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Werfel T, Heratizadeh A, Aberer W, Ahrens F, Augustin M, Biedermann T, Diepgen T, Fölster-Holst R, Kahle J, Kapp A, Nemat K, Peters E, Schlaeger M, Schmid-Grendelmeier P, Schmitt J, Schwennesen T, Staab D, Traidl-Hoffmann C, Werner R, Wollenberg A, Worm M, Ott H. Aktualisierung„ Systemtherapie bei Neurodermitis“ zur S2k‐Leitlinie Neurodermitis. J Dtsch Dermatol Ges 2021; 19:151-169. [PMID: 33491881 DOI: 10.1111/ddg.14371_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas Werfel
- Abteilung für Immundermatologie und experimentelle Allergologie, Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover
| | - Annice Heratizadeh
- Abteilung für Immundermatologie und experimentelle Allergologie, Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover
| | - Werner Aberer
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Austria
| | | | - Matthias Augustin
- Kompetenzzentrum Versorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Eppendorf, Hamburg
| | - Tilo Biedermann
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München
| | - Thomas Diepgen
- Institut für Klinische Sozialmedizin, Hautklinik, Universitätsklinikum Heidelberg
| | - Regina Fölster-Holst
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Julia Kahle
- Deutscher Allergie- und Asthmabund (DAAB) e.V., Mönchengladbach
| | - Alexander Kapp
- Abteilung für Immundermatologie und experimentelle Allergologie, Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover
| | - Katja Nemat
- Praxis für Kinderpneumologie und Allergologie, Kinderzentrum Dresden-Friedrichstadt (Kid), Dresden
| | - Eva Peters
- Klinik für Psychosomatik und Psychotherapie, Universitätsklinikum Gießen (UKGM), Gießen
| | | | | | - Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), Medizinische Fakultät Gustav Carus, Technische Universität Dresden
| | | | - Doris Staab
- Klinik für Pädiatrie m. S. Pneumologie und Immunologie, Charité Campus Virchow-Klinikum, Berlin
| | | | - Ricardo Werner
- Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin
| | - Andreas Wollenberg
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwigs-Maximilians-Universität, München
| | - Margitta Worm
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin
| | - Hagen Ott
- Fachbereich Pädiatrische Dermatologie und Allergologie, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover
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Werfel T, Heratizadeh A, Aberer W, Ahrens F, Augustin M, Biedermann T, Diepgen T, Fölster-Holst R, Kahle J, Kapp A, Nemat K, Peters E, Schlaeger M, Schmid-Grendelmeier P, Schmitt J, Schwennesen T, Staab D, Traidl-Hoffmann C, Werner R, Wollenberg A, Worm M, Ott H. Update "Systemic treatment of atopic dermatitis" of the S2k-guideline on atopic dermatitis. J Dtsch Dermatol Ges 2021; 19:151-168. [PMID: 33491884 DOI: 10.1111/ddg.14371] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This guideline is an update from August 2020 the S2k-guideline "Atopic dermatitis" published in 2015. The reason for updating this chapter of the guideline were the current developments in the field of systemic therapy of atopic dermatitis. The agreed recommendations for systemic treatment in atopic dermatitis of the present guideline are based on current scientific data. Due to the approval of dupilumab for the treatment of moderate to severe atopic dermatitis, which cannot be treated sufficiently with topical drugs alone, this part of the guideline has now been adapted and newly consented. The indication for systemic therapy and the therapeutic response to topical and systemic treatment should be recorded and documented in a suitable form in clinic and practice. A standardized documentation of the indication for system therapy in atopic dermatitis can be recommended and is also part of the updated chapter of this guideline.
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Affiliation(s)
- Thomas Werfel
- Abteilung für Immundermatologie und experimentelle Allergologie, Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover
| | - Annice Heratizadeh
- Abteilung für Immundermatologie und experimentelle Allergologie, Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover
| | - Werner Aberer
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Austria
| | | | - Matthias Augustin
- Kompetenzzentrum Versorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Eppendorf, Hamburg
| | - Tilo Biedermann
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München
| | - Thomas Diepgen
- Institut für Klinische Sozialmedizin, Hautklinik, Universitätsklinikum Heidelberg
| | - Regina Fölster-Holst
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Julia Kahle
- Deutscher Allergie- und Asthmabund (DAAB) e.V., Mönchengladbach
| | - Alexander Kapp
- Abteilung für Immundermatologie und experimentelle Allergologie, Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover
| | - Katja Nemat
- Praxis für Kinderpneumologie und Allergologie, Kinderzentrum Dresden-Friedrichstadt (Kid), Dresden
| | - Eva Peters
- Klinik für Psychosomatik und Psychotherapie, Universitätsklinikum Gießen (UKGM), Gießen
| | | | | | - Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsforschung, Technische Universität Dresden
| | | | - Doris Staab
- Klinik für Pädiatrie m. S. Pneumologie und Immunologie, Charité Campus Virchow-Klinikum, Berlin
| | | | - Ricardo Werner
- Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin
| | - Andreas Wollenberg
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwigs-Maximilians-Universität, München
| | - Margitta Worm
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin
| | - Hagen Ott
- Fachbereich Pädiatrische Dermatologie und Allergologie, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover
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3
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Phan K, Smith SD. Mycophenolate mofetil and atopic dermatitis: systematic review and meta-analysis. J DERMATOL TREAT 2019; 31:810-814. [PMID: 31294617 DOI: 10.1080/09546634.2019.1642996] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background: For severe cases of atopic dermatitis, systemic or potent agents may be required for control of disease. There have been some reports of treatment efficacy of off-label use of mycophenolate mofetil (MMF) in patients with refractory atopic dermatitis or have developed adverse effects to initial systemic agents.Methods: Electronic searches were performed using six databases from their inception to April 2019. Data were extracted and analyzed according to predefined clinical endpoints.Results: From 140 cases, the mean age was 38.21 ± 22.8 years. There were 52.9% males and 47.1% females. The average number of failed agents was 3.5 ± 1.2. 77.6% reported partial or full remission. Relapses occurred in 8.2% of cases. The average time for initial effects was 6.8 ± 7 weeks. There was a significant reduction in pre to post SCORAD scores by 18 points (p = .0002). More males had complications compared to females. Prolonged duration of treatment ≥1 year was associated with herpes infections.Conclusions: In summary, the current evidence to date is low-quality in nature but is promising regarding the efficacy and safety of MMF for adult and pediatric atopic dermatitis. There should be ongoing monitoring for infections that may develop on long term therapy.
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Affiliation(s)
- Kevin Phan
- Department of Dermatology, Liverpool Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Saxon D Smith
- Department of Dermatology, Royal North Shore Hospital, St Leonards, Sydney, Australia.,Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia.,The Dermatology and Skin Cancer Centre, Sydney, Australia
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4
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Abstract
Therapy of severe atopic dermatitis, which is refractory to consistent treatment with topical steroids and topical calcineurin inhibitors is still a problem in many cases. The use of cyclosporine, which is the only approved systemic drug for the therapy of severe atopic dermatitis, is often limited by contraindications or adverse reactions. In this context, results from controlled and open-label studies with novel therapeutic approaches such as methotrexate, omalizumab or rituximab, which are in part very promising, are of great interest. In this work we would like to provide an overview of established and new therapeutic options for the treatment of severe atopic dermatitis.
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Systemic Therapy of Atopic Dermatitis: When, How, for How Long? CURRENT DERMATOLOGY REPORTS 2017. [DOI: 10.1007/s13671-017-0176-7] [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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6
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Megna M, Napolitano M, Patruno C, Villani A, Balato A, Monfrecola G, Ayala F, Balato N. Systemic Treatment of Adult Atopic Dermatitis: A Review. Dermatol Ther (Heidelb) 2017; 7:1-23. [PMID: 28025775 PMCID: PMC5336433 DOI: 10.1007/s13555-016-0170-1] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Indexed: 12/17/2022] Open
Abstract
Atopic dermatitis (AD) is a common chronic inflammatory skin disease that predominantly affects children. However, it can persist in adulthood and/or start at older ages. Due to its chronic nature and frequently occurring relapses, AD has a substantial effect on patients' quality of life, often requiring long-term systemic treatment, especially in adult patients, who are more frequently refractory to adequate topical treatment with mid- to high-potent corticosteroids and/or calcineurin inhibitors. Therefore, treatment with systemic therapies is often needed to take control of the disease, prevent exacerbations and improve quality of life. However, data regarding systemic treatment effectiveness and long-term safety in adult patients with AD are insufficient. Indeed, standardized international guidelines are lacking, and the treatment approach widely differs among diverse countries. This review focuses on the use of systemic treatments in adult AD patients analyzing published literature.
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Affiliation(s)
- Matteo Megna
- Department of Dermatology, University of Naples Federico II, Naples, Italy.
| | | | - Cataldo Patruno
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - Alessia Villani
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - Anna Balato
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | | | - Fabio Ayala
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - Nicola Balato
- Department of Dermatology, University of Naples Federico II, Naples, Italy
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7
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Abstract
Mycophenolate mofetil (MMF) is an immunosuppressive drug the efficiency of which has been established in renal transplantation. Recent studies suggest that it may also be effective in the treatment of variant skin diseases especially if the skin lesions are triggered by lymphocytes. Studies have shown efficacy in autoimmune bullous dermatoses, atopic dermatitis and psoriasis. However, there are no placebo-controlled trials that support the use of MMF as first line therapy in these skin diseases.
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Affiliation(s)
- M Hartmann
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - A Enk
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
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8
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Abstract
Mycophenolate mofetil (MMF) is an immunosuppressive drug the efficiency of which has been established in renal transplantation. Recent studies suggest that it may also be effective in the treatment of variant skin diseases especially if the skin lesions are triggered by lymphocytes. Studies have shown efficacy in autoimmune bullous dermatoses, atopic dermatitis and psoriasis. However, there are no placebo-controlled trials that support the use of MMF as first line therapy in these skin diseases.
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Affiliation(s)
- M Hartmann
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany.
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10
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Thomas W, Werner A, Frank A, Matthias A, Tilo B, Thomas D, Regina FH, Uwe G, Annice H, Julia K, Alexander K, Alexander N, Katja N, Hagen O, Bernhard P, Martin R, Martin S, Peter SG, Jochen S, Thomas S, Doris S, Margitta W. Leitlinie Neurodermitis [atopisches Ekzem; atopische Dermatitis]. J Dtsch Dermatol Ges 2015; 14:e1-75. [DOI: 10.1111/ddg.12884] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
| | - Aberer Werner
- Österreichische Gesellschaft für Dermatologie und Venerologie
| | - Ahrens Frank
- Gesellschaft für Pädiatrische Allergologie und Umweltmedizin e.V
| | - Augustin Matthias
- Arbeitsgemeinschaft Gesundheitsökonomie und Evidenzbasierte Medizin der Deutschen Dermatologischen Gesellschaft
| | | | - Diepgen Thomas
- Arbeitsgemeinschaft Berufs- und Umweltdermatologie der Deutschen Dermatologischen Gesellschaft
| | - Fölster-Holst Regina
- Arbeitsgemeinschaft Pädiatrische Dermatologie der Deutschen Dermatologischen Gesellschaft
| | | | | | | | - Kapp Alexander
- Deutsche Gesellschaft für Allergologie und Klinische Immunologie
| | - Nast Alexander
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V. (Moderation)
| | - Nemat Katja
- Berufsverband der Kinder- und Jugendärzte e.V
| | - Ott Hagen
- Deutsche Gesellschaft für Kinder- und Jugendmedizin e.V
| | - Przybilla Bernhard
- Arbeitsgemeinschaft Allergologie der Deutschen Dermatologischen Gesellschaft
| | | | | | | | | | | | - Staab Doris
- Arbeitsgemeinschaft Neurodermitisschulung e.V
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11
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Nygaard U, Vestergaard C, Deleuran M. Systemic Treatment of Severe Atopic Dermatitis in Children and Adults. CURRENT TREATMENT OPTIONS IN ALLERGY 2014. [DOI: 10.1007/s40521-014-0032-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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Chaptini C, Sidhu S. Mycophenolate mofetil as a treatment for urticarial dermatitis. Australas J Dermatol 2014; 55:275-8. [PMID: 25178716 DOI: 10.1111/ajd.12192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 04/27/2014] [Indexed: 11/27/2022]
Abstract
We report two cases of adults with urticarial dermatitis who could not be managed by a variety of treatments but who obtained good control with mycophenolate mofetil (MMF). A clinical response was seen 6-8 weeks from treatment onset and they were maintained on MMF 1 g twice daily (case 1), and MMF 1 g omni mane and 500 mg omni nocte (case 2), with no major exacerbations for many years. MMF is an immunosuppressive agent, which is currently used off-label for many dermatological conditions. To date, there have been no studies investigating the use of MMF as a treatment for urticarial dermatitis. The cases we present suggest that MMF is an effective treatment for this condition, and we recommend that MMF be considered as a treatment option.
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13
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Abstract
Systemic therapy for atopic dermatitis (AD) is indicated in patients with severe disease refractory to adequate topical treatment. Currently available drugs aim to decrease inflammation by suppressing and/or modulating immune responses and thus may indirectly improve skin barrier function, resulting in a decrease in clinical signs and symptoms in particular pruritus. Before considering systemic treatment, patient adherence to topical treatment including skin care has to be ensured. The selection of the drug depends on the disease severity, localization, complications, concomitant diseases, and age of the patient, but also on their availability and costs as well as the doctor's experience. Bearing in mind the potential risk of resistance, systemic therapy with antibiotics should be exclusively considered in clinically manifest infections such as in children. Here, we review recently published clinical trials and case reports on systemic therapy of pediatric and adult patients with AD to draw conclusions for clinical practice. Although AD is a common disease, controlled clinical studies investigating the efficacy of systemic drugs are scarce, except for cyclosporine, which has been approved for the therapy of severe AD.
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Affiliation(s)
- D. Simon
- Department of Dermatology; Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - T. Bieber
- Department of Dermatology and Allergy; University of Bonn; Bonn Germany
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14
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George L, Hamann I, Chen K, Choi J, Fernandez-Peñas P. An analysis of the dermatological uses of mycophenolate mofetil in a tertiary hospital. J DERMATOL TREAT 2013; 26:63-6. [DOI: 10.3109/09546634.2013.860419] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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15
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Schneider L, Tilles S, Lio P, Boguniewicz M, Beck L, LeBovidge J, Novak N, Bernstein D, Blessing-Moore J, Khan D, Lang D, Nicklas R, Oppenheimer J, Portnoy J, Randolph C, Schuller D, Spector S, Tilles S, Wallace D. Atopic dermatitis: a practice parameter update 2012. J Allergy Clin Immunol 2013; 131:295-9.e1-27. [PMID: 23374261 DOI: 10.1016/j.jaci.2012.12.672] [Citation(s) in RCA: 269] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 12/18/2012] [Indexed: 10/27/2022]
Abstract
This parameter was developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma and Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Atopic dermatitis: a practice parameter update 2012." This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology. These parameters are not designed for use by pharmaceutical companies in drug promotion. Published practice parameters of the Joint Task Force on Practice Parameters for Allergy & Immunology are available online at http://www.jcaai.org.
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16
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Abstract
Atopic eczema, also known as atopic dermatitis, is a frequent, highly pruritic, chronic skin disease, which is typically running in flares. The traditional treatment mainly consists of the reactive application of topical anti-inflammatory agents such as topical corticosteroids and topical calcineurin inhibitors. The short term benefit of this approach is well known, but long term remission between flares is difficult to achieve. Therefore, innovative long-term treatment strategies targeting flare prevention and skin barrier stabilization are needed. We and others have shown that normal looking, non-lesional skin of atopic dermatitis patients is immunobiologially not normal but characterized by an invisible inflammation and barrier defect. This has led to the novel concept of proactive therapy, which is defined as long-term, low-dose intermittent application of anti-inflammatory therapy to the previously affected skin, together with an ongoing emollient treatment of unaffected skin. This review article describes the most important long-term treatment options for atopic dermatitis, which includes emollient therapy, the novel concept of proactive treatment, the different ultraviolet light modalities and a selection of systemic immunosuppressive drugs and biologics. Current trial data, licensed indications, off-label use and relevant side effects of the different treatment modalities are summarized.
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Affiliation(s)
- Andreas Wollenberg
- Department of Dermatology and Allergy, Ludwig Maximilian University, Munich, Germany
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17
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Haeck IM, Knol MJ, Ten Berge O, van Velsen SGA, de Bruin-Weller MS, Bruijnzeel-Koomen CAFM. Enteric-coated mycophenolate sodium versus cyclosporin A as long-term treatment in adult patients with severe atopic dermatitis: a randomized controlled trial. J Am Acad Dermatol 2011; 64:1074-84. [PMID: 21458107 DOI: 10.1016/j.jaad.2010.04.027] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 04/10/2010] [Accepted: 04/12/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cyclosporin A (CsA) is frequently used in the treatment of severe atopic dermatitis (AD). Enteric-coated mycophenolate sodium (EC-MPS) may be an alternative with equal efficacy and fewer side effects. OBJECTIVE The aim of this observer-blinded randomized controlled trial was to compare EC-MPS with CsA as long-term treatment in adult patients with severe AD. METHODS Fifty five patients with AD were treated with CsA (5 mg/kg) in a 6-week run-in period. Thereafter, patients either received CsA (3 mg/kg; n = 26) or EC-MPS (1440 mg; n = 24) during a maintenance phase of 30 weeks and there was a 12-week follow-up period. Disease activity was measured using the objective SCORAD and serum thymus and activation-regulated chemokine (TARC) levels and side effects were registered. RESULTS During the first 10 weeks the objective SCORAD and serum TARC levels in the EC-MPS study arm were higher in comparison with the CsA study arm. In addition, 7 of the 24 patients treated with EC-MPS required short oral corticosteroid courses. During maintenance phase disease activity was comparable in both study arms. Side effects in both study arms were mild and transient. After study medication withdrawal, disease activity of the patients in the CsA study arm significantly increased compared with the EC-MPS study arm. LIMITATION The nonblinding of patients and prescriber of rescue medication are limitations. CONCLUSIONS This study shows that EC-MPS is as effective as CsA as maintenance therapy in patients with AD. However, clinical improvement with EC-MPS is delayed in comparison with CsA. Clinical remission after stopping EC-MPS lasts longer compared with CsA.
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Affiliation(s)
- Inge M Haeck
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
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18
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Ballester I, Silvestre J, Pérez-Crespo M, Lucas A. Tratamiento de la dermatitis atópica grave del adulto con mofetil micofenolato en 8 pacientes. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s0001-7310(09)72917-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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19
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Ballester I, Silvestre J, Pérez-Crespo M, Lucas A. Severe Adult Atopic Dermatitis: Treatment With Mycophenolate Mofetil in 8 Patients. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s1578-2190(09)70559-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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20
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Neri P, Manoni M, Fortuna C, Lettieri M, Mariotti C, Giovannini A. Association of systemic steroids and mycophenolate mofetil as rescue therapy for uveitic choroidal neovascularization unresponsive to the traditional immunesuppressants: interventional case series. Int Ophthalmol 2009; 30:583-90. [DOI: 10.1007/s10792-009-9323-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 08/16/2009] [Indexed: 10/20/2022]
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21
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Abstract
Recently, the use of mycophenolate mofetil (MMF) has expanded in dermatological practice. Three patients with PG received MMF in conjunction with prednisone and a fourth patient received MMF monotherapy daily. MMF in combination with prednisone in three of our patients and alone in our fourth patient induced healing of their ulcers. The first patient tolerated MMF apart from gastrointestinal upset, while treatment in our second patient was complicated by staphylococcal and pseudomonal sepsis. The third patient complained of palpitations and headaches.
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Affiliation(s)
- M R Lee
- Department of Dermatology, Royal North Shore Hospital, St Leonard's, New South Wales, Australia.
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22
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Abstract
Atopic dermatitis (AD) is a common disease in childhood that is a serious burden on patients and their families. Most AD is mild and can be managed with the use of emollients and standard therapy consisting of topical corticosteroids or topical calcineurin inhibitors. However, in a subgroup of patients with moderate to severe AD, the disease is recalcitrant to topical therapy and systemic treatments become necessary. Short courses of systemic corticosteroids are often used in clinical practice, but their use is controversial. International guidelines suggest that in the case of acute flare-ups, patients might benefit from a short course of systemic corticosteroids, but long-term use and use in children should be avoided. Ciclosporin is an immunosuppressant agent that acts directly on cells of the immune system, with an inhibitory effect on T cells. When AD cannot be controlled by standard topical therapies, ciclosporin significantly decreases symptom scores, disease extent, pruritus and sleep deprivation, and improves quality of life. The most frequent adverse effects associated with the use of ciclosporin are hypertension and renal dysfunction, but they are usually reversible after drug discontinuation. Ciclosporin has been found to be safely used, effective and well tolerated in children with severe AD. However, studies to assess the long-term effectiveness and safety of ciclosporin in AD are lacking. In patients for whom ciclosporin is not suitable, or when there is a lack of response, alternative drugs should be considered, such as azathioprine or interferon-gamma. Intravenous immunoglobulins and the monoclonal antibody infliximab only have a place in the systemic therapy of AD when other drugs have failed. Mycophenolate mofetil has recently been introduced in the treatment of recalcitrant AD. Efalizumab and omalizumab are monoclonal antibodies with a possible future role in the treatment of AD, but further studies are needed.
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Affiliation(s)
- Giampaolo Ricci
- Department of Pediatrics, University of Bologna, Bologna, Italy.
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Mycophenolate mofetil in dermatology. J Am Acad Dermatol 2009; 60:183-99; quiz 200-2. [DOI: 10.1016/j.jaad.2008.08.049] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Revised: 08/01/2008] [Accepted: 08/11/2008] [Indexed: 11/17/2022]
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BuBmann C, Bieber T, Novak N. Systemic therapeutic options for severe atopic dermatitis. J Dtsch Dermatol Ges 2008; 7:205-19. [PMID: 18759739 DOI: 10.1111/j.1610-0387.2008.06834.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Systemic therapy of severe atopic dermatitis (AD) is difficult in some cases, because the use of immunosuppressive agents such as cyclosporine A, mofetil mycophenolate, tacrolimus, and azathioprine is limited by adverse reactions or contraindications. Recent reports suggest a helpful role for biologics, methotrexate, anti-IgE antibodies, and immunotherapy. We review the modes of action, as well as advantages and disadvantages of current and new systemic therapeutic options for severe AD.
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Affiliation(s)
- Caroline BuBmann
- Clinic and Polyclinic for Dermatology and Allergology, University of Bonn, Germany
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25
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Eedy D. What's new in atopic dermatitis? Br J Dermatol 2008. [DOI: 10.1111/j.1365-2133.2001.04373.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Atopic dermatitis is a chronically relapsing eczematous disease of the skin. A wide range of therapeutic regimens has been used for atopic dermatitis. A better understanding of its pathogenesis will also lead to the development of novel approaches to treating this disease. This article reviews the recent advances in allergen-specific sublingual immunotherapy and therapy with antileukotriene drugs, probiotics, mycophenolate mofetil, leflunomide, and intermittent fluticasone propionate ointment, which the authors expect will be clinically useful therapies in the near future.
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Affiliation(s)
- Chih-Jung Hsu
- Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
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Neri P, Mariotti C, Cimino L, Mercanti L, Giovannini A. Long-term control of cystoid macular oedema in noninfectious uveitis with Mycophenolate Mofetil. Int Ophthalmol 2008; 29:127-33. [PMID: 18297240 DOI: 10.1007/s10792-008-9200-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2007] [Accepted: 10/08/2007] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate the long-term safety and efficacy of Mycophenolate Mofetil (MMF) for the control of cystoid macular oedema (CMO) secondary to noninfectious uveitis (NU). METHODS The medical records of 19 consecutive patients with inflammatory CMO treated with MMF were retrospectively reviewed. Patient demographics, best corrected visual acuity (BCVA), fluorescein angiography (FA), and optical coherence tomography (OCT) findings were evaluated. RESULTS There were eight females and 11 males with a mean age of 32.9 +/- 8.9 years. After a 1-year follow-up, 18/19 patients (31 eyes, 96.9%, P < 0.05) no longer had signs of CMO, as per their FA and OCT findings; the mean central foveal thickness (CFT) was 167.2 +/- 12.8 microm. At the last follow-up, only 3/19 patients, all affected by Behçet panuveitis, had recurrences of CMO. Mean BCVA improved from 0.34 +/- 0.14 SD at baseline to 0.65 +/- 0.2 SD at last follow-up. CONCLUSIONS MMF was safe and effective in controlling CMO and in reducing the uveitis relapse rate in patients not responding to traditional immunosuppressants. Further case-controlled studies are mandatory to validate those preliminary results.
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Affiliation(s)
- Piergiorgio Neri
- Neuroscience Department, Ophthalmology Section, Polytechnic University of Marche, Via Tronto 10, Torrette, Ancona, Italy.
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28
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Heller M, Shin HT, Orlow SJ, Schaffer JV. Mycophenolate mofetil for severe childhood atopic dermatitis: experience in 14 patients. Br J Dermatol 2007; 157:127-32. [PMID: 17489974 DOI: 10.1111/j.1365-2133.2007.07947.x] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Reports of successful treatment of atopic dermatitis (AD) with mycophenolate mofetil (MMF) have thus far been limited to adults. Considering that the condition typically develops during childhood and is most active during this period, MMF would represent a valuable addition to the therapeutic armamentarium for paediatric AD. OBJECTIVES To evaluate the safety and efficacy of MMF in the treatment of severe childhood AD. METHODS A retrospective analysis was performed of all children treated with MMF as systemic monotherapy for severe, recalcitrant AD between August 2003 and August 2006 at New York University Medical Center. Fourteen patients meeting these criteria were identified. RESULTS Four patients (29%) achieved complete clearance, four (29%) had > 90% improvement (almost complete), five (35%) had 60-90% improvement and one (7%) failed to respond. Initial responses occurred within 8 weeks (mean 4 weeks), and maximal effects were attained after 8-12 weeks (mean 9 weeks) at MMF doses of 40-50 mg kg(-1) daily in younger children and 30-40 mg kg(-1) daily in adolescents. The medication was well tolerated in all patients, with no infectious complications or development of leucopenia, anaemia, thrombocytopenia or elevated aminotransferases. CONCLUSIONS This retrospective case series demonstrates that MMF can be a safe and effective treatment for severe, refractory AD in children. MMF represents a promising therapeutic alternative to traditional systemic immunosuppressive agents with less favourable side-effect profiles, and prospective controlled studies are warranted, further to assess its benefits in paediatric AD.
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Affiliation(s)
- M Heller
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY 10016, USA
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29
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Conner ER, Beck LA. Emerging therapeutic options for atopic dermatitis: beyond TIMs. Curr Allergy Asthma Rep 2006; 6:275-81. [PMID: 16822379 DOI: 10.1007/s11882-006-0060-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease that significantly impacts both patients and their families. Although current therapies provide relief of symptoms for most but not all patients, they do not prevent or eradicate the disease. In this new era of biological therapy, medications that precisely target the molecular mediators of inflammation are being developed at a rapid pace. These biologic agents have proven useful for treating many inflammatory illnesses, as well as providing insight into disease pathogenesis. In atopic dermatitis, these new therapies may prove highly useful to both treat and prevent the disease. In this review article, we briefly review the pathogenesis of AD to discuss current therapies and to introduce potential new treatments.
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Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory disease of the skin that can be refractory to topical and systemic corticosteroids, phototherapy, topical immunomodulators and systemic immunosuppressive drugs. Recent studies have shown promise for the use of mycophenolate mofetil (MMF) to treat recalcitrant AD. AIM To assess the effectiveness and adverse effects of MMF used for moderate to severe AD in a university outpatient dermatology clinic. METHODS A retrospective chart review of 20 patient charts was conducted for patient age, gender, duration of disease, prior therapies, concomitant therapy, clinical response and adverse side-effects. RESULTS Of the 20 patients, 17 improved within 4 weeks of starting MMF therapy. Ten patients had disease remission and were subsequently able to discontinue MMF. Seven attained satisfactory control of their AD using MMF as maintenance therapy. Overall, MMF was well tolerated, with mild headaches, gastrointestinal complaints and fatigue as the commonest side-effects. During therapy, herpes zoster developed in four patients, Staphylococcus aureus cutaneous infections in two, and herpes simplex in one. One patient discontinued MMF because of insufficient control of pruritus. CONCLUSION MMF can be rapidly effective and well tolerated in patients with moderate to severe AD resistant to conventional therapies. The limitations of this retrospective study include no control group and a lack of a standardized scoring index to assess improvement, and the concomitant use of adjuvant therapies makes the contribution of MMF alone difficult to assess. Larger controlled studies are needed.
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Affiliation(s)
- M L Murray
- Methodist Medical Center and University of Texas South-western Medical Center Dallas, TX, USA
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31
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Abstract
Atopic dermatitis is a common inflammatory skin condition with increasing incidence in recent decades. The mainstay of treatment has been the combination of emollients and topical corticosteroids, with the addition of systemic therapies in severe cases. New drugs such as the topical calcineurin inhibitors have shown promise in treating mild-to-severe atopic dermatitis. Other novel therapies that have been reported in the literature include leukotriene antagonists, monoclonal antibodies such as infliximab, leflunomide, recombinant interferon gamma and intravenous immunoglobulin. This review will focus on the treatment of adult atopic dermatitis.
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Affiliation(s)
- Vernon S C Pua
- Department of Dermatology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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Siepmann K, Huber M, Stübiger N, Deuter C, Zierhut M. Mycophenolate mofetil is a highly effective and safe immunosuppressive agent for the treatment of uveitis : a retrospective analysis of 106 patients. Graefes Arch Clin Exp Ophthalmol 2005; 244:788-94. [PMID: 16163494 DOI: 10.1007/s00417-005-0066-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2004] [Revised: 05/16/2005] [Accepted: 05/17/2005] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND We evaluated the outcomes of patients with different forms of chronic uveitis treated with mycophenolate mofetil (MMF) as an immunomodulatory and steroid-sparing agent. The multi-system side effects that arise after long-term treatment with corticosteroids and other immunosuppressants prompted us to use MMF. MMF is a selective inhibitor of inosine monophosphate dehydrogenase, thus blocking purine synthesis via the de novo pathway preferentially used by T and B lymphocytes. METHODS Between 1998 and 2003, 106 patients were treated for uveitis (anterior n=26, intermediate n=51, posterior n=23, panuveitis n=6) with MMF at a dose of 1g twice daily. Treatment duration was at least 6 months (n=10), in most cases greater than 12 months (n=77) and in 25 cases between 24 months and 41 months, when the present retrospective evaluation was undertaken. Patient charts were analysed according to a standardized evaluation protocol. RESULTS In 95 patients MMF was combined with prednisolone at a dosage of 2.5-10 mg per day. In 8 patients MMF was used as a monotherapy, and in 3 cases one further systemic immunosuppressant was required. The number of recurrences during MMF treatment was none or one in 92 patients, two in 6 cases and three or more in 8 patients. In none of the patients had MMF been stopped at the time of data analysis. The most frequently observed side effects were gastrointestinal upset (15%), followed by headache (9.3%), fatigue (5.7%), eczema (5%), and hair loss (3.5%). Other side effects were sporadic. Most of these phenomena were transitory. Forty-two patients experienced no side effects at all. In 4 patients MMF was judged ineffective due to failure to reduce the number of recurrences of severe inflammation compared with the previous therapeutic regime, or indeed occurrence of persistent macular oedema. CONCLUSIONS Our results show that MMF is an effective immunosuppressant in patients with uveitis. We provide evidence that MMF controls the disease in the majority of patients with an acceptable profile of side effects.
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Affiliation(s)
- Kirsten Siepmann
- Ophthalmology I, University Eye Hospital, Schleichstrasse 12, 72076 Tübingen, Germany
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33
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Quelle prise en charge pour les dermatites atopiques sévères et chroniques de l’enfant ? Ann Dermatol Venereol 2005. [DOI: 10.1016/s0151-9638(05)86149-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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34
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Bernier C. Quelle prise en charge pour les dermatites atopiques sévères et chroniques de l’enfant ? Ann Dermatol Venereol 2005. [DOI: 10.1016/s0151-9638(05)86157-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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35
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Leung DYM, Nicklas RA, Li JT, Bernstein IL, Blessing-Moore J, Boguniewicz M, Chapman JA, Khan DA, Lang D, Lee RE, Portnoy JM, Schuller DE, Spector SL, Tilles SA. Disease management of atopic dermatitis: an updated practice parameter. Joint Task Force on Practice Parameters. Ann Allergy Asthma Immunol 2004; 93:S1-21. [PMID: 15478395 DOI: 10.1016/s1081-1206(10)61385-3] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
MESH Headings
- Adjuvants, Immunologic/therapeutic use
- Administration, Cutaneous
- Administration, Oral
- Adrenal Cortex Hormones/administration & dosage
- Adrenal Cortex Hormones/therapeutic use
- Adult
- Algorithms
- Anti-Allergic Agents/administration & dosage
- Anti-Allergic Agents/therapeutic use
- Anti-Bacterial Agents/therapeutic use
- Anti-Inflammatory Agents/administration & dosage
- Anti-Inflammatory Agents/therapeutic use
- Calcineurin Inhibitors
- Case Management
- Child
- Child, Preschool
- Dermatitis, Atopic/diagnosis
- Dermatitis, Atopic/drug therapy
- Dermatitis, Atopic/therapy
- Dermatitis, Irritant/complications
- Dermatitis, Irritant/therapy
- Emollients/administration & dosage
- Emollients/therapeutic use
- Food Hypersensitivity/complications
- Food Hypersensitivity/diet therapy
- Humans
- Infant
- Phototherapy
- Skin Diseases, Infectious/drug therapy
- Skin Diseases, Infectious/etiology
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Affiliation(s)
- Donald Y M Leung
- Division of Pediatric Allergy-Immunology, Department of Pediatrics, National Jewish Medical and Research Center and University of Colorado Health Sciences Center, Denver, Colorado, USA
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Lau CH, Comer M, Lightman S. Long-term efficacy of mycophenolate mofetil in the control of severe intraocular inflammation. Clin Exp Ophthalmol 2004; 31:487-91. [PMID: 14641155 DOI: 10.1046/j.1442-9071.2003.00704.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To assess whether the previously demonstrated short-term efficacy of the immunosuppressant mycophenolate mofetil (MMF; CellCept, Roche) is maintained in the long-term management of refractory uveitis. METHODS The study was an open-label, non-comparative retrospective series of 14 patients with refractory uveitis and treated with MMF for a mean of >33 months. Mycophenolate mofetil was given at a dosage of 1 g (oral) twice daily. Indications included prednisolone reduction, additive agent with cyclosporin, or replacement therapy (azathioprine or methotrexate). The intraocular inflammatory response, side-effects, and toxicity were monitored. RESULTS Intraocular inflammation remained under control in 10 patients, unchanged in three and deteriorated in one patient. Transient side-effects included tiredness, headache and dizziness (one patient each, lasting less than 2 weeks from the time of MMF introduction). Mycophenolate mofetil was stopped in one patient because of absence of prolonged clinical improvement. Vision improved in 25% (7 eyes), did not change in 50% (14 eyes), but was reduced in 25% (7 eyes). CONCLUSIONS Mycophenolate mofetil is safe for long-term usage and is recommended for treatment of refractory panuveitis or posterior uveitis with uncontrolled inflammation despite high prednisolone maintenance dosage (>15 mg/day) or toxicity or lack of efficacy of other immuno-suppressive agents. However, MMF is less effective for refractory uveitis unresponsive to azathioprine.
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Affiliation(s)
- Chun H Lau
- Department of Clinical Ophthalmology, Institute of Ophthalmology and Moorfields Eye Hospital, City Road, London EC1V 2PD, UK
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37
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Akhavan A, Rudikoff D. The treatment of atopic dermatitis with systemic immunosuppressive agents. Clin Dermatol 2003; 21:225-40. [PMID: 12781440 DOI: 10.1016/s0738-081x(02)00362-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Arash Akhavan
- Department of Dermatology, Mount Sinai School of Medicine, New York, New York 10029, USA
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38
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Ellis C, Luger T, Abeck D, Allen R, Graham-Brown RAC, De Prost Y, Eichenfield LF, Ferrandiz C, Giannetti A, Hanifin J, Koo JYM, Leung D, Lynde C, Ring J, Ruiz-Maldonado R, Saurat JH. International Consensus Conference on Atopic Dermatitis II (ICCAD II): clinical update and current treatment strategies. Br J Dermatol 2003; 148 Suppl 63:3-10. [PMID: 12694268 DOI: 10.1046/j.1365-2133.148.s63.1.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- C Ellis
- Department of Dermatology, University of Michigan Medical Center, Ann Arbor, MI, U.S.A.
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Frieling U, Luger TA. Mycophenolate mofetil and leflunomide: promising compounds for the treatment of skin diseases. Clin Exp Dermatol 2002; 27:562-70. [PMID: 12464151 DOI: 10.1046/j.1365-2230.2002.01150.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In the past decade, there has been enormous progress in the understanding of the pathomechanisms of immune-mediated diseases, which has led to major advances in immunotherapeutic strategies. As a consequence, the armamentarium of specific and nonspecific immune-modulating and immunosuppressive drugs for the treatment of skin diseases has been widely extended. Among the nonspecific immunomodulators, mycophenolate mofetil and leflunomide show promising effects in a variety of autoimmune and inflammatory skin disorders. Both compounds inhibit a key enzyme in nucleotide biosynthesis, a step that is pivotal for the production of cytotoxic T cells and antibody formation. They do not act in the nucleus, which may explain their advantageous side-effect profile.
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Affiliation(s)
- U Frieling
- Department of Dermatology, University of Münster, Germany
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41
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Assmann T, Ruzicka T. New immunosuppressive drugs in dermatology (mycophenolate mofetil, tacrolimus): unapproved uses, dosages, or indications. Clin Dermatol 2002; 20:505-14. [PMID: 12435521 DOI: 10.1016/s0738-081x(02)00271-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Till Assmann
- Department of Dermatology, University of Dusseldorf, Dusseldorf, Germany.
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42
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Worm M. New compounds for the treatment of eczematous skin diseases. Expert Opin Ther Pat 2002. [DOI: 10.1517/13543776.12.7.1023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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43
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Schanz S, Ulmer A, Rassner G, Fierlbeck G. Successful treatment of subacute cutaneous lupus erythematosus with mycophenolate mofetil. Br J Dermatol 2002; 147:174-8. [PMID: 12100205 DOI: 10.1046/j.1365-2133.2002.04875.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Mycophenolate mofetil (MMF) is an immunosuppressive agent that has been shown to be effective in transplant patients. Some case reports and pilot studies have suggested efficacy against systemic lupus erythematosus (LE), particularly in the case of lupus nephritis. Reports on MMF treatment of skin manifestations of LE are still anecdotal. We report two cases with extensive skin lesions owing to subacute cutaneous LE (SCLE). Both patients had been treated with azathioprine and antimalarials without effect. Finally both patients were given highly dosed glucocorticosteroids, which were also ineffective but led to vertebral fractures because of long-term steroid treatment in one patient and steroid-induced psychosis in the other. MMF 2 g daily caused the skin manifestations to disappear within a few weeks in both patients. One patient was followed up for more than 24 months, and showed good toleration of MMF treatment. The skin remained stable over this period when at least 1 g MMF per day was administered. In conclusion, MMF appears to be an attractive treatment option in skin manifestations of SCLE, and seems to be beneficial for patients with steroid-refractory lesions that are also resistant to treatment with immunosuppressants or antimalarials. The observations suggest that further evaluation of this route in randomized controlled trials is warranted.
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Affiliation(s)
- S Schanz
- Department of Dermatology, University of Tübingen, Liebermeisterstrasse 25, Germany
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44
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Affiliation(s)
- T Jung
- Novartis Research Institute, Vienna, Austria.
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45
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Abstract
UNLABELLED Atopic dermatitis (AD) is today the most common, chronic inflammatory skin disease among children in developed countries. Its cumulative prevalence varies from 20% in northern Europe and the USA to approximately 5% in Mediterranean countries. As a chronic disease it puts a special demand on treatment. There is no curative therapy, but competent guidance on treatment principles can control the disease in most, if not all children. This article summarizes the evidence-based knowledge that relates to the treatment of atopic eczema. It also gives advice and opinions on prophylactic measures as these are the focus of interest from most parents. LEARNING OBJECTIVE This article should enable you to give advice and guidance to parents of children with AD, including what is necessary for diagnosis, what is of value and importance considering allergies and allergological investigations, allergen exposure, prophylactic measures, diets and indoor environment. Finally, you should be able to explain the diversity of treatment principles for parents.
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Affiliation(s)
- K Thestrup-Pedersen
- Department of Dermatology, University of Aarhus, Marselisborg Hospital, Denmark.
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Affiliation(s)
- D J Eedy
- Department of Dermatology, Craigavon Area Hospital Group Trust, 68 Lurgan Road, Portadown BT63 5QQ, UK.
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