GBU, Lausanne, Switzerland
| | - R Chavda
- Galderma SA, Prescription GBU, Lausanne, Switzerland
| | - S G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Association of Atopic Dermatitis With Bacterial, Fungal, Viral, and Sexually Transmitted Skin Infections. Dermatitis 2021; 31:157-164. [PMID: 32049716 DOI: 10.1097/der.0000000000000526] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is associated with altered skin barrier, microbiome, and immune dysregulation that may increase risk of skin infections. OBJECTIVE The aim of the study was to determine whether AD is associated with skin infections and related outcomes. METHODS Data from the 2006 to 2012 National Emergency Department Sample were analyzed, including an approximately 20% sample of all US emergency department (ED) visits (N = 198,102,435 adults or children). RESULTS Skin infections were increased in ED visits of adults (7.14% vs 3.76%) and children (5.15% vs 2.48%) with AD. In multivariable logistic regression models, AD was associated with significantly higher odds of skin infection in adults (adjusted odds ratio [95% confidence interval] = 1.93 [1.89-1.97]) and children (2.23 [2.16-2.31]). Pediatric and adult AD were associated with significantly higher odds of carbuncle/furuncles, impetigo, cellulitis, erysipelas, methicillin-resistant and methicillin-sensitive Staphylococcus aureus infections, molluscum contagiosum, cutaneous warts, herpes simplex and zoster viruses, eczema herpeticum, dermatophytosis, and candidiasis of skin/nails and vulva/urogenitals. Adults with AD had significantly higher odds of genital warts (1.51 [1.36-1.52]) and herpes (1.23 [1.11-1.35]). Skin infections were associated with US $19 million excess annual costs of ED care in persons with AD. CONCLUSIONS Atopic dermatitis patients had higher odds of multiple bacterial, viral, fungal, and sexually transmitted skin infections.
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Wang V, Boguniewicz J, Boguniewicz M, Ong PY. The infectious complications of atopic dermatitis. Ann Allergy Asthma Immunol 2021; 126:3-12. [PMID: 32771354 PMCID: PMC7411503 DOI: 10.1016/j.anai.2020.08.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Atopic dermatitis (AD) is a chronic inflammatory skin disease that is complicated by an increased risk for skin and systemic infections. Preventive therapy for AD is based on skin barrier improvement and anti-inflammatory treatments, whereas overt skin and systemic infections require antibiotics or antiviral treatments. This review updates the pathophysiology, diagnosis, management, controversy of antibiotic use, and potential treatments of infectious complications of AD. DATA SOURCES Published literature obtained through PubMed database searches and clinical pictures. STUDY SELECTIONS Studies relevant to the mechanisms, diagnosis, management, and potential therapy of infectious complications of AD. RESULTS Skin barrier defects, type 2 inflammation, Staphylococcusaureus colonization, and cutaneous dysbiosis are the major predisposing factors for the increased infections in AD. Although overt infections require antibiotics, the use of antibiotics in AD exacerbation remains controversial. CONCLUSION Infectious complications are a comorbidity of AD. Although not common, systemic bacterial infections and eczema herpeticum can be life-threatening. Preventive therapy of infections in AD emphasizes skin barrier improvement and anti-inflammatory therapy. The use of antibiotics in AD exacerbation requires further studies.
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Affiliation(s)
- Vivian Wang
- Veterans Affairs Greater Los Angeles Healthcare System, United States Department of Veteran Affairs, Los Angeles, California
| | - Juri Boguniewicz
- Section of Infectious Diseases, Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Mark Boguniewicz
- Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health, Denver, Colorado; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Peck Y Ong
- Division of Clinical Immunology and Allergy, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California; Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California.
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Role of Antimicrobial Peptides in Skin Barrier Repair in Individuals with Atopic Dermatitis. Int J Mol Sci 2020; 21:ijms21207607. [PMID: 33066696 PMCID: PMC7589391 DOI: 10.3390/ijms21207607] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 12/17/2022] Open
Abstract
Atopic dermatitis (AD) is a common chronic inflammatory skin disease that exhibits a complex interplay of skin barrier disruption and immune dysregulation. Patients with AD are susceptible to cutaneous infections that may progress to complications, including staphylococcal septicemia. Although most studies have focused on filaggrin mutations, the physical barrier and antimicrobial barrier also play critical roles in the pathogenesis of AD. Within the physical barrier, the stratum corneum and tight junctions play the most important roles. The tight junction barrier is involved in the pathogenesis of AD, as structural and functional defects in tight junctions not only disrupt the physical barrier but also contribute to immunological impairments. Furthermore, antimicrobial peptides, such as LL-37, human b-defensins, and S100A7, improve tight junction barrier function. Recent studies elucidating the pathogenesis of AD have led to the development of barrier repair therapy for skin barrier defects in patients with this disease. This review analyzes the association between skin barrier disruption in patients with AD and antimicrobial peptides to determine the effect of these peptides on skin barrier repair and to consider employing antimicrobial peptides in barrier repair strategies as an additional approach for AD management.
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Bieber T, Thyssen JP, Reich K, Simpson EL, Katoh N, Torrelo A, De Bruin-Weller M, Thaci D, Bissonnette R, Gooderham M, Weisman J, Nunes F, Brinker D, Issa M, Holzwarth K, Gamalo M, Riedl E, Janes J. Pooled safety analysis of baricitinib in adult patients with atopic dermatitis from 8 randomized clinical trials. J Eur Acad Dermatol Venereol 2020; 35:476-485. [PMID: 32926462 DOI: 10.1111/jdv.16948] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/07/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Janus kinase (JAK) inhibition is a new mode of action in atopic dermatitis (AD); clarity about drug class safety considerations in the context of AD is important. Baricitinib, an oral, reversible, selective inhibitor of JAK1/JAK2, is in late-stage development for adult patients with moderate-to-severe AD. OBJECTIVE To report pooled safety data for baricitinib in patients with moderate-to-severe AD in the clinical development program including long-term extension (LTE) studies. METHODS This analysis included patient-level safety data from six double-blinded, randomized, placebo-controlled studies (one phase 2 and five phase 3), one double-blinded, randomized, LTE study and one open-label LTE study, reported in three data sets: placebo-controlled, 2-mg - 4-mg extended and All-bari AD. Safety outcomes include treatment-emergent adverse events, adverse events of special interest and abnormal laboratory changes. Proportions of patients with events and incidence rates were calculated. RESULTS Data were collected for 2531 patients who were given baricitinib for 2247 patient-years (median duration 310 days). The frequency of serious infections, opportunistic infections and conjunctival disorders was low and similar between treatment groups in the placebo-controlled period. The most common serious infections were eczema herpeticum [n = 11, incidence rates (IR) = 0.5], cellulitis (n = 6, IR = 0.3) and pneumonia (n = 3, IR = 0.1). There were four opportunistic infections (IR = 0.2). No malignancies, gastrointestinal perforations, positively adjudicated cardiovascular events or tuberculosis were reported in the placebo-controlled period in baricitinib-treated patients. Frequency of herpes simplex was higher in the 4-mg group (6.1%) vs. the 2-mg (3.6%) and placebo group (2.7%); IRs in the extended data set (2-mg IR = 9.6; 4-mg IR = 14.5) were lower vs. the placebo-controlled data set (2-mg IR = 12.4; 4-mg IR = 21.3). In the All-bari AD data set, there were two positively adjudicated major adverse cardiovascular events (2-mg group): two venous thrombosis events (4-mg group) and one death. CONCLUSION This integrated safety analysis in patients with moderate-to-severe AD confirms the established safety profile of baricitinib.
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Affiliation(s)
- T Bieber
- University Hospital of Bonn, Bonn, Germany
| | - J P Thyssen
- Department of Dermatology and Allergy, Herlev-Gentofte Hospital University of Copenhagen, Copenhagen, Denmark
| | - K Reich
- University Med Cen Hamburg-Eppendorf, Hamburg, Germany
| | - E L Simpson
- Oregon Health & Science University, Portland, OR, USA
| | - N Katoh
- Department of Dermatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - A Torrelo
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - D Thaci
- Comprehensive Center for Inflammation Medicine, University Hospital Schleswig Holstein, Luebeck, Germany
| | | | - M Gooderham
- SKiN Centre for Dermatology, Peterborough, ON, Canada
| | - J Weisman
- Medical Dermatology Specialists, Atlanta, GA, USA
| | - F Nunes
- Eli Lilly and Company, Indianapolis, IN, USA
| | - D Brinker
- Eli Lilly and Company, Indianapolis, IN, USA
| | - M Issa
- Eli Lilly and Company, Indianapolis, IN, USA
| | - K Holzwarth
- Eli Lilly and Company, Indianapolis, IN, USA
| | - M Gamalo
- Eli Lilly and Company, Indianapolis, IN, USA
| | - E Riedl
- Eli Lilly and Company, Indianapolis, IN, USA
| | - J Janes
- Eli Lilly and Company, Indianapolis, IN, USA
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Mathé PJ, Joost I, Peyerl-Hoffmann G, Schneider C, Kern W, Rieg S. Staphylococcus aureus Bloodstream Infection in Patients with Atopic Dermatitis, or: Think Twice Before Placing a Venous Catheter into Lesional Atopic Skin. J Invest Dermatol 2020; 140:1870-1872. [DOI: 10.1016/j.jid.2020.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/19/2020] [Accepted: 02/04/2020] [Indexed: 11/29/2022]
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Droitcourt C, Vittrup I, Kerbrat S, Egeberg A, Thyssen JP. Risk of systemic infections in adults with atopic dermatitis: A nationwide cohort study. J Am Acad Dermatol 2020; 84:290-299. [PMID: 32750384 DOI: 10.1016/j.jaad.2020.07.111] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/23/2020] [Accepted: 07/26/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) has been linked to systemic infections in adulthood, but large-scale studies are few, and potential associations are unclear. OBJECTIVE To examine whether adults with AD have increased risk of developing systemic infections leading to hospital-based management. METHODS Nationwide register-based cohort study including all Danish adults from 1995 through 2017. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated by using Cox models. RESULTS A total of 10,602 adults with AD (median age, 29.8 y; interquartile range, 22.6-44.8) and 106,020 reference individuals were included. The overall incidence rate per 10,000 person-years of systemic infections was 180.6 (95% CI, 172.6-189.0) among adults with AD compared with 120.4 (95% CI, 118.3-122.5) among reference adults. The association between AD and systemic infections was observed for musculoskeletal (adjusted HR [aHR], 1.81; 95% CI, 1.42-2.31), heart (aHR, 1.75; 95% CI, 1.21-2.53), and upper (aHR, 1.42; 95% CI, 1.15-1.73) and lower respiratory tract infections (aHR, 1.21; 95% CI, 1.10-1.33). The risk of sepsis (aHR, 1.19; 95% CI, 1.01-1.44) and skin infections (aHR, 2.30; 95% CI, 2.01-2.62) was also increased. LIMITATIONS The findings cannot be generalized to adults with milder AD seen outside the hospital system. CONCLUSION We found an increased risk of systemic infections among adults with hospital managed AD.
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Affiliation(s)
- Catherine Droitcourt
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin, Herlev and Gentofte Hospital, Hellerup, Denmark; Department of Dermatology, Centre Hospitalier Universitaire Rennes, Rennes, France; University of Rennes, Equipe d'Accueil 7449 REcherche en Pharmaco-Epidemiologie et REcours aux Soins "Pharmacoepidemiology and Health Services Research", Rennes, France.
| | - Ida Vittrup
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Sandrine Kerbrat
- University of Rennes, Equipe d'Accueil 7449 REcherche en Pharmaco-Epidemiologie et REcours aux Soins "Pharmacoepidemiology and Health Services Research", Rennes, France
| | - Alexander Egeberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Jacob P Thyssen
- Department of Dermatology and Venereology, Bispebjerg Hospital, University of Copenhagen, Denmark
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Hong MR, Lei D, Yousaf M, Chavda R, Gabriel S, Janmohamed SR, Silverberg JI. A real-world study of the longitudinal course of adult atopic dermatitis severity in clinical practice. Ann Allergy Asthma Immunol 2020; 125:686-692.e3. [PMID: 32682980 DOI: 10.1016/j.anai.2020.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/03/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Little is known about the longitudinal course of adult atopic dermatitis (AD) lesional severity and extent in clinical practice. OBJECTIVE To determine the longitudinal course of AD in clinical practice. METHODS A prospective, dermatology practice-based study was performed (n = 400). Patients were assessed at baseline and approximately 6, 12, 18, and 24 months by eczema area and severity index (EASI) and objective-scoring atopic dermatitis (objective-SCORAD). Multivariable repeated measures linear regression models were constructed to evaluate AD severity over time. RESULTS Overall, 36.2% and 18.2% of patients had moderate (6.0-22.9) or severe (23.0-72.0) EASI scores at any visit, respectively. Similarly, 29.0% and 26.4% of patients had moderate (24.0-37.9) or severe (38.0-83.0) objective-SCORAD scores at any visit, respectively. Among patients with baseline moderate (6.0-22.9) or severe (23.0-72.0) EASI scores, 25.0% and 18.6% continued to have moderate or severe scores at 1 or more follow-up visits, respectively. Similarly, among patients with baseline moderate (24.0-37.9) or severe (38.0-83.0) objective-SCORAD scores, 22.6% and 24.5% continued to have moderate or severe scores at 1 or more follow-up visits, respectively. In longitudinal regression models, EASI was significantly associated with body surface area (adjusted β [95% confidence interval]: 0.16 [0.09-0.23]) and edema/papulation (2.31 [0.19-4.43]). In addition, objective-SCORAD was significantly associated with body surface area (0.12 [0.04-0.21]), edema/papulation (4.69 [2.05-7.32]), and scratch (3.34 [0.45-6.24]) over time. CONCLUSION AD lesional severity has a heterogeneous longitudinal course. Many patients had fluctuating lesional severity scores over time. A minority of patients had persistently moderate or severe lesions over time. Most patients with moderate-severe disease at baseline were unable to achieve persistent lesional clearance.
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Affiliation(s)
- Mindy R Hong
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Donald Lei
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Muhammad Yousaf
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rajeev Chavda
- Prescription Strategy and Innovation Group, Galderma SA, La Tour-de-Peilz, Switzerland
| | - Sylvie Gabriel
- Prescription Strategy and Innovation Group, Galderma SA, La Tour-de-Peilz, Switzerland
| | - Sherief R Janmohamed
- Department of Dermatology, Universitair Ziekenhuis Brussel (UZB), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Jette, Belgium
| | - Jonathan I Silverberg
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Dermatology, the George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
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Matusiak Ł, Szepietowska M, Krajewski PK, Białynicki-Birula R, Szepietowski JC. The use of face masks during the COVID-19 pandemic in Poland: A survey study of 2315 young adults. Dermatol Ther 2020; 33:e13909. [PMID: 32602208 PMCID: PMC7361243 DOI: 10.1111/dth.13909] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 12/23/2022]
Abstract
Face masks wearing during the coronavirus disease 2019 (COVID‐19) pandemic became ubiquitous. The aim of our study was to assess the use of face masks among young adults during the current viral pandemic. The survey was based on specially created Google Forms and posted on numerous Facebook groups for young people in Poland. Seven days were considered as a recall period. A total of 2315 answers were obtained, 2307 were finally analysis, as eight questionnaires were removed because of data incompleteness. 60.4% of responders declared using the face masks. Those who reported an atopic predisposition wore face masks significantly (P = .007) more commonly (65.5% and 57.7%, respectively). Cloth masks (46.2%) appeared to be most popular ones, followed by surgical masks (39.2%), respirators (N95 and FFP) (13.3%), half‐face elastomeric respirators (0.8%) and full‐face respirators (0.4%). Females significantly more frequently (P = .0001) used cloth masks; respirators, half‐face elastomeric respirators and full‐face respirators were used more commonly by males (P < .0001, P = .001 and P = .001, respectively). 23.9% of responders who used single‐use mask wore it again. Moreover, 73.6% participants declared mask decontamination; however, the procedures were not always appropriate. We suggest that our results may be of help in construction of general public education campaigns on the proper use of face masks.
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Affiliation(s)
- Łukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Marta Szepietowska
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr K Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Rafał Białynicki-Birula
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
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Mendes JT, Balogh EA, Strowd LC, Feldman SR. An evaluation of baricitinib as a therapeutic option for adult patients with moderate to severe atopic dermatitis. Expert Opin Pharmacother 2020; 21:1027-1033. [PMID: 32208940 DOI: 10.1080/14656566.2020.1739268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Moderate-to-severe AD burdens a large proportion of AD patients and may represent an inadequacy of treatment options available for resistant disease. AREAS COVERED This review provides an overview of the therapies for moderate-to-severe AD in late-stage development and in the clinic, and focuses on baricitinib as an emerging therapeutic option. Baricitinib is an orally available selective JAK1/JAK2 inhibitor that is approved for use in the treatment of moderate-to-severe rheumatoid arthritis (RA). Baricitinib decreases AD lesions, disease severity, and improves quality of life. Overall, the small molecule inhibitor is well tolerated. However, its black-box warnings in the RA population raise a concern for its long-term safety. EXPERT OPINION Baricitinib is a promising treatment modality for moderate-to-severe AD. Its primary advantage over dupilumab, the revolutionary biologic agent approved for AD, is that patients prefer an oral medication over an injection. However, providers will likely prescribe an injectable over an oral medication if baricitinib has an unfavorable safety profile. Insurance coverage of baricitinib will also have a major role in clinical use. Baricitinib will likely face competition from other JAK inhibitors in the future; however, it will have an advantage if it becomes the first FDA-approved medication of its kind for resistant AD.
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Affiliation(s)
- Jocelyn T Mendes
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine , Winston-Salem, North Carolina
| | - Esther A Balogh
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine , Winston-Salem, North Carolina
| | - Lindsay C Strowd
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine , Winston-Salem, North Carolina
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine , Winston-Salem, North Carolina
- Department of Pathology, Wake Forest School of Medicine , Winston-Salem, NC, USA
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine , Winston-Salem, NC, USA
- Department of Dermatology, University of Southern Denmark , Odense, Denmark
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Alexander H, Paller AS, Traidl-Hoffmann C, Beck LA, De Benedetto A, Dhar S, Girolomoni G, Irvine AD, Spuls P, Su J, Thyssen JP, Vestergaard C, Werfel T, Wollenberg A, Deleuran M, Flohr C. The role of bacterial skin infections in atopic dermatitis: expert statement and review from the International Eczema Council Skin Infection Group. Br J Dermatol 2019; 182:1331-1342. [PMID: 31677162 PMCID: PMC7317931 DOI: 10.1111/bjd.18643] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 12/27/2022]
Abstract
Patients with atopic dermatitis (AD) have an increased risk of bacterial skin infections, which cause significant morbidity and, if untreated, may become systemic. Staphylococcus aureus colonizes the skin of most patients with AD and is the most common organism to cause infections. Overt bacterial infection is easily recognized by the appearance of weeping lesions, honey‐coloured crusts and pustules. However, the wide variability in clinical presentation of bacterial infection in AD and the inherent features of AD – cutaneous erythema and warmth, oozing associated with oedema, and regional lymphadenopathy – overlap with those of infection, making clinical diagnosis challenging. Furthermore, some features may be masked because of anatomical site‐ and skin‐type‐specific features, and the high frequency of S. aureus colonization in AD makes positive skin swab culture of suspected infection unreliable as a diagnostic tool. The host mechanisms and microbial virulence factors that underlie S. aureus colonization and infection in AD are incompletely understood. The aim of this article is to present the latest evidence from animal and human studies, including recent microbiome research, to define the clinical features of bacterial infections in AD, and to summarize our current understanding of the host and bacterial factors that influence microbial colonization and virulence.
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Affiliation(s)
- H Alexander
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, SE1 7EH, U.K
| | - A S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, U.S.A
| | - C Traidl-Hoffmann
- Chair and Institute of Environmental Medicine, UNIKA-T, Technical University of Munich and Helmholtz Zentrum München, Augsburg, Germany.,CK-CARE, Christine Kühne Center for Allergy Research and Education, Davos, Switzerland
| | - L A Beck
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY, U.S.A
| | - A De Benedetto
- Department of Dermatology, College of Medicine, University of Florida, Gainesville, FL, U.S.A
| | - S Dhar
- Department of Pediatric Dermatology, Institute of Child Health, Kolkata, India
| | - G Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - A D Irvine
- Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland.,Dermatology, Children's Health Ireland, Dublin, Ireland.,National Children's Research Centre, Dublin, Ireland
| | - P Spuls
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - J Su
- Departments of Dermatology and Paediatrics, Murdoch Children's Research Institute, University of Melbourne and Monash University, Eastern Health, Melbourne, VIC, Australia
| | - J P Thyssen
- Department of Dermatology and Allergy, Herlev-Gentofte Hospital, Hellerup, Denmark
| | - C Vestergaard
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - T Werfel
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - A Wollenberg
- Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany
| | - M Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - C Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, SE1 7EH, U.K
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Wollenberg A, Beck LA, Blauvelt A, Simpson EL, Chen Z, Chen Q, Shumel B, Khokhar FA, Hultsch T, Rizova E, Rossi AB, Graham NMH, Pirozzi G, Lu Y, Ardeleanu M. Laboratory safety of dupilumab in moderate-to-severe atopic dermatitis: results from three phase III trials (LIBERTY AD SOLO 1, LIBERTY AD SOLO 2, LIBERTY AD CHRONOS). Br J Dermatol 2019; 182:1120-1135. [PMID: 31407311 PMCID: PMC7317598 DOI: 10.1111/bjd.18434] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2019] [Indexed: 12/13/2022]
Abstract
Background Dupilumab [a monoclonal antibody blocking the shared receptor subunit for interleukin (IL)‐4 and IL‐13] is approved for patients aged ≥ 12 years with inadequately controlled, moderate‐to‐severe atopic dermatitis (AD). Dupilumab trials of up to 52 weeks demonstrated efficacy and a favourable safety profile in patients with moderate‐to‐severe AD inadequately controlled with topical medications. Objectives To further characterize the safety of dupilumab by evaluating clinical laboratory findings from three randomized, double‐blinded, placebo‐controlled phase III trials (LIBERTY AD SOLO 1 & 2 and LIBERTY AD CHRONOS). Methods Patients were randomized 1 : 1 : 1 (SOLO 1 & 2) or 3 : 1 : 3 (CHRONOS) for 16 and 52 weeks, respectively, to dupilumab weekly, every 2 weeks or placebo. CHRONOS patients received a standardized concomitant topical corticosteroid regimen. Laboratory outcomes were summarized descriptively in 1376 patients from SOLO 1 & 2 and 740 from CHRONOS. Results Treatment groups had similar results in baseline laboratory parameters. Platelets and neutrophils showed mild decreases from baseline in dupilumab vs. placebo groups. Some dupilumab‐treated patients had small transient increases in eosinophils. Grade 3 eosinophilia was reported in < 1% of dupilumab‐treated and placebo‐treated patients; no adverse events were associated with eosinophilia. Lactate dehydrogenase levels decreased from baseline during dupilumab treatment in all trials. No clinically meaningful changes were observed between treatment groups in other haematology, chemistry or urinalysis parameters. Conclusions There were no clinically important changes in routine laboratory parameters that could be attributed to dupilumab. This study supports the use of dupilumab as a systemic treatment for moderate‐to‐severe AD that does not require laboratory monitoring. What's already known about this topic? Long‐term treatment of atopic dermatitis (AD) with conventional immunosuppressive agents is limited by the risk of significant side‐effects and a need for repeated tests to monitor haematological and/or organ (e.g. liver, kidney) toxicities. Dupilumab [a monoclonal antibody blocking the shared receptor subunit for interleukin (IL)‐4 and IL‐13] is approved for the treatment of patients with inadequately controlled, moderate‐to‐severe AD. In 16‐week and 52‐week studies, dupilumab demonstrated a positive risk/benefit profile in moderate‐to‐severe AD.
What does this study add? This study is the first comprehensive analysis of dupilumab laboratory safety data of the 16‐week SOLO 1 & 2 (pooled N = 1376) and 52‐week CHRONOS (N = 740) trials, demonstrating an absence of clinically important changes in haematology, serum chemistry and urinalysis parameters in patients with moderate‐to‐severe AD treated with dupilumab. Our data support the use of dupilumab as a systemic treatment for the long‐term management of moderate‐to‐severe AD without routine laboratory monitoring in clinical practice.
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Affiliation(s)
- A Wollenberg
- Department of Dermatology and Allergology, Ludwig Maximilian University of Munich, Frauenlobstraße 9-11, 80337, Munich, Germany
| | - L A Beck
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY, U.S.A
| | - A Blauvelt
- Oregon Medical Research Center, Portland, OR, U.S.A
| | - E L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, OR, U.S.A
| | - Z Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - Q Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - B Shumel
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - F A Khokhar
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - T Hultsch
- Sanofi Genzyme, Cambridge, MA, U.S.A
| | - E Rizova
- Sanofi Genzyme, Cambridge, MA, U.S.A
| | - A B Rossi
- Sanofi Genzyme, Cambridge, MA, U.S.A
| | - N M H Graham
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | | | - Y Lu
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
| | - M Ardeleanu
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, U.S.A
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The Best of 2018 in the Annals of Allergy, Asthma, and Immunology: The Editors' Choices. Ann Allergy Asthma Immunol 2019; 122:127-133. [PMID: 30711033 DOI: 10.1016/j.anai.2018.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 11/15/2018] [Indexed: 11/23/2022]
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Leung DYM. The effect of being African American on atopic dermatitis. Ann Allergy Asthma Immunol 2019; 122:1. [PMID: 30579430 DOI: 10.1016/j.anai.2018.09.454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 09/11/2018] [Indexed: 12/14/2022]
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