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Barei F, Calzari P, Valtellini L, Chiei Gallo A, Perego G, Tavecchio S, Zussino M, Marzano AV, Ferrucci S. Five-year real-world drug survival of dupilumab in severe atopic dermatitis and associate predictors. J DERMATOL TREAT 2024; 35:2404718. [PMID: 39396818 DOI: 10.1080/09546634.2024.2404718] [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: 07/31/2024] [Accepted: 09/09/2024] [Indexed: 10/15/2024]
Abstract
BACKGROUND Atopic dermatitis (AD) profoundly impacts patients' lives, necessitating long-term systemic treatments. METHODS This retrospective study involved 709 severe AD patients receiving dupilumab. Drug survival (DS) was analyzed using Kaplan-Meier curves, evaluating reasons for discontinuation. The log-rank test and Cox regression analysis were applied to assess differences in drug survival across baseline clinical characteristic groups. RESULTS Dupilumab showcased remarkable overall drug survival, reaching 74.1% at 65 months. Survival rates remained robust even when considering discontinuation solely due to primary or secondary inefficacy (86.4% at 65 months). For overall DS, the log-rank test did not reveal a statistically significant difference among the groups. Cox regression analysis showed that patients with nummular eczema-like as a phenotype have an increased risk of discontinuing dupilumab due to the development of psoriasis (p < .001, hazard ratio = 26.15, confidence interval [CI] 6.903-99.016). The multivariate logistic regression analysis confirmed these results (p < .001, OD = 18.956, CI 4.205-85.458), even when considering other clinical and epidemiological characteristics. CONCLUSION This investigation establishes dupilumab's enduring efficacy and safety in severe AD, emphasizing its potential as a sustained therapeutic option over 5+ years. Baseline characteristics did not seem to influence DS, with the exception of the nummular eczema-like phenotype, which emerged as a significant predictor of psoriasis occurrence.
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Affiliation(s)
- Francesca Barei
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Calzari
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Luca Valtellini
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Alessandra Chiei Gallo
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Gabriele Perego
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Simona Tavecchio
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Martina Zussino
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Silvia Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Chiang CC, Cheng WJ, Dela Cruz JRMS, Raviraj T, Wu NL, Korinek M, Hwang TL. Neutrophils in Atopic Dermatitis. Clin Rev Allergy Immunol 2024:10.1007/s12016-024-09004-3. [PMID: 39294505 DOI: 10.1007/s12016-024-09004-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2024] [Indexed: 09/20/2024]
Abstract
Neutrophils have a critical role in inflammation. Recent studies have identified their distinctive presence in certain types of atopic dermatitis (AD), yet their exact function remains unclear. This review aims to compile studies elucidating the role of neutrophils in AD pathophysiology. Proteins released by neutrophils, including myeloperoxidase, elastase, and lipocalin, contribute to pruritus progression in AD. Neutrophilic oxidative stress and the formation of neutrophil extracellular traps may further worsen AD. Elevated neutrophil elastase and high-mobility group box 1 protein expression in AD patients' skin exacerbates epidermal barrier defects. Neutrophil-mast cell interactions in allergic inflammation steer the immunological response toward Th2 imbalance and activate the Th17 pathway, particularly in response to allergens or infections linked to AD. Notably, drugs alleviating pruritic symptoms in AD inhibit neutrophilic inflammation. In conclusion, these findings underscore that neutrophils may be therapeutic targets for AD symptoms, emphasizing their inclusion in AD treatment strategies.
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Affiliation(s)
- Chih-Chao Chiang
- Department of Nutrition and Health Sciences, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Puxin Fengze Chinese Medicine Clinic, Taoyuan, Taiwan
| | - Wei-Jen Cheng
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Joseph Renz Marion Santiago Dela Cruz
- Graduate Institute of Health Industry Technology and Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Thiyagarajan Raviraj
- Graduate Institute of Natural Products, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Nan-Lin Wu
- Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan.
- Institute of Biomedical Sciences and Department of Medicine, Mackay Medical College, New Taipei, Taiwan.
| | - Michal Korinek
- Graduate Institute of Natural Products, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Graduate Institute of Natural Products, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Tsong-Long Hwang
- Graduate Institute of Health Industry Technology and Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
- Graduate Institute of Natural Products, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- Department of Chemical Engineering, Ming Chi University of Technology, New Taipei City, Taiwan.
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Shim S, Kim JS, Yee J, Gwak HS. A risk-scoring system to predict dupilumab-associated ocular surface disease in patients with atopic dermatitis. Front Pharmacol 2024; 15:1425550. [PMID: 39148538 PMCID: PMC11324479 DOI: 10.3389/fphar.2024.1425550] [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] [Received: 04/30/2024] [Accepted: 07/19/2024] [Indexed: 08/17/2024] Open
Abstract
Introduction Dupilumab is the first biological treatment for atopic dermatitis (AD). Dupilumab-associated ocular surface disease (DAOSD) is one of the most commonly reported side effects in patients with AD during dupilumab treatment. This study aimed to identify risk factors for DAOSD in a real-world setting and construct a risk-scoring system for predicting DAOSD risk. Methods A retrospective analysis was conducted for dupilumab-treated adult patients with AD between April 2019 and September 2023 at Yeouido St. Mary's Hospital in Korea. Patients aged ≥18 years who received dupilumab to treat AD were included. Univariate and multivariable logistic regression analyses were performed to determine independent risk factors for DAOSD. A risk scoring system was constructed to predict DAOSD risk based on the adjusted odd ratios of significant variables. Results Of the 97 dupilumab-treated patients, 28 (28.9%) developed DAOSD. Among them, three (10.7%) patients discontinued dupilumab due to ocular side effects. In the multivariable analysis, older age, history of conjunctivitis, and a baseline Eczema Area and Severity Index (EASI) score ≥28 were independent risk factors for developing DAOSD. Using these variables, a risk-scoring system was constructed. The predicted DAOSD risks for AD patients with 0, 1, 2, 3, 4, and 5 points were 5.8%, 14.2%, 30.7%, 54.3%, 76.2%, and 89.6%, respectively. Conclusion In this study, the patient's age, history of conjunctivitis, and higher baseline EASI score were significantly associated with DAOSD. This risk-scoring system would help identify high-risk patients requiring more caution when initiating dupilumab treatment.
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Affiliation(s)
- Sunyoung Shim
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
- Department of Pharmacy, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Sun Kim
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
| | - Jeong Yee
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Hye Sun Gwak
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
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Du X, Litifu D, Yuan W, Chen Z, Chen Z, Zhang R, Zuo J, Lin Z, Zhao W. N-Containing triterpenoid saponins from Mussaenda densiflora and identification of heinsiagenin A as a potent immunosuppressant. Bioorg Chem 2024; 147:107351. [PMID: 38593530 DOI: 10.1016/j.bioorg.2024.107351] [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: 01/25/2024] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/11/2024]
Abstract
Eleven triterpenoid saponins, including five new compounds, which were named densiflorasides A - E (1 - 5), were isolated from aerial parts of Mussaenda densiflora (Rubiaceae). Their structures were elucidated based on spectroscopic and single-crystal X-ray diffraction analyses and chemical methods. All the isolated compounds and the aglycone heinsiagenin A were evaluated for their immunosuppressive and antiosteoclastogenic activities in vitro. Compounds 6 - 8 and heinsiagenin A inhibited osteoclastogenesis, with IC50 values ranging from 8.24 to 17.7 µM. Furthermore, compounds 3, 6 - 8, and heinsiagenin A significantly inhibited T-cell proliferation, with IC50 values ranging from 2.56 to 8.60 µM, and compounds 3 - 5 and 11 inhibited the proliferation of B lymphocytes, with IC50 values ranging from 1.29 to 8.49 µM. Further in vivo experiments indicated that heinsiagenin A could significantly attenuate IMQ-induced psoriasis and DSS-induced colitis in mice.
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Affiliation(s)
- Xiuying Du
- School of Chinese Material Medica, Nanjing University of Chinese Medicine, Nanjing 210023, People's Republic of China; Natural Product Research Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, People's Republic of China
| | - Dilinaer Litifu
- University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China; Laboratory of Immunopharmacology, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, People's Republic of China
| | - Wenlong Yuan
- University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China; Laboratory of Immunopharmacology, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, People's Republic of China
| | - Zhongxian Chen
- Natural Product Research Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, People's Republic of China; University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China
| | - Zhenhua Chen
- Natural Product Research Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, People's Republic of China
| | - Rujun Zhang
- Natural Product Research Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, People's Republic of China
| | - Jianping Zuo
- University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China; Laboratory of Immunopharmacology, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, People's Republic of China.
| | - Zemin Lin
- University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China; Laboratory of Immunopharmacology, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, People's Republic of China.
| | - Weimin Zhao
- School of Chinese Material Medica, Nanjing University of Chinese Medicine, Nanjing 210023, People's Republic of China; Natural Product Research Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, People's Republic of China; University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China.
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Schuler CF, Tsoi LC, Billi AC, Harms PW, Weidinger S, Gudjonsson JE. Genetic and Immunological Pathogenesis of Atopic Dermatitis. J Invest Dermatol 2024; 144:954-968. [PMID: 38085213 PMCID: PMC11040454 DOI: 10.1016/j.jid.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/05/2023] [Accepted: 10/25/2023] [Indexed: 02/03/2024]
Abstract
Type 2 immune-mediated diseases give a clear answer to the issue of nature (genetics) versus nurture (environment). Both genetics and environment play vital complementary roles in the development of atopic dermatitis (AD). As a key component of the atopic march, AD demonstrates the interactive nature of genetic and environmental contributions to atopy. From sequence variants in the epithelial barrier gene encoding FLG to the hygiene hypothesis, AD combines a broad array of contributions into a single syndrome. This review will focus on the genetic contribution to AD and where genetics facilitates the elicitation or enhancement of AD pathogenesis.
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Affiliation(s)
- Charles F Schuler
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA; Mary H. Weiser Food Allergy Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Lam C Tsoi
- Mary H. Weiser Food Allergy Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA; Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Allison C Billi
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Paul W Harms
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA; Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Stephan Weidinger
- Department of Dermatology, Venereology, and Allergology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Johann E Gudjonsson
- Mary H. Weiser Food Allergy Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA; Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.
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Fomina DS, Mukhina OA, Mikhailova VI, Lebedkina MS, Sedova EL, Bobrikova EN, Elisyutina OG, Fedenko ES, Nurpeisov TT, Karaulov AV, Lysenko MA, Ensina LFC. Treatment of atopic dermatitis with upadacitinib: adcare single center experience. Front Med (Lausanne) 2024; 11:1385720. [PMID: 38695023 PMCID: PMC11061355 DOI: 10.3389/fmed.2024.1385720] [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] [Received: 02/13/2024] [Accepted: 03/12/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction The role of upadacitinib in the management of moderate to severe atopic dermatitis seems promising, but more data on its efficacy and safety are needed. This study endeavors to assess the practical impact and safety of upadacitinib in patients with moderate to severe atopic dermatitis. The study aims to evaluate the efficacy and safety of upadacitinib in the treatment of moderate to severe atopic dermatitis, focusing on analyzing patient responses to the treatment. Methods In this study, adult patients diagnosed with moderate to severe atopic dermatitis received upadacitinib at daily doses of 15 mg or 30 mg, as prescribed by their attending physicians. The therapeutic efficacy of upadacitinib was meticulously assessed using established clinical metrics. Simultaneously, a comprehensive safety assessment was conducted through monthly monitoring, including the evaluation of potential effects of upadacitinib intake on hepatic function, lipid profile, and hematopoiesis using the pertinent laboratory tests. Results Sixteen participants were enrolled in the study. At 1month follow-up, there was a significant reduction in the mean Eczema Area and Severity Index (EASI) score to 18.8 points, which further increased to 24 points at the 4-month mark. Additionally, 9 participants (56%) demonstrated an EASI-50 response after 1 month of treatment, with this response increasing to 9 participants (90%) after 4 months. Furthermore, enhanced therapeutic responses were observed at 4 months, with 6 patients (38%) achieving an EASI-75 response at 1month and 8 patients (80%) achieving this milestone at the 4-month follow-up. This study highlights the potential of upadacitinib as an effective treatment option for moderate to severe atopic dermatitis. While it demonstrates improved symptom management, close monitoring for potential adverse events, particularly infections and the known risks of Janus kinase inhibitors, is essential. Further research is essential to determine the long-term safety and efficacy of upadacitinib.
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Affiliation(s)
- Daria S. Fomina
- City Clinical Hospital No. 52 of the Moscow Healthcare Department, State Budgetary Healthcare Institution, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Olga A. Mukhina
- City Clinical Hospital No. 52 of the Moscow Healthcare Department, State Budgetary Healthcare Institution, Moscow, Russia
| | - Valeria I. Mikhailova
- City Clinical Hospital No. 52 of the Moscow Healthcare Department, State Budgetary Healthcare Institution, Moscow, Russia
| | - Marina S. Lebedkina
- City Clinical Hospital No. 52 of the Moscow Healthcare Department, State Budgetary Healthcare Institution, Moscow, Russia
| | - Elizaveta L. Sedova
- City Clinical Hospital No. 52 of the Moscow Healthcare Department, State Budgetary Healthcare Institution, Moscow, Russia
| | - Elena N. Bobrikova
- City Clinical Hospital No. 52 of the Moscow Healthcare Department, State Budgetary Healthcare Institution, Moscow, Russia
| | - Olga G. Elisyutina
- NRC Institute of Immunology FMBA of Russia, Moscow, Russia
- Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | | | - Tair T. Nurpeisov
- Department of General Immunology, Asfendiyarov Kazakh National Medical University (KazNMU), Almaty, Kazakhstan
- Republican Allergy Center, Research Institute of Cardiology and Internal Medicine, Almaty, Kazakhstan
| | - Alexander V. Karaulov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Mar’yana A. Lysenko
- City Clinical Hospital No. 52 of the Moscow Healthcare Department, State Budgetary Healthcare Institution, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Luis Felipe C. Ensina
- Division of Allergy, Immunology, Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
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Martínez-Navarrete M, Guillot AJ, Lobita MC, Recio MC, Giner R, Aparicio-Blanco J, Montesinos MC, Santos HA, Melero A. Cyclosporin A-loaded dissolving microneedles for dermatitis therapy: Development, characterisation and efficacy in a delayed-type hypersensitivity in vivo model. Drug Deliv Transl Res 2024:10.1007/s13346-024-01542-9. [PMID: 38472726 DOI: 10.1007/s13346-024-01542-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/14/2024]
Abstract
Several drugs can be used for treating inflammatory skin pathologies like dermatitis and psoriasis. However, for the management of chronic and long-term cases, topical administration is preferred over oral delivery since it prevents certain issues due to systemic side effects from occurring. Cyclosporin A (CsA) has been used for this purpose; however, its high molecular weight (1202 Da) restricts the diffusion through the skin structure. Here, we developed a nano-in-micro device combining lipid vesicles (LVs) and dissolving microneedle array patches (DMAPs) for targeted skin delivery. CsA-LVs allowed the effective incorporation of CsA in the hydrophilic DMAP matrix despite the hydrophobicity of the drug. Polymeric matrix composed of poly (vinyl alcohol) (5% w/v), poly (vinyl pyrrolidine) (15% w/v) and CsA-LV dispersion (10% v/v) led to the formation of CsA-LVs@DMAPs with adequate mechanical properties to penetrate the stratum corneum barrier. The safety and biocompatibility were ensured in an in vitro viability test using HaCaT keratinocytes and L929 fibroblast cell lines. Ex vivo permeability studies in a Franz-diffusion cell setup showed effective drug retention in the skin structure. Finally, CsA-LVs@DMAPs were challenged in an in vivo murine model of delayed-type hypersensitivity to corroborate their potential to ameliorate skin inflammatory conditions. Different findings like photon emission reduction in bioluminescence study, normalisation of histological damage and decrease of inflammatory cytokines point out the effectivity of CsA-LVs@DMAPs to treat these conditions. Overall, our study demonstrates that CsA-LVs@DMAPs can downregulate the skin inflammatory environment which paves the way for their clinical translation and their use as an alternative to corticosteroid-based therapies.
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Affiliation(s)
- Miquel Martínez-Navarrete
- Department of Pharmacy and Pharmaceutical Technology and Parasitology, University of Valencia, Ave. Vicent Andrés Estellés s/n, 46100, Burjassot, Valencia, Spain
| | - Antonio José Guillot
- Department of Pharmacy and Pharmaceutical Technology and Parasitology, University of Valencia, Ave. Vicent Andrés Estellés s/n, 46100, Burjassot, Valencia, Spain.
- Department of Biomaterials and Biomedical Technology, University Medical Center Groningen, University of Groningen, Ant. Deusinglaan 1, 9713 AV, Groningen, The Netherlands.
| | - Maria C Lobita
- Department of Biomaterials and Biomedical Technology, University Medical Center Groningen, University of Groningen, Ant. Deusinglaan 1, 9713 AV, Groningen, The Netherlands
| | - María Carmen Recio
- Department of Pharmacology, University of Valencia, Ave. Vicent Andrés Estellés s/n, 46100, Burjassot, Valencia, Spain
| | - Rosa Giner
- Department of Pharmacology, University of Valencia, Ave. Vicent Andrés Estellés s/n, 46100, Burjassot, Valencia, Spain
| | - Juan Aparicio-Blanco
- Department of Pharmaceutics and Food Technology, Faculty of Pharmacy, Complutense University of Madrid, Plaza Ramón y Cajal s/n, 28040, Madrid, Spain
| | - María Carmen Montesinos
- Department of Pharmacology, University of Valencia, Ave. Vicent Andrés Estellés s/n, 46100, Burjassot, Valencia, Spain
- Interuniversity Research Institute for Molecular Recognition and Technological Development (IDM), University of Valencia, Polytechnic University of Valencia, Valencia, Spain
| | - Hélder A Santos
- Department of Biomaterials and Biomedical Technology, University Medical Center Groningen, University of Groningen, Ant. Deusinglaan 1, 9713 AV, Groningen, The Netherlands
- Drug Research Program, Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, FI-00014, Helsinki, Finland
| | - Ana Melero
- Department of Pharmacy and Pharmaceutical Technology and Parasitology, University of Valencia, Ave. Vicent Andrés Estellés s/n, 46100, Burjassot, Valencia, Spain
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Schlösser AR, Boeijink N, Olydam J, Nijsten TEC, Hijnen D. Upadacitinib treatment in a real-world difficult-to-treat atopic dermatitis patient cohort. J Eur Acad Dermatol Venereol 2024; 38:384-392. [PMID: 37864486 DOI: 10.1111/jdv.19581] [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: 06/30/2023] [Accepted: 09/29/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Upadacitinib was the first JAK-1 selective inhibitor registered for the treatment of moderate-to-severe atopic dermatitis (AD). Although efficacy and safety have been shown in clinical trials, real-world data on the use of upadacitinib in patients that have been treated with other immunosuppressants and targeted therapies is limited. OBJECTIVES To provide real-world evidence on the use of upadacitinib treatment in moderate-to-severe atopic dermatitis. METHODS In this prospective observational single-centre study, all AD patients treated with upadacitinib treatment in the context of standard care were included between August 2021 and September 2022. Clinical outcome measures and adverse events (AEs) were analysed. RESULTS Forty-eight patients were included. The majority (n = 39; 81%) had failed (ineffectiveness) on other targeted therapies, including other JAK inhibitors and biologics. Thirty-four (71%) patients were still using upadacitinib treatment at last follow up (median duration 46.5 weeks). Fourteen (29%) patients discontinued treatment due to ineffectiveness or AE. Upadacitinib treatment led to a significant decrease of disease severity during a median follow up of 37.5 weeks. Median IGA at baseline decreased from 3 (IQR 2-3) to 1.5 (IQR 1-2) at last review (p < 0.001). Median NRS itch decreased from 7 (IQR 5-8) at baseline to 2.25 (IQR 0.25-6.5) at last review (p < 0.001). Three patients discontinued treatment due to AE. Forty-eight AEs were reported, including acne-like eruptions (25%), nausea (13%) and respiratory tract infections (10%). CONCLUSIONS In this real-world cohort, we confirmed that upadacitinib is an effective treatment in a subset of AD patients that have failed several previous systemic immunosuppressive and biologic treatments. Overall, AE were mostly well tolerated and not a reason to discontinue treatment for most patients.
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Affiliation(s)
- Anne R Schlösser
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Neill Boeijink
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Jill Olydam
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Tamar E C Nijsten
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - DirkJan Hijnen
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Roustán G, Loro M, Rosell Á, Menchen B, Vicente O, Elosua-González M, Castaño JL, Peña C, Isidoro O. Development of a Patient Journey Map for Improving Patient Experience and Quality of Atopic Dermatitis Care. Dermatol Ther (Heidelb) 2024; 14:505-519. [PMID: 38334904 PMCID: PMC10891039 DOI: 10.1007/s13555-024-01100-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/14/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Atopic dermatitis (AD) is a chronic inflammatory skin condition that affects both children and adults. AD increases the risk of developing comorbidities like asthma, allergic rhinitis and food allergies. AD patients face difficulties, including itching, lack of effective treatments, lack of funding and discomfort in seeking a diagnosis or treatment. This study aims to identify the main barriers and opportunities to improve the experience of patients with AD and provide high-quality care. METHODS Patients, caregivers and healthcare professionals were recruited from the Dermatology Department at Puerta de Hierro Majadahonda University Hospital (Madrid, Spain). Interviews with patients, caregivers and professionals were performed. Participants used storyboards to depict their preferred scenarios for improving healthcare interactions and create a Patient Journey Map. RESULTS A total of 15 participants were included in the study. Early symptoms of AD were commonly described as undefined stages. As symptoms worsened, patients and caregivers expressed uncertainty and frustration. Patients became concerned about AD after their first serious flare and started experiencing intense itching, eczema, wounds, shedding or asthma. Topical corticosteroids were used to manage flares, but their effectiveness diminished over time, causing further frustration. Because of the ineffectiveness of their initial treatments, dermatologists observed that patients tended to downplay symptoms and how they affected their quality of life. The specialized treatment of severe AD significantly changed patients' emotional states. Despite AD's chronic nature, patients strived to enjoy remission periods and cope with flares. Psychological and emotional support was crucial for patients and caregivers, a need addressed by the Patients' School initiative at HUPHM hospital. CONCLUSION The severity of AD has a profound impact on patients' lives. Patient and caregiver emotional and social needs can be met by adequate communication, access to effective treatments and comprehensive psychological support.
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Affiliation(s)
- Gastón Roustán
- Department of Dermatology, Puerta de Hierro Majadahonda University (HUPHM) Hospital, Madrid, Spain.
| | - Marta Loro
- Department of Dermatology, Puerta de Hierro Majadahonda University (HUPHM) Hospital, Madrid, Spain
| | - Ángel Rosell
- Department of Dermatology, Puerta de Hierro Majadahonda University (HUPHM) Hospital, Madrid, Spain
| | - Belén Menchen
- Hospital Pharmacy, Puerta de Hierro Majadahonda University (HUPHM) Hospital, Madrid, Spain
| | | | - Marta Elosua-González
- Department of Dermatology, Puerta de Hierro Majadahonda University (HUPHM) Hospital, Madrid, Spain
| | - Juan L Castaño
- Department of Dermatology, Puerta de Hierro Majadahonda University (HUPHM) Hospital, Madrid, Spain
| | - Catalina Peña
- Instituto de Experiencia del Paciente, Madrid, Spain
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Xu P, Xiao W, Xu K, He Y, Miao X, Dong Y, Sun L. Potential strategy of microneedle-based transdermal drug delivery system for effective management of skin-related immune disorders. Eur J Pharm Biopharm 2024; 195:114148. [PMID: 37995878 DOI: 10.1016/j.ejpb.2023.11.013] [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: 09/15/2023] [Revised: 11/03/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023]
Abstract
Skin-related immune disorders are a category of diseases that lead to the dysregulation of the body's immune response due to imbalanced immune regulation. These disorders exhibit diverse clinical manifestations and complicated pathogenesis. The long-term use of corticosteroids, anti-inflammatory drugs, and immunosuppressants as traditional treatment methods for skin-related immune disorders frequently leads to adverse reactions in patients. In addition, the effect of external preparations is not ideal in some cases due to the compacted barrier function of the stratum corneum (SC). Microneedles (MNs) are novel transdermal drug delivery systems that have theapparent advantages ofpenetrating the skin barrier, such as long-term and controlled drug delivery, less systemic exposure, and painless and minimally invasive targeted delivery. These advantages make it a good candidate formulation for the treatment of skin-related immune disorders and a hotspot for research in this field. This paper updates the classification, preparation, evaluation strategies, materials, and related applications of five types of MNs. Specific information, including the mechanical properties, dimensions, stability, and in vitro and in vivo evaluations of MNs in the treatment of skin-related immune disorders, is also discussed. This review provides an overview of the advances and applications of MNs in the effective treatment of skin-related immune disorders and their emerging trends.
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Affiliation(s)
- Peng Xu
- Department of Zhuhai Campus of Zunyi Medical University, Zhuhai 519041, China
| | - Wei Xiao
- Department of Zhuhai Campus of Zunyi Medical University, Zhuhai 519041, China
| | - Kun Xu
- Department of Zhuhai Campus of Zunyi Medical University, Zhuhai 519041, China
| | - Yuan He
- Department of Pharmacy, Xuzhou Medical University, Xuzhou 221004, China
| | - Xiaoqing Miao
- Marine College, Shandong University, Weihai 264209, China
| | - Yan Dong
- Department of Zhuhai Campus of Zunyi Medical University, Zhuhai 519041, China
| | - Lin Sun
- Department of Zhuhai Campus of Zunyi Medical University, Zhuhai 519041, China.
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11
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Davis DMR, Drucker AM, Alikhan A, Bercovitch L, Cohen DE, Darr JM, Eichenfield LF, Frazer-Green L, Paller AS, Schwarzenberger K, Silverberg JI, Singh AM, Wu PA, Sidbury R. Guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies. J Am Acad Dermatol 2024; 90:e43-e56. [PMID: 37943240 DOI: 10.1016/j.jaad.2023.08.102] [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: 06/27/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND For people with atopic dermatitis (AD) refractory to topical therapies, treatment with phototherapy and systemic therapies can be considered. Multiple biologic therapies and Janus kinase (JAK)inhibitors have been approved since 2014 to treat AD. These guidelines update the 2014 recommendations for management of AD with phototherapy and systemic therapies. OBJECTIVE To provide evidence-based recommendations on the use of phototherapy and systemic therapies for AD in adults. METHODS A multidisciplinary workgroup conducted a systematic review and applied the GRADE approach for assessing the certainty of evidence and formulating and grading recommendations. RESULTS The workgroup developed 11 recommendations on the management of AD in adults with phototherapy and systemic agents, including biologics, oral JAK inhibitors, and other immunomodulatory medications. LIMITATIONS Most randomized controlled trials of phototherapy and systemic therapies for AD are of short duration with subsequent extension studies, limiting comparative long-term efficacy and safety conclusions. CONCLUSIONS We make strong recommendations for the use of dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib. We make conditional recommendations in favor of using phototherapy, azathioprine, cyclosporine, methotrexate, and mycophenolate, and against the use of systemic corticosteroids.
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Affiliation(s)
- Dawn M R Davis
- Departments of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota
| | - Aaron M Drucker
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Ali Alikhan
- Department of Dermatology, Sutter Medical Foundation, Sacramento, California
| | - Lionel Bercovitch
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - David E Cohen
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York City, New York
| | - Jennifer M Darr
- Department of Pediatrics, Pediatric Behavioral Health, National Jewish Health, Denver, Colorado
| | - Lawrence F Eichenfield
- Departments of Dermatology and Pediatrics, University of California San Diego and Rady Children's Hospital San Diego, San Diego, California
| | | | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Anne Marie Singh
- Departments of Pediatrics, Dermatology and Medical Microbiology/Immunology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Peggy A Wu
- Department of Dermatology, University of California, Davis, Sacramento, California
| | - Robert Sidbury
- Division of Dermatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington
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12
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Pezzolo E, Ortoncelli M, Ferrucci SM, Guanti MB, Schena D, Napolitano M, Rossi M, Foti C, D’Amico D, Amoruso GF, Morrone P, Ribero S, Barei F, Biagi M, Pascucci E, Patruno C, Calzavara Pinton P, Romita P, Gargiulo L, Narcisi A, Naldi L. Drug Survival of Upadacitinib and Predicting Factors of Discontinuation in Adult Patients Affected by Moderate-to-Severe Atopic Dermatitis: An Italian Multicenter Analysis. J Clin Med 2024; 13:553. [PMID: 38256686 PMCID: PMC10816142 DOI: 10.3390/jcm13020553] [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: 12/24/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Background: Limited real-world data are available on upadacitinib drug survival in patients with atopic dermatitis (AD). Objectives: To investigate upadacitinib drug survival, and the reasons and predictors of drug discontinuation in AD patients. Methods: All consecutive patients aged 18-75 years, affected by moderate-to-severe AD, and treated with upadacitinib for more than 1 month at dermatological clinics were included during November 2020-August 2023. Upadacitinib survival was investigated through Kaplan-Meier survival analysis and the predictors through multivariable logistic regression analysis. Results: Overall, 325 adult AD patients (mean (SD) age, 38.6(15.6) years) had a 1-year and 1.5-year upadacitinib drug survival of 91.5% and 80.2%, respectively. The main reasons for drug discontinuation (25/325, 7.7%) were adverse events (4.9%), including cutaneous or infectious diseases (1.5%), such as acne and herpes zoster; blood test changes (1.2%), including hypercholesterolemia, creatine phosphokinase or liver enzyme elevation, and lymphopenia; urinary or respiratory infections (0.9%); deep venous thrombosis (0.3%); malignancies (0.3%); loss of consciousness (0.3%); and arthralgias (0.3%); followed by ineffectiveness (0.6%). No specific characteristic was significantly associated with an increased risk of upadacitinib discontinuation. Conclusions: Our findings show that upadacitinib was effective in moderate-to-severe AD after more than 1 year of continuous treatment but point to the need for clinical and laboratory monitoring of patients.
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Affiliation(s)
- Elena Pezzolo
- Dermatology Unit, Ospedale San Bortolo, 36100 Vicenza, Italy
- Study Centre of the Italian Group for Epidemiologic Research in Dermatology (GISED), 24128 Bergamo, Italy
| | - Michela Ortoncelli
- Dermatology Clinic, Department of Medical Sciences, University of Turin, 10124 Turin, Italy
| | - Silvia Mariel Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Mario Bruno Guanti
- Department of Dermatology, University of Modena and Reggio Emilia, 41100 Modena, Italy
| | - Donatella Schena
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37100 Verona, Italy
| | - Maddalena Napolitano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | | | - Caterina Foti
- Unit of Dermatology, Department of Precision and Regenerative Medicine and Jonian Area, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Domenico D’Amico
- UOC Dermatologia, AOU “R. Dulbecco”, Ospedale ‘A. Pugliese’, 88100 Catanzaro, Italy
| | | | - Pietro Morrone
- UOC Dermatologia, Azienda Ospedaliera Cosenza, 87100 Cosenza, Italy
| | - Simone Ribero
- Dermatology Clinic, Department of Medical Sciences, University of Turin, 10124 Turin, Italy
| | - Francesca Barei
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Matteo Biagi
- Department of Dermatology, University of Modena and Reggio Emilia, 41100 Modena, Italy
| | - Enrico Pascucci
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37100 Verona, Italy
| | - Cataldo Patruno
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy;
| | | | - Paolo Romita
- Unit of Dermatology, Department of Precision and Regenerative Medicine and Jonian Area, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Luigi Gargiulo
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
- Dermatology Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy;
| | - Alessandra Narcisi
- Dermatology Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy;
| | - Luigi Naldi
- Dermatology Unit, Ospedale San Bortolo, 36100 Vicenza, Italy
- Study Centre of the Italian Group for Epidemiologic Research in Dermatology (GISED), 24128 Bergamo, Italy
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13
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Napolitano M, Ferrucci SM, Foggia L, Hansel K, Pezzolo E, Stingeni L, Antonelli E, Picone V, Patruno C. Comparison of Long-Term Effectiveness and Safety of Upadacitinib for Atopic Dermatitis Between Dupilumab-Exposed and Dupilumab-Naïve Patients. Clin Drug Investig 2024; 44:71-77. [PMID: 38105393 DOI: 10.1007/s40261-023-01336-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Upadacitinib is an oral selective Janus kinase-1 inhibitor approved for the treatment of moderate-to-severe atopic dermatitis (AD) in patients [Formula: see text] 12 years of age. In real life, upadacitinib currently represents a valid therapeutic option for patients failing available systemic therapies, in particular patients who discontinued dupilumab because of lack of efficacy or occurrence of adverse events. The objectives of the present study were to compare the effectiveness and safety of upadacitinib in patients affected by AD who had previously failed dupilumab therapy versus biologic naïve patients. METHODS A retrospective, multi-centre, observational, real-life study was conducted in four Italian dermatological referral centres (Milan, Perugia, Naples and Vicenza). Baseline characteristics included age, sex, AD history and severity, prior treatments, comorbidities and concomitant therapies. AD severity was assessed at baseline and at week 4 (W4), W16, W24 and W52, using Eczema Area Severity Index (EASI), Dermatology Life Quality Index (DLQI) and Pruritus Numerical Rating Scale (P-NRS) scores. Full blood count, hepatic and renal function, lipid panel, and muscle enzymes [lactate dehydrogenase (LDH) and creatine phosphokinase (CPK)] were assessed at baseline and at each follow-up visit. RESULTS A total of 113 patients (72 males, 63.7%; mean age: 37.22 ± 16.8 years) were included in the analysis, all patients were in treatment and underwent follow-up period until W16, whilst 91 (80.5%) and 75 (66.4%) patients were in treatment and in follow-up period until W24 and W52, respectively. Mean EASI score significantly changed from 24.30 ± 10.27 to 1.28 ± 4.34, 0.74 ± 2.31 and 0.25 ± 1.34 at W16, W24 and W52, respectively (p < 0.0001). Specifically, at W16 the percentage of patients achieving EASI-75, EASI-90 and EASI-100 was 85.21, 76.35 and 66.11%, respectively. At W24, EASI-75, EASI-90 and EASI-100 were reached by 88.54, 85.42, and 78.37% of patients, respectively. Finally, 90.1% of patients achieved EASI-75, 88.3% achieved EASI-90 and 83.0% achieved EASI-100 at W52. CONCLUSIONS This study confirmed the clinical effectiveness of upadacitinib treatment in adult patients in a real-world setting with moderate-to-severe AD who had discontinued dupilumab due to poor effectiveness or adverse events and who were biologic naïve; therefore, previous treatments do not seem to affect the response to upadacitinib treatment.
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Affiliation(s)
- Maddalena Napolitano
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | | | - Luciano Foggia
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Katharina Hansel
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elena Pezzolo
- Dermatology Unit, Ospedale San Bortolo, Vicenza, Italy
| | - Luca Stingeni
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elettra Antonelli
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Vincenzo Picone
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.
| | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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14
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Jia T, Che D, Zheng Y, Zhang H, Li Y, Zhou T, Peng B, Du X, Zhu L, An J, Geng S. Mast Cells Initiate Type 2 Inflammation through Tryptase Released by MRGPRX2/MRGPRB2 Activation in Atopic Dermatitis. J Invest Dermatol 2024; 144:53-62.e2. [PMID: 37482287 DOI: 10.1016/j.jid.2023.06.201] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 06/22/2023] [Accepted: 06/25/2023] [Indexed: 07/25/2023]
Abstract
Atopic dermatitis (AD) is a common chronic inflammatory skin disease characterized by T helper 2 inflammation as the core pathogenic mechanism. MRGPRX2 plays a key role in nonhistamine allergies and neuroimmune mechanisms in chronic inflammatory dermatitis. However, the role of MRGPRX2 in AD and the development of type 2 inflammation is not yet clear. This study aimed to define the role of MRGPRX2 in type 2 inflammation development and cytokine release in AD by determining its levels in patients with AD and healthy controls. Furthermore, MrgprB2-conditional knockout (MrgprB2-/-) and wild-type mice were used to construct an MC903-induced AD mouse model to observe skin inflammation and cytokine release. Tryptase and its antagonist were applied separately to MrgprB2-/- mice with AD and wild-type mice with AD to confirm the role of the MRGPRB2-tryptase axis in the development of type 2 inflammation in AD. We found that AD severity and type 2 cytokine levels were not associated with IgE levels but were associated with MRGPRX2/MRGPRB2 expression. MrgprB2-/- mice with AD showed milder phenotypes and inflammatory infiltration in the skin than wild-type mice with AD. Tryptase released by MRGPRX2/MRGPRB2 activation is involved in the release of type 2 cytokines, which contributes to inflammatory development in AD.
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Affiliation(s)
- Tao Jia
- Department of Dermatology, Northwest Hospital, The Second Hospital Affiliated to Xi'an Jiaotong University, Xi'an, China
| | - Delu Che
- Department of Dermatology, Northwest Hospital, The Second Hospital Affiliated to Xi'an Jiaotong University, Xi'an, China; Center for Dermatology Disease, Precision Medical Institute, Xi'an, China
| | - Yi Zheng
- Department of Dermatology, Northwest Hospital, The Second Hospital Affiliated to Xi'an Jiaotong University, Xi'an, China
| | - Huan Zhang
- Department of Dermatology, Northwest Hospital, The Second Hospital Affiliated to Xi'an Jiaotong University, Xi'an, China
| | - Yaxiang Li
- Department of Dermatology, Northwest Hospital, The Second Hospital Affiliated to Xi'an Jiaotong University, Xi'an, China
| | - Tong Zhou
- Department of Dermatology, Northwest Hospital, The Second Hospital Affiliated to Xi'an Jiaotong University, Xi'an, China
| | - Bin Peng
- Department of Dermatology, Northwest Hospital, The Second Hospital Affiliated to Xi'an Jiaotong University, Xi'an, China
| | - Xueshan Du
- Department of Dermatology, Northwest Hospital, The Second Hospital Affiliated to Xi'an Jiaotong University, Xi'an, China
| | - Longfei Zhu
- Department of Dermatology, Northwest Hospital, The Second Hospital Affiliated to Xi'an Jiaotong University, Xi'an, China
| | - Jingang An
- Department of Dermatology, Northwest Hospital, The Second Hospital Affiliated to Xi'an Jiaotong University, Xi'an, China
| | - Songmei Geng
- Department of Dermatology, Northwest Hospital, The Second Hospital Affiliated to Xi'an Jiaotong University, Xi'an, China.
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15
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Dhar S, De A, Saha A, Chitnis KR, Mane A, Dhoot D, Barkate H. Intermittent or Sequential Topical Tacrolimus in Atopic Dermatitis: Systematic Review and Meta-Analysis. Cureus 2023; 15:e50640. [PMID: 38229798 PMCID: PMC10789587 DOI: 10.7759/cureus.50640] [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: 12/16/2023] [Indexed: 01/18/2024] Open
Abstract
Topical calcineurin inhibitors (TCIs) and topical corticosteroids (TCS) are the mainstays of flare management for atopic eczema or atopic dermatitis (AD). Tacrolimus (an immunomodulator), belongs to the class of calcineurin inhibitors, with promising efficacy in AD. We performed this systematic review to obtain an up-to-date coverage map of controlled clinical trials of sequential or intermittent treatments with TCI as a therapeutic intervention for AD. Articles of interest were retrieved from PubMed, Google Scholar, and EMBASE published between between January 2000 and March 2023. Key words were "calcineurin inhibitors," "corticosteroids," "atopic dermatitis," "pruritus," "sequential," "intermittent" and "consecutive" while fixed language search consisted of "Intermittent topical calcineurin inhibitors AND topical corticosteroids AND atopic dermatitis OR eczema" AD patients who were administered sequential and/or intermittent applications of TCI for management of atopic eczema were included. Outcome measures included but were not limited to Scoring of Atopic Dermatitis (SCORAD) and the Eczema Area Severity Score (EASI). Four clinical trials were considered for the purpose of review. A total of 101 patients with AD were analysed. The risk of bias was low in two studies, while the other two had an unclear risk of bias. Overall, pooled data from two trials revealed that sequential therapy with TCS/TCI was comparable to monotherapy or emollients, as the test for overall effect determined was non-significant with a p-value of 0.33. The two studies were highly heterogeneous, as indicated by a very high I2 of 92% and an extremely significant p-value (p=0.0005). Sequential therapy with TCS and TCIs was effective and well tolerated in the management of AD and it may be considered an important treatment approach during the initial period.
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Affiliation(s)
- Sandipan Dhar
- Dermatology, Institute of Child Health, Kolkata, IND
| | - Abhishek De
- Dermatology, Calcutta National Medical College and Hospital, Kolkata, IND
| | - Abhijit Saha
- Dermatology, Institute of Child Health, Kolkata, IND
| | - Kruttika R Chitnis
- Pharmacology and Therapeutics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
| | - Abhishek Mane
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
| | - Dhiraj Dhoot
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
| | - Hanmant Barkate
- Global Medical Affairs, Glenmark Pharmaceuticals Limited, Mumbai, IND
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16
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Chiricozzi A, Ortoncelli M, Schena D, Gori N, Ferrucci SM, Babino G, Napolitano M, Fargnoli MC, Stingeni L, Rossi M, Romanelli M, Balestri R, Pellegrino M, Parodi A, Bertoldi AM, Palazzo G, Antonelli F, Pitino A, Tripepi G, Fabbrocini G, Balato A, Marzano AV, Girolomoni G, Ribero S, Peris K. Long-term Effectiveness and Safety of Upadacitinib for Atopic Dermatitis in a Real-world Setting: An Interim Analysis Through 48 Weeks of Observation. Am J Clin Dermatol 2023; 24:953-961. [PMID: 37322324 PMCID: PMC10570196 DOI: 10.1007/s40257-023-00798-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Janus kinase (JAK) inhibitors, including upadacitinib, have been recently approved for the treatment of moderate-severe atopic dermatitis (AD) and real-world data on upadacitinib effectiveness and safety are limited. This interim analysis aimed to assess effectiveness and safety of upadacitinib throughout 48 weeks of observation in a real-world adult AD population. METHODS This prospective study collected data on adult patients affected by moderate-to-severe AD and treated with upadacitinib at the dosage of either 15 mg or 30 mg daily based on the physician decision. Upadacitinib was prescribed in the context of a national compassionate use programme. In this interim analysis, within patient comparisons of continuous scores of different scales (namely Eczema Area and Severity Index [EASI], body surface area [BSA], Dermatology Life Quality Index [DLQI], Patient Oriented Eczema Measure [POEM], Numeric Rating Scale [NRS] subtests) were performed. The percentage of patients achieving EASI 75, EASI 90 and EASI 100 at Week 16, 32 and 48 was also evaluated. RESULTS One hundred and forty-six patients were included in the analysis. Upadacitinib 15 mg or 30 mg daily was prescribed as monotherapy in most cases (127/146, 87.0%). Upadacitinib was initially prescribed at the dosage of 30 mg daily in 118 of 146 (80.8%) patients and 15 mg daily in 28/146 (19.2%) patients. A significant improvement in the clinical signs and symptoms of AD was detected by Week 16 and throughout the study period. EASI 75, EASI 90 and EASI 100 responses were achieved by 87.6%, 69.1% and 44.3% at Week 48, associated with a sustained reduction in the mean values of all physician-reported (EASI and BSA) and patient-reported (Itch- Sleep- and Pain-NRS, DLQI, and POEM) disease severity outcomes, up to 48 weeks of treatment. Treatment response observed in 15 mg upadacitinib-treated patients was comparable with that detected in 30 mg upadacitinib-treated patients, revealing no statistical difference between the two patient sub-cohorts. Through the observation period, dose reduction or escalation was observed in 38/146 (26%) of treated cases. Overall, 26 of 146 (17.8%) patients experienced at least one adverse event (AE) during the treatment period. In total, 29 AEs were recorded and most of them were evaluated as mild to moderate, while in 4 cases the occurrence of AE led to drug discontinuation, for a total of 7/146 (4.8%) dropouts. CONCLUSION This study provides strong evidence of a sustained response obtained by upadacitinib in AD patients, who had failed to respond to conventional or biological systemic agents, through 48 weeks of observation. Upadacitinib was also demonstrated to be advantageous in terms of flexibility in dose reduction or escalation as upadacitinib dose was shaped on clinical needs that, in a real-world setting, might frequently change.
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Affiliation(s)
- Andrea Chiricozzi
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy.
- UOC di Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Michela Ortoncelli
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Donatella Schena
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Niccolò Gori
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
- UOC di Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Silvia Mariel Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Graziella Babino
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Maddalena Napolitano
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maria Concetta Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Dermatology Unit, Ospedale San Salvatore, L'Aquila, Italy
| | - Luca Stingeni
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | | | | | | | | | - Aurora Parodi
- Department of Health and Science (Dissal), Section of Dermatology, University of Genoa, Polyclinic Hospital San Martino, IRCCS, Genoa, Italy
| | | | | | - Flaminia Antonelli
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
- UOC di Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Annalisa Pitino
- Institute of Clinical Physiology (IFC-CNR), Section of Rome, 00185, Rome, Italy
| | - Giovanni Tripepi
- Institute of Clinical Physiology (IFC-CNR), Section of Reggio Calabria, 89124, Reggio Calabria, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Anna Balato
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Simone Ribero
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Ketty Peris
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
- UOC di Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Orfali RL, Lorenzini D, Bressan A, Tanaka AA, Cerqueira AMMD, Hirayama ADS, Ramos AMC, Proença CC, Silva CMDR, Laczynski CMM, Carneiro FR, Duarte G, Hans Filho G, Gonçalves HDS, Melo LPD, Azulay-Abulafia L, Weber MB, Rivitti-Machado MC, Zaniboni MC, Ogawa M, Pires MC, Ianhez M, Felix PAO, Bonamigo R, Takaoka R, Lazzarini R, Cestari S, Mayor SAS, Cestari T, Oliveira ZNPD, Spuls PI, Gerbens LAA, Aoki V. Consensus on the therapeutic management of atopic dermatitis ‒ Brazilian Society of Dermatology: an update on phototherapy and systemic therapy using e-Delphi technique. An Bras Dermatol 2023; 98:814-836. [PMID: 37302894 PMCID: PMC10589461 DOI: 10.1016/j.abd.2023.04.003] [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: 03/11/2023] [Revised: 04/04/2023] [Accepted: 04/09/2023] [Indexed: 06/13/2023] Open
Abstract
This publication is an update of the "Consensus on the therapeutic management of atopic dermatitis - Brazilian Society of Dermatology" published in 2019, considering the novel, targeted-oriented systemic therapies for atopic dermatitis. The initial recommendations of the current consensus for systemic treatment of patients with atopic dermatitis were based on a recent review of scientific published data and a consensus was reached after voting. The Brazilian Society of Dermatology invited 31 experts from all regions of Brazil and 2 international experts on atopic dermatitis who fully contributed to the process. The methods included an e-Delphi study to avoid bias, a literature search and a final consensus meeting. The authors added novel approved drugs in Brazil and the indication for phototherapy and systemic therapy for AD. The therapeutical response to systemic treatment is hereby reported in a suitable form for clinical practice and is also part of this updated manuscript.
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Affiliation(s)
- Raquel Leao Orfali
- Department of Dermatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Daniel Lorenzini
- Department of Dermatology, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Aline Bressan
- Department of Dermatology, Hospital Universitário Pedro Ernesto, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Anber Ancel Tanaka
- Department of Dermatology, Hospital Universitário Evangélico Mackenzie, Curitiba, PR, Brazil
| | | | - André da Silva Hirayama
- Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Andréa Machado Coelho Ramos
- Department of Dermatology, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Carolina Contin Proença
- Dermatology Clinic, Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Gleison Duarte
- Department of Dermatology, Instituto Bahiano de Imunoterapia, Salvador, BH, Brazil
| | - Gunter Hans Filho
- Department of Dermatology, Hospital Universitário Maria Aparecida Pedrossian, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Heitor de Sá Gonçalves
- Department of Health, National Reference Center in Sanitary Dermatology Dona Libânia, Fortaleza, CE, Brazil
| | - Ligia Pessoa de Melo
- Department of Dermatology, Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil; Health Department, Hospital Otávio de Freitas, Recife, PE, Brazil
| | - Luna Azulay-Abulafia
- Department of Dermatology, Hospital Universitário Pedro Ernesto, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Professor Rubem David Azulay Institute of Dermatology, Santa Casa de Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Maria Cecília Rivitti-Machado
- Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Department of Dermatology, Universidade Metropolitana de Santos, Santos, SP, Brazil
| | - Mariana Colombini Zaniboni
- Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marília Ogawa
- Department of Dermatology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Mario Cezar Pires
- Department of Dermatology, Complexo Hospitalar Padre Bento, Guarulhos, SP, Brazil; Department of Dermatology, State Public Servant Hospital, São Paulo, SP, Brazil
| | - Mayra Ianhez
- Department of Dermatology, Hospital for Tropical Diseases, Goiânia, GO, Brazil; Department of Dermatology, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | | | - Renan Bonamigo
- Department of Dermatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Roberto Takaoka
- Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rosana Lazzarini
- Dermatology Clinic, Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Silmara Cestari
- Department of Dermatology, Teaching and Research Institute of Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | | | - Tania Cestari
- Department of Dermatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Phyllis I Spuls
- Department of Dermatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, The Netherlands
| | - Louise A A Gerbens
- Department of Dermatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, The Netherlands
| | - Valeria Aoki
- Department of Dermatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Shih PY, Li CJ, Yong SB. Emerging trends in clinical research on Janus kinase inhibitors for atopic dermatitis treatment. Int Immunopharmacol 2023; 124:111029. [PMID: 37820425 DOI: 10.1016/j.intimp.2023.111029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/26/2023] [Accepted: 10/04/2023] [Indexed: 10/13/2023]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease that affects millions of people worldwide, characterized by immune function imbalance and impaired epidermal barrier function. It is a complex disorder that involves multiple pathogenic pathways, including the JAK/STAT signaling pathway, which plays a critical role in regulating immune and inflammatory responses. The therapeutic potential of Janus kinase inhibitors (JAKi) in the management of atopic dermatitis (AD) has garnered significant interest in recent years. AD is a chronic inflammatory skin condition characterized by impaired epidermal barrier function and immune function imbalance, and its pathogenesis is closely associated with dysregulated JAK/signal transducer and activator of transcription (STAT) signaling pathways. JAKi offer a novel therapeutic approach by selectively inhibiting JAK enzymes, thereby blocking downstream STAT signaling and preventing the expression of cytokines involved in AD pathogenesis. This review will focus on several JAKi including tofacitinib, baricitinib, ruxolitinib and upadacitinib, and provide a comprehensive overview of the latest research on the application of JAKi in AD treatment, including its mechanism of action, clinical trial results and safety profile.
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Affiliation(s)
- Pei-Yun Shih
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Chia-Jung Li
- Department of Obstetrics and Gynaecology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan; Institute of Biopharmaceutical Sciences, National Sun Yat-sen University, Kaohsiung 804, Taiwan.
| | - Su-Boon Yong
- Department of Allergy and Immunology, China Medical University Children's Hospital, Taichung, Taiwan; Department of Medicine, College of Medicine, China Medical University, Taiwan.
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Birkner T, Siegels D, Heinrich L, Haufe E, Abraham S, Heratizadeh A, Harder I, Bell M, Fell I, Worm M, Handrick C, Effendy I, Asmussen A, Kleinheinz A, Homey B, Sticherling M, Hong-Weldemann SH, Augustin M, Weisshaar E, Schäkel K, Schaefer T, Schwarz B, Wiemers F, Brücher JJ, Quist S, Wollenberg A, Biedermann T, Ertner K, von Kiedrowski R, Werfel T, Weidinger S, Schmitt J. Itch, sleep loss, depressive symptoms, fatigue, and productivity loss in patients with moderate-to-severe atopic dermatitis: Analyses of TREATgermany registry data. J Dtsch Dermatol Ges 2023; 21:1157-1168. [PMID: 37485573 DOI: 10.1111/ddg.15159] [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: 01/30/2023] [Accepted: 05/28/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND TREATgermany is a multicenter registry including patients with moderate-to-severe atopic dermatitis (AD) from currently 74 study centers (university clinics, hospitals and practices) in Germany. As of August 31, 2021, 1,230 adult patients were enrolled. METHODS In TREATgermany, patients and physicians fill in questionnaires pertaining to symptoms, disease severity, quality of life, depressiveness, and fatigue. In particular, limitations in work performance are assessed using the Work Limitations Questionnaire (WLQ). To assess associations between occupational performance/work limitations and symptoms, correlations and regression models were calculated. RESULTS The examined sample of 228 employed patients reported an average of 6% at-work productivity loss within the past two weeks prior to enrolment in the registry. The WLQ productivity loss score was moderately associated with itch (r = 0.32) and sleep loss (r = 0.39) and strongly associated with depressive symptoms (r = 0.68) and fatigue (r = 0.60). CONCLUSIONS The analyses of the registry data show that moderate-to-severe atopic dermatitis has a negative impact on the work productivity of the patients. The analyses further point out the relevant associations between work productivity, depressive symptoms, and fatigue highlighting the disease burden caused by the psychological components of AD.
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Affiliation(s)
- Thomas Birkner
- Center of Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Doreen Siegels
- Center of Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Luise Heinrich
- Center of Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Eva Haufe
- Center of Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Susanne Abraham
- Department of Dermatology, University Allergy Center, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Annice Heratizadeh
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Inken Harder
- Center for Inflammatory Skin Diseases, Department of Dermatology and Allergy, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Magnus Bell
- Practice Dr. med. Magnus Bell, Andernach, Germany
| | - Isabell Fell
- Hautmedizin Bad Soden Studienzentrum, Bad Soden, Germany
| | - Margitta Worm
- Department of Dermatology, Allergy and Venereology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Isaak Effendy
- Department of Dermatology, OWL University Hospital of Bielefeld University, Campus Clinic Bielefeld, Bielefeld, Germany
| | - Andrea Asmussen
- Practice Dr. med. Andrea Asmussen, Dermatology at Lesum, Bremen, Germany
| | | | - Bernhard Homey
- Department of Dermatology and Allergology, University Hospital Duesseldorf, Düsseldorf, Germany
| | - Michael Sticherling
- Department of Dermatology, University, German Center for Immunotherapy, Erlangen, Germany
| | | | - Matthias Augustin
- Institute for Health Services Research in Dermatology Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Elke Weisshaar
- Division of Occupational Dermatology, Department of Dermatology, Ruprecht-Karls University, Heidelberg, Germany
| | - Knut Schäkel
- Department of Dermatology, University Hospital, Heidelberg, Germany
| | - Thomas Schaefer
- Practice Dr. med. Thomas Schaefer/ Dr. med. Doreen Belz, Derma Koeln, Köln, Germany
| | | | | | - Jens-Joachim Brücher
- Practice Dr. med. Jens-Joachim Brücher, Hautambulatorium Magdeburg, Magdeburg, Germany
| | - Sven Quist
- Dermatology Clinic, Helix Medical Excellence Center Mainz, Mainz, Germany
| | - Andreas Wollenberg
- Clinics and Outpatient Clinics for Dermatology and Allergy, LMU Munich, München, Germany and Vrije Universiteit Brussel, Universitair Ziekenhuis, Department of Dermatology, Brussels, Belgium
| | - Tilo Biedermann
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, München, Germany
| | | | - Ralph von Kiedrowski
- Focus Practice for chronic inflammatory dermatoses, skin cancer and allergology and also Study Center CMS3 (Company for Medical Study and Service), Selters/Westerwald, Germany
| | - Thomas Werfel
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Stephan Weidinger
- Center for Inflammatory Skin Diseases, Department of Dermatology and Allergy, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Jochen Schmitt
- Center of Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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Birkner T, Siegels D, Heinrich L, Haufe E, Abraham S, Heratizadeh A, Harder I, Bell M, Fell I, Worm M, Handrick C, Effendy I, Asmussen A, Kleinheinz A, Homey B, Sticherling M, Hong-Weldemann SH, Augustin M, Weisshaar E, Schäkel K, Schaefer T, Schwarz B, Wiemers F, Brücher JJ, Quist S, Wollenberg A, Biedermann T, Ertner K, von Kiedrowski R, Werfel T, Weidinger S, Schmitt J. Juckreiz, Schlafstörungen, depressive Symptome, Fatigue und Einschränkungen der Arbeitsproduktivität bei Patienten mit moderater bis schwerer atopischer Dermatitis: Daten aus dem TREATgermany-Register. J Dtsch Dermatol Ges 2023; 21:1157-1169. [PMID: 37845075 DOI: 10.1111/ddg.15159_g] [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: 01/30/2023] [Accepted: 05/28/2023] [Indexed: 10/18/2023]
Abstract
ZusammenfassungHintergrundTREATgermany ist ein multizentrisches Register, das Patienten mit moderater bis schwerer atopischer Dermatitis (AD) aus derzeit 74 Studienzentren (Universitätskliniken, Krankenhäuser und Praxen) in Deutschland umfasst. Bis zum 31. August 2021 wurden 1.230 erwachsene Patienten eingeschlossen.MethodenIn TREATgermany füllen Patienten und Ärzte Fragebögen zu Symptomen, Krankheitsschwere, Lebensqualität, Depressivität und Fatigue aus. Die Einschränkungen der Arbeitsleistung werden insbesondere mit dem Work Limitations Questionnaire (WLQ) erfasst. Um Assoziationen zwischen beruflicher Leistung/Arbeitseinschränkungen und Symptomen zu bestimmen, wurden Korrelationen und Regressionsmodelle berechnet.ErgebnisseDie untersuchte Stichprobe von 228 berufstätigen Patienten beschrieb einen durchschnittlichen Produktivitätsverlust von 6% bei der Arbeit innerhalb der letzten zwei Wochen vor der Aufnahme in das Register. Der WLQ‐Wert für den Produktivitätsverlust war moderat mit Juckreiz (r = 0,32) und Schlafstörungen (r = 0,39) und stark mit depressiven Symptomen (r = 0,68) und Fatigue (r = 0,60) korreliert.SchlussfolgerungenDie Analysen der Registerdaten zeigen, dass eine moderate bis schwere AD einen negativen Einfluss auf die Arbeitsproduktivität der Patienten hat. Die Analysen weisen außerdem auf die relevanten Zusammenhänge zwischen Arbeitsproduktivität, depressiven Symptomen und Fatigue hin, was die durch die psychologischen Komponenten der AD verursachte Krankheitslast verdeutlicht.
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Affiliation(s)
- Thomas Birkner
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden
| | - Doreen Siegels
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden
| | - Luise Heinrich
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden
| | - Eva Haufe
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden
| | - Susanne Abraham
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden
| | - Annice Heratizadeh
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover
| | - Inken Harder
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | | | | | - Margitta Worm
- Klinik für Dermatologie, Venerologie und Allergologie am Campus Mitte (CCM), Charité - Universitätsmedizin Berlin
| | | | - Isaak Effendy
- Hautklinik, Universitätsklinikum OWL der Universität Bielefeld, Campus Klinikum Bielefeld
| | - Andrea Asmussen
- Praxis Dr. med. Andrea Asmussen, Dermatologie an der Lesum, Bremen
| | - Andreas Kleinheinz
- Klinik für Dermatologie, Allergologische Ambulanz, Elbe Klinikum Buxtehude
| | - Bernhard Homey
- Klinik für Dermatologie, Universitätsklinikum Düsseldorf
| | | | | | - Matthias Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Elke Weisshaar
- Berufsdermatologie, Hautklinik, Universitätsklinikum Heidelberg
| | - Knut Schäkel
- Universitäts-Hautklinik, Universitätsklinikum Heidelberg
| | - Thomas Schaefer
- Praxis Dr. med. Thomas Schaefer/ Dr. med. Doreen Belz, Derma Köln
| | - Beate Schwarz
- Praxis Dr. med. Beate Schwarz, Dermatologie und Allergologie, Langenau
| | | | | | - Sven Quist
- Dermatologische Klinik, Helix Medical Excellence Center, Mainz
| | - Andreas Wollenberg
- Klinik und Poliklinik für Dermatologie und Allergologie, LMU München und Hautklinik, Vrije Universiteit Brussel, Universitair Ziekenhuis, Brüssel, Belgien
| | - Tilo Biedermann
- Klinik für Dermatologie und Allergologie, Klinikum rechts der Isar, Technischen Universität München
| | | | - Ralph von Kiedrowski
- Spezialpraxis für chronisch-entzündliche Dermatosen, Hautkrebs und Allergologie/Berufsdermatologie und Studienzentrums CMS3 (Company for Medical Study and Service), Selters/Westerwald
| | - Thomas Werfel
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover
| | - Stephan Weidinger
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden
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21
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Chiricozzi A, Ferrucci SM, Di Nardo L, Gori N, Balato A, Ortoncelli M, Maurelli M, Galluzzo M, Munera Campos M, Seremet T, Caldarola G, De Simone C, Ippoliti E, Torres T, Gkalpakiotis S, Conrad C, Carrascosa JM, Bianchi L, Argenziano G, Ribero S, Girolomoni G, Marzano AV, Peris K. Current treatment goals are achieved by the majority of patients with atopic dermatitis treated with tralokinumab: results from a multicentric, multinational, retrospective, cohort study. Expert Opin Biol Ther 2023; 23:1307-1315. [PMID: 38108300 DOI: 10.1080/14712598.2023.2292627] [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: 09/25/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Tralokinumab is a human monoclonal antibody targeting interleukin-13 that is approved for the treatment of moderate-severe atopic dermatitis. Studies analyzing the efficacy and safety of tralokinumab in a real-world setting are scarce. RESEARCH DESIGN AND METHODS A European, multicentric, real-world, retrospective cohort study was defined to assess the effectiveness and safeness profile of tralokinumab, investigating the achievement of pre-specified treatment goals; and to detect potential differences in terms of effectiveness and safeness across some selected patient subcohorts. RESULTS A total of 194 adult patients were included in this study. A significant improvement in physician-assessed disease severity was detected at each follow-up visit as compared with baseline and similar trend was observed for patient-reported outcomes and quality of life. No meaningful difference in effectiveness was found when considering patient age (<65 versus ≥65 years), neither dissecting patient cohort in dupilumab-naive vs dupilumab-treated subjects. Among tralokinumab-treated patients, 88% achieved at least one currently identified real-world therapeutic goal at week 16. CONCLUSIONS This retrospective multicenter study confirmed the effectiveness and safeness of tralokinumab throughout 32 weeks of observation, showing the achievement of therapeutic goals identified in both trial and real-world settings in a large proportion of tralokinumab-treated patients.
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Affiliation(s)
- A Chiricozzi
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - S M Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - L Di Nardo
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - N Gori
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Balato
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - M Ortoncelli
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - M Maurelli
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - M Galluzzo
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Dermatology Unit, Fondazione Policlinico "Tor Vergata", Rome, Italy
| | - M Munera Campos
- Department of Dermatology, Germans Trias i Pujol University Hospital (HUGTP), Autonomous University of Barcelona (UAB), Badalona, Spain
| | - T Seremet
- Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, Switzerland
| | - G Caldarola
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - C De Simone
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - E Ippoliti
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - T Torres
- Department of Dermatology, Centro Hospitalar Universitário de Santo António, University of Porto, Porto, Portugal
| | - S Gkalpakiotis
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, Prague, Czech Republic
| | - C Conrad
- Department of Dermatology, Lausanne University Hospital CHUV and University of Lausanne, Lausanne, Switzerland
| | - J M Carrascosa
- Department of Dermatology, Germans Trias i Pujol University Hospital (HUGTP), Autonomous University of Barcelona (UAB), Badalona, Spain
| | - L Bianchi
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Dermatology Unit, Fondazione Policlinico "Tor Vergata", Rome, Italy
| | - G Argenziano
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - S Ribero
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - G Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - K Peris
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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22
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Lugović-Mihić L, Meštrović-Štefekov J, Potočnjak I, Cindrić T, Ilić I, Lovrić I, Skalicki L, Bešlić I, Pondeljak N. Atopic Dermatitis: Disease Features, Therapeutic Options, and a Multidisciplinary Approach. Life (Basel) 2023; 13:1419. [PMID: 37374201 DOI: 10.3390/life13061419] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/31/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
The latest findings regarding AD pathogenesis point to an impaired function of the epidermal barrier, changed immune response, colonization of the skin by microorganisms, and certain psychological factors among other causes/triggers. The inflammatory response of AD patients is mainly associated with the activation of T cells (Th2 cells predominate), dendritic cells, macrophages, keratinocytes, mast cells, and eosinophils. Therapy usually involves medical evaluations and adequate management including treatment of concomitant diseases (e.g., allergies and infections), patient education and nursing care, psychological support, and nutritional consultations, which are organized through specific programs and structured educational groups. Systemic AD therapy includes conventional systemic treatment (cyclosporine, methotrexate, azathioprine) and new, specific drugs, interleukin inhibitors (e.g., dupilumab) and JAK inhibitors (baricitinib, abrocitinib, upadacitinib, etc.). Since many AD patients are affected by various psychological factors and comorbidities, they should be assessed and managed through a multidisciplinary approach, involving different professions (psychologists, ear-nose-throat specialists, pulmonologists, allergologists, immunologists, nutritionists, pediatricians, gastroenterologists, psychiatrists (when necessary), and others). A multidisciplinary approach provides better coping strategies and improves control over the disease, patient adherence to therapy, and quality of life. It also has a positive influence on family quality of life while at the same time making more efficient use of dermatology healthcare resources, reducing the economic burden on both patients and society.
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Affiliation(s)
- Liborija Lugović-Mihić
- Department of Dermatovenereology, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Jelena Meštrović-Štefekov
- Department of Dermatovenereology, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ines Potočnjak
- Institute for Clinical Medical Research and Education, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
| | - Tea Cindrić
- Department of Dermatovenereology, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
| | - Ivana Ilić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Ivan Lovrić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Lucija Skalicki
- Department of Dermatovenereology, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
| | - Iva Bešlić
- Department of Dermatovenereology, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Nives Pondeljak
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Dermatology and Venereology, General Hospital Sisak, 44000 Sisak, Croatia
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23
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Maniscalco M, Detoraki A, Sarnelli G, Nolano M, De Paulis A, Spadaro G, Cantone E. A Multidisciplinary Approach for Type 2 Allergic Diseases: What Do Biologics Teach Us? J Pers Med 2023; 13:941. [PMID: 37373930 DOI: 10.3390/jpm13060941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
Patients with atopic/allergic disorders, including atopic dermatitis (AD), allergic rhino-conjunctivitis (AR), chronic rhinosinusitis with/without nasal polyps (CRSwNP/CRSsNP), bronchial asthma, food allergy, and eosinophilic esophagitis (EoE), often share a common genetic background, a type Th2 polarized immune response, and several environmental factors [...].
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Affiliation(s)
- Mauro Maniscalco
- Department of Clinical Medicine and Surgery, Federico II University, 80138 Naples, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy
| | - Aikaterini Detoraki
- Department of Translational Medicine, Federico II University, 80138 Naples, Italy
| | - Giovanni Sarnelli
- Department of Clinical Medicine and Surgery, Federico II University, 80138 Naples, Italy
| | - Maria Nolano
- Department of Neuroscience, Reproductive and Odontostomatological Sciences-ENT Section, University of Naples Federico II, 80131 Naples, Italy
| | - Amato De Paulis
- Department of Translational Medicine, Federico II University, 80138 Naples, Italy
| | - Giuseppe Spadaro
- Department of Translational Medicine, Federico II University, 80138 Naples, Italy
| | - Elena Cantone
- Department of Neuroscience, Reproductive and Odontostomatological Sciences-ENT Section, University of Naples Federico II, 80131 Naples, Italy
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24
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Schuler CF, Billi AC, Maverakis E, Tsoi LC, Gudjonsson JE. Novel insights into atopic dermatitis. J Allergy Clin Immunol 2023; 151:1145-1154. [PMID: 36428114 PMCID: PMC10164702 DOI: 10.1016/j.jaci.2022.10.023] [Citation(s) in RCA: 48] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/23/2022]
Abstract
Recent research into the pathophysiology and treatment of atopic dermatitis (AD) has shown notable progress. An increasing number of aspects of the immune system are being implicated in AD, including the epithelial barrier, TH2 cytokines, and mast cells. Major advances in therapeutics were made in biologic cytokine and receptor antagonists and among Janus kinase inhibitors. We focus on these areas and address new insights into AD epidemiology, biomarkers, endotypes, prevention, and comorbidities. Going forward, we expect future mechanistic insights and therapeutic advances to broaden physicians' ability to diagnose and manage AD patients, and perhaps to find a cure for this chronic condition.
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Affiliation(s)
- Charles F Schuler
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Mich; Mary H. Weiser Food Allergy Center, University of Michigan, Ann Arbor, Mich
| | - Allison C Billi
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Mich
| | - Emanual Maverakis
- Department of Dermatology, University of California-Davis, Sacramento, Calif
| | - Lam C Tsoi
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Mich
| | - Johann E Gudjonsson
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Mich.
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25
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Ferrucci SM, Tavecchio S, Marzano AV, Buffon S. Emerging Systemic Treatments for Atopic Dermatitis. Dermatol Ther (Heidelb) 2023; 13:1071-1081. [PMID: 37072648 PMCID: PMC10149421 DOI: 10.1007/s13555-023-00920-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/24/2023] [Indexed: 04/20/2023] Open
Abstract
Atopic dermatitis (AD) is a chronic or chronically relapsing inflammatory skin disease which results from a complex, multifaceted interaction between environmental factors in genetically predisposed patients. Epidermal barrier impairment, alteration of the cutaneous microbiota, effect of external antigens, neurosensory dysfunction, and inflammatory and immune dysregulation all play a pivotal role in inducing and maintaining AD lesions. AD significantly impacts the patient's quality of life and general well-being and is often associated with anxiety and/or depressive symptoms. Classical treatment options include topical corticosteroids and calcineurin inhibitors, phototherapy, and systemic immunosuppression with oral corticosteroids, cyclosporine, methotrexate, and azathioprine in more severe cases. A turning point in facing AD was accomplished when the efficacy and safety of dupilumab, a monoclonal antibody targeting the interleukin (IL)-4 receptor α subunit, led to its approval for the treatment of moderate-to-severe or severe AD in children, adolescents, and adults. Subsequently, a more extensive understanding of AD etiology and pathogenesis has allowed the development of several topical and systemic novel therapy options. Most of these drugs are monoclonal antibodies which interfere with the type 2 inflammatory cascade, especially its key cytokines IL-4 and IL-13, or its downstream Janus kinase signaling pathway. However, considering the relevance of other subtypes of T helper (Th) cells, such as Th1 and Th22, and the important role of specific cytokines (IL-31) in generating pruritus, the horizon of potential therapeutic targets has widened extremely. In this review, we aim to present the most promising systemic agents currently under investigation and illustrate the most significant aspects of their efficacy, safety, and tolerability.
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Affiliation(s)
- Silvia Mariel Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Pace 9, 20122, Milan, Italy.
| | - Simona Tavecchio
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Pace 9, 20122, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Stefano Buffon
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Pace 9, 20122, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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26
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Chang LS, Kuo HC, Suen JJB, Yang PH, Hou CP, Sun HR, Lee ZM, Huang YH. Multimedia Mixed Reality Interactive Shared Decision-Making Game in Children with Moderate to Severe Atopic Dermatitis, a Pilot Study. CHILDREN 2023; 10:children10030574. [PMID: 36980133 PMCID: PMC10047264 DOI: 10.3390/children10030574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/07/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023]
Abstract
(1) Objective: Atopic dermatitis (AD) is a recurring skin disease that affects children’s daily activities and sleep quality. Due to the limitations of children’s understanding and ability to express themselves, shared decision making (SDM) is often made by guardians, which thus affects the acceptance and effectiveness of children’s treatments. Previous studies have demonstrated that involving both children and parents in decision making may help improve treatment outcomes; thus, we designed a multimedia mixed reality (MR) interactive game of SDM for children with moderate to severe AD. (2) Methods: Research participants included 6–18-year-old patients with moderate to severe AD. This research consisted of the following steps: designing SDM; character setting and visual design; performing games; system modification and optimization; screen editing and dubbing; and user testing and questionnaires by the System Usability Scale (SUS). (3) Results: We completed the SDM design for children with moderate to severe AD. Four different treatments were biologics, oral immune-modulating drugs, phototherapy, and wet wrap. An animated PowerPoint slide showed the AD apple rolling around before treatments and the AD apple sleeping soundly after treatments. Instructions with video teaching for the four different treatments were played, and then, the MR was turned on so that the patients could help the AD apple in the metaverse to undergo these four treatments. A total of 12 moderate to severe AD patients and six control patients used the game, all aged between six and eighteen years old, with an average SUS score of 81.0 and a standard error of 2.1 points. Adjective ratings yielded a rating between good and excellent. The game showed acceptable usability. We found no statistically significant differences in SUS scores between patients with and without moderate to severe AD or between boys and girls nor significant associations between SUS and age or severity. The analysis identified that the two items with the lowest SUS scores were “I think that I would need the support of a technical person to be able to use this product” and “I needed to learn a lot of things before I could get going with this product”. Both of these comments show the limitations of this game. (4) Conclusions: Overall, this study provides the first MR SDM game that has passed the SUS and can be used as an aid in clinical SDM.
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Affiliation(s)
- Ling-Sai Chang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
- Correspondence:
| | - Ho-Chang Kuo
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Jason Jyh-Bin Suen
- Department of Digital Media Design, I-Shou University, Kaohsiung 83301, Taiwan
| | - Pei-Hsin Yang
- Department of Nursing and Pediatric Ward, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan
| | - Chiu-Ping Hou
- Department of Nursing and Pediatric Ward, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan
| | - Hui-Ru Sun
- Department of Nursing and Pediatric Ward, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan
| | - Zon-Min Lee
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Ying-Hsien Huang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
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27
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Kim K, Kim M, Rhee E, Lee MH, Yang HJ, Park S, Kim HS. Efficacy and Safety of Low-Dose Cyclosporine Relative to Immunomodulatory Drugs Used in Atopic Dermatitis: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12041390. [PMID: 36835928 PMCID: PMC9959975 DOI: 10.3390/jcm12041390] [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] [Received: 12/28/2022] [Revised: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023] Open
Abstract
Cyclosporine A (CsA) is effective in treating moderate-to-severe atopic dermatitis (AD). This systematic review and meta-analysis aimed to summarize the effectiveness and safety of low-dose (<4 mg/kg) versus high-dose (≥4 mg/kg) CsA and other systemic immunomodulatory agents in patients with AD. Five randomized controlled trials met the inclusion criteria. The meta-analysis included 159 patients with moderate-to-severe AD who were randomized to receive low-dose CsA, and 165 patients randomized to receive high-dose CsA and other systemic immunomodulatory agents. We found that low-dose CsA was not inferior to high-dose CsA and other systemic immunomodulatory agents in reducing AD symptoms [standard mean difference (SMD) -1.62, 95% confidence interval (CI) -6.47; 3.23]. High-dose CsA and other systemic immunomodulatory agents showed a significantly lower incidence of adverse events [incidence rate ratio (IRR) 0.72, 95% CI 0.56; 0.93], however, after sensitivity analysis, there was no difference between the two groups except for one study (IRR 0.76, 95% CI 0.54; 1.07). Regarding serious adverse events requiring discontinuation of treatment, we observed no significant differences between low-dose CsA and other systemic immunomodulatory agents (IRR 1.83, 95% CI 0.62; 5.41). Our study may justify the use of low-dose CsA rather than high-dose CsA and other systemic immunomodulatory agents in moderate-to-severe AD.
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Affiliation(s)
- Kyunghoon Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Mina Kim
- Department of Applied Statistics, Chung-Ang University, Seoul 06974, Republic of Korea
| | - EunHee Rhee
- SCH Biomedical Informatics Research Unit, Soonchunhyang University Seoul Hospital, Seoul 04401, Republic of Korea
- Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul 04401, Republic of Korea
| | - Mi-Hee Lee
- Department of Pediatrics, Incheon Medical Center, Incheon 22532, Republic of Korea
| | - Hyeon-Jong Yang
- SCH Biomedical Informatics Research Unit, Soonchunhyang University Seoul Hospital, Seoul 04401, Republic of Korea
- Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul 04401, Republic of Korea
| | - Suyeon Park
- Department of Applied Statistics, Chung-Ang University, Seoul 06974, Republic of Korea
- Department of Biostatistics, Soonchunhyang University Seoul Hospital, Seoul 04401, Republic of Korea
- Correspondence: (S.P.); (H.S.K.)
| | - Hwan Soo Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Correspondence: (S.P.); (H.S.K.)
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28
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David E, Ungar B, Renert-Yuval Y, Facheris P, Del Duca E, Guttman-Yassky E. The evolving landscape of biologic therapies for atopic dermatitis: Present and future perspective. Clin Exp Allergy 2023; 53:156-172. [PMID: 36653940 DOI: 10.1111/cea.14263] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/05/2022] [Accepted: 11/23/2022] [Indexed: 01/20/2023]
Abstract
Atopic dermatitis (AD) is one of the most common, chronic inflammatory skin diseases with a significant physical, emotional and socioeconomic burden. In recent years the understanding of AD pathogenesis has expanded from the Th2-centred perspective, with the recognition of the involvement of other immune axes. In different AD endotypes, influenced by environment, genetics and race, transcriptomic profiles have identified differing contributions of multiple immune axes such as, Th17, Th22 and Th1. The enriched pathogenic model of AD has catalysed the development of numerous biologic therapies targeting a range of key molecules implicated in disease progression. Currently, dupilumab and tralokinumab, which both target the Th2 pathway, are the only approved biologic therapies for AD in the United States and Europe. New biologic therapies in development, however, target different Th2-pathway molecules along with cytokines in other immune axes, including Th17 and Th22, offering promise for varied treatments for this heterogeneous disease. As the biologic pipeline advances, the integration into clinical practice and approval of these experimental biologics may provide more effective, tailored therapeutic solutions and illuminate on the pathologic processes of AD across a broader, more diverse patient population.
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Affiliation(s)
- Eden David
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Benjamin Ungar
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yael Renert-Yuval
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Paola Facheris
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ester Del Duca
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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29
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Caruso C, Laterza L, Settanni CR, Colantuono S, Di Mario C, Tolusso B, Castrì F, Gremese E, Scaldaferri F, Armuzzi A, De Simone C, Peris K, Chiricozzi A, Gasbarrini A. Case report: Dupilumab treatment improved type 2 disorders in a patient with IPEX syndrome diagnosis. Front Immunol 2023; 13:995304. [PMID: 36713411 PMCID: PMC9875030 DOI: 10.3389/fimmu.2022.995304] [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] [Received: 07/15/2022] [Accepted: 11/18/2022] [Indexed: 01/13/2023] Open
Abstract
We described a case of IPEX syndrome successfully controlled with dupilumab, an anti-IL4 receptor alpha subunit inhibitor. IPEX syndrome is a rare and generally fatal genetic disorder characterized by immune dysregulation, polyendocrinopathy and enteropathy, mostly diagnosed in early childhood. Nonetheless, cases reported in the last 20 years demonstrated that IPEX clinical spectrum encompasses more than the classical triad of early-onset intractable diarrhea, type 1 diabetes and eczema. Atypical cases of IPEX include patients with late-onset of symptoms, single-organ involvement, mild disease phenotypes or rare clinical features. A 21-year-old caucasian man presented with immune dysregulation (hypereosinophilia and elevated IgE), protein-losing enteropathy, polyendocrinopathy (thyroiditis, osteoporosis, delayed puberty), weight loss, eczema manifestations and celiac disease. IPEX syndrome was diagnosed because of the presence of a hemizygous mutation in FOXP3 gene (c.543C>T (p.S181S) in the exon 5). During the course of the disease, the patient developed erosive proctitis, pyoderma gangrenosum, and erythema nodosum. Symptoms improved only after enteral and parenteral corticosteroid therapy and the patient soon developed steroid-dependence. Notwithstanding various therapies including azathioprine, sirolimus, tacrolimus, adalimumab, vedolizumab, the patient failed to achieve a good control of symptoms without steroids. Almost exclusive enteral nutrition with a hypoallergenic, milk-protein free, amino acid-based food for special medical purposes. He continued to lose weight (BMI 14.5 kg/m2) with a consequent high limitation of physical activity and a progressive worsening of the quality of life. In consideration of the poor response to conventional immunosuppressants and the presence of type 2 inflammatory manifestations, treatment with dupilumab at an initial dose of 600 mg, followed by a maintenance dose of 300 mg every other week, according to atopic dermatitis labeled dose, was started and combined to oral budesonide 6 mg/day and 6-mercaptopurine 75 mg/day. The patient experienced a rapid improvement in bowel and skin symptoms, leading to a progressive tapering of steroids. By our knowledge, this is the first report of IPEX syndrome successfully treated by antiIL-4/IL-13 therapy. In this case dupilumab demonstrated to be an effective, safe and steroid-sparing option.
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Affiliation(s)
- C. Caruso
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy,*Correspondence: C. Caruso,
| | - L. Laterza
- UOC di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - C. R. Settanni
- UOC di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - S. Colantuono
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - C. Di Mario
- Immunology Core Facility, Gemelli Science Technological Park (GSTeP), Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - B. Tolusso
- Division of Clinical Immunology, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - F. Castrì
- Dipartimento di Anatomia Patologica, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
| | - E. Gremese
- Immunology Core Facility, Gemelli Science Technological Park (GSTeP), Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,Division of Clinical Immunology, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - F. Scaldaferri
- Istituto di Patologia Speciale Medica, Università Cattolica del Sacro Cuore, Rome, Italy,Faculty of Medicine and Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - A. Armuzzi
- IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - C. De Simone
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - K. Peris
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A. Chiricozzi
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A. Gasbarrini
- Faculty of Medicine and Surgery, Catholic University of the Sacred Heart, Rome, Italy,Faculty of Internal Medicine, Catholic University of the Sacred Heart, Rome, Italy,Internal Medicine and Gastroenterology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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30
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Schäbitz A, Hillig C, Mubarak M, Jargosch M, Farnoud A, Scala E, Kurzen N, Pilz AC, Bhalla N, Thomas J, Stahle M, Biedermann T, Schmidt-Weber CB, Theis F, Garzorz-Stark N, Eyerich K, Menden MP, Eyerich S. Spatial transcriptomics landscape of lesions from non-communicable inflammatory skin diseases. Nat Commun 2022; 13:7729. [PMID: 36513651 PMCID: PMC9747967 DOI: 10.1038/s41467-022-35319-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Abundant heterogeneous immune cells infiltrate lesions in chronic inflammatory diseases and characterization of these cells is needed to distinguish disease-promoting from bystander immune cells. Here, we investigate the landscape of non-communicable inflammatory skin diseases (ncISD) by spatial transcriptomics resulting in a large repository of 62,000 spatially defined human cutaneous transcriptomes from 31 patients. Despite the expected immune cell infiltration, we observe rather low numbers of pathogenic disease promoting cytokine transcripts (IFNG, IL13 and IL17A), i.e. >125 times less compared to the mean expression of all other genes over lesional skin sections. Nevertheless, cytokine expression is limited to lesional skin and presented in a disease-specific pattern. Leveraging a density-based spatial clustering method, we identify specific responder gene signatures in direct proximity of cytokines, and confirm that detected cytokine transcripts initiate amplification cascades of up to thousands of specific responder transcripts forming localized epidermal clusters. Thus, within the abundant and heterogeneous infiltrates of ncISD, only a low number of cytokine transcripts and their translated proteins promote disease by initiating an inflammatory amplification cascade in their local microenvironment.
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Affiliation(s)
- A Schäbitz
- Division of Dermatology and Venereology, Department of Medicine Solna, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - C Hillig
- Institute of Computational Biology, Helmholtz Zentrum München-German Research Centre for Environmental Health, Ingolstädter Landstrasse 1, 85764, Neuherberg, Germany
| | - M Mubarak
- Center for Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Biedersteinerstrasse 29, 80802, Munich, Germany
| | - M Jargosch
- Center for Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Biedersteinerstrasse 29, 80802, Munich, Germany
- Department of Dermatology and Allergy, Technical University of Munich, Biedersteinerstrasse 29, 80802, Munich, Germany
| | - A Farnoud
- Institute of Computational Biology, Helmholtz Zentrum München-German Research Centre for Environmental Health, Ingolstädter Landstrasse 1, 85764, Neuherberg, Germany
| | - E Scala
- Division of Dermatology and Venereology, Department of Medicine Solna, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Dermatology and Venerology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - N Kurzen
- Center for Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Biedersteinerstrasse 29, 80802, Munich, Germany
| | - A C Pilz
- Department of Dermatology and Allergy, Technical University of Munich, Biedersteinerstrasse 29, 80802, Munich, Germany
- Department of Dermatology and Venerology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - N Bhalla
- Department of Gene Technology, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
| | - J Thomas
- Center for Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Biedersteinerstrasse 29, 80802, Munich, Germany
| | - M Stahle
- Division of Dermatology and Venereology, Department of Medicine Solna, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - T Biedermann
- Department of Dermatology and Allergy, Technical University of Munich, Biedersteinerstrasse 29, 80802, Munich, Germany
| | - C B Schmidt-Weber
- Center for Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Biedersteinerstrasse 29, 80802, Munich, Germany
| | - F Theis
- Institute of Computational Biology, Helmholtz Zentrum München-German Research Centre for Environmental Health, Ingolstädter Landstrasse 1, 85764, Neuherberg, Germany
| | - N Garzorz-Stark
- Division of Dermatology and Venereology, Department of Medicine Solna, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Dermatology and Allergy, Technical University of Munich, Biedersteinerstrasse 29, 80802, Munich, Germany
| | - K Eyerich
- Division of Dermatology and Venereology, Department of Medicine Solna, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Dermatology and Venerology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Dermatology and Venereology, Unit of Dermatology, Karolinska University Hospital, Stockholm, Sweden
| | - M P Menden
- Institute of Computational Biology, Helmholtz Zentrum München-German Research Centre for Environmental Health, Ingolstädter Landstrasse 1, 85764, Neuherberg, Germany
- Department of Biology, Ludwig-Maximilians University, Goßhadernerstrasse 2, Martinsried, 82152, Germany
- German Center for Diabetes Research (DZD e.V.), Ingolstädter Landstrasse 1, 85764, Neuherberg, Germany
| | - S Eyerich
- Center for Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Biedersteinerstrasse 29, 80802, Munich, Germany.
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Koskeridis F, Evangelou E, Ntzani EE, Kostikas K, Tsabouri S. Treatment With Dupilumab in Patients With Atopic Dermatitis: Systematic Review and Meta-Analysis. J Cutan Med Surg 2022; 26:613-621. [DOI: 10.1177/12034754221130969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Atopic dermatitis (AD) is a type 2 chronic skin disorder associated with systemic and psychosocial comorbidities decreasing the quality of life for many patients. Dupilumab, a human monoclonal antibody that blocks interleukins IL-4 and IL-13, is a recently added systematic treatment option with an emerging evidence base. Here, we assessed the safety and efficacy of dupilumab in patients with AD. We conducted a systematic review and meta-analysis of placebo-controlled randomized clinical trials evaluating the safety and efficacy of dupilumab on AD-related outcomes including clinical symptoms, quality of life and adverse events (AE). Subgroup analysis was further performed in adults and children/adolescents. Fourteen trials were included: twelve in adults (n = 3,817) and two in children/adolescents (n = 618). Dupilumab decreased the Eczema Area Severity Index (EASI) score [standardized mean difference (SMD) = −0.98; 95% confidence interval (95% CI) = (−1.09, −0.88)], the percent change difference in Scoring Atopic Dermatitis (SCORAD) [mean difference (MD) = −31.56, 95% CI = (−33.75, −29.36)], and in pruritus Numeric Rating Scale (pNRS) [MD = −29.24, 95% CI = (−32.11, −26.37)]. It also achieved a reduction of at least ≥75% in the EASI score [Risk Ratio (RR) = 2.89, 95% CI = (2.47, 3.38)], the Investigator’s Global Assessment (IGA) score ≤1 [RR = 3.47, 95% CI = (2.96, 4.06)] and eight additional endpoints with no signs of increased AE compared to placebo. In subgroup analysis, the results were concordant for both groups. Dupilumab improved clinical symptoms and quality of life in adults and children/adolescents with a safety profile comparable to placebo.
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Affiliation(s)
- Fotios Koskeridis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Evangelos Evangelou
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK
- Institute of Biosciences, University Research Center of Ioannina, University of Ioannina, Ioannina, Greece
| | - Evangelia E. Ntzani
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Institute of Biosciences, University Research Center of Ioannina, University of Ioannina, Ioannina, Greece
- Center for Evidence Synthesis in Health, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | | | - Sophia Tsabouri
- Department of Pediatrics, University of Ioannina, School of Medicine, Ioannina, Greece
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32
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Ong PY. Atopic dermatitis: Is innate or adaptive immunity in control? A clinical perspective. Front Immunol 2022; 13:943640. [PMID: 35967329 PMCID: PMC9363562 DOI: 10.3389/fimmu.2022.943640] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/01/2022] [Indexed: 11/25/2022] Open
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease with barrier defects and immune dysregulations. The pathogenesis of AD involves the physical barrier as well as epithelial cells, which are considered a vital part of the innate immunity of the skin. The importance of filaggrin mutations in the pathogenesis of AD has also been well-established with reproducible results around the world in multiple studies and ethnic groups. This protein plays an important role in skin barrier functions and further reaffirms barrier defects as one of the primary causes of AD. The main epithelial cells, keratinocytes, function as a major sentinel for the skin in detecting danger signals or microbial pathogens, and trigger downstream immune responses. In AD, these cells express TSLP, IL-33 and IL-25, which lead to downstream systemic production of type 2 cytokines. In spite of major advances in our understanding of the innate immunity of AD, recent success in the systemic therapeutics of AD have focused on targeting the products of the adaptive immunity, particularly cytokines produced by T cells. In addition to type 2 cytokines, type 17 cytokines have also been implicated in the pathogenesis of AD. The current review examines the implications of these cytokines in AD from clinical perspectives.
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Bracho-Borro M, Franco-Ruiz PA, Magaña M. The Use of Azathioprine in Atopic Dermatitis. A Review. Dermatol Ther 2022; 35:e15665. [PMID: 35751547 DOI: 10.1111/dth.15665] [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: 05/18/2022] [Accepted: 06/19/2022] [Indexed: 11/26/2022]
Abstract
Most patients with atopic dermatitis (AD) have a good response to topical treatment. However, some need systemic therapy in order to satisfactorily control the disease. Azathioprine is an accessible drug for patients in many countries, including underdeveloped countries, and therefore it's used by many dermatologists in moderate and severe AD. It is important to have a deep knowledge and understanding about this drug since it is an alternative therapy as a steroid-sparing agent and an affordable one. However, when it comes to systemic therapy for AD, it's not always clear its indications and it is necessary to have a closer follow-up of the patient. In this paper we describe thoroughly it's indications in AD, the mechanism of action of the drug, as well as the interactions, adverse effects, adequate monitoring, and precautions in special population that must be considered when prescribing azathioprine. This review will help dermatologists prescribe it safely to all patients who require it. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Maria Bracho-Borro
- Service of Dermatology, Hospital General de México Dr. Eduardo Liceaga, S. S. (Ministry of Health) Mexico City, México
| | - Paulina Ailed Franco-Ruiz
- Service of Dermatology, Hospital General de México Dr. Eduardo Liceaga, S. S. (Ministry of Health) Mexico City, México
| | - Mario Magaña
- Service of Dermatology, Hospital General de México Dr. Eduardo Liceaga, S. S. (Ministry of Health) Mexico City, México
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34
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Goh MS, Yun JS, Su JC. Management of atopic dermatitis: a narrative review. Med J Aust 2022; 216:587-593. [PMID: 35644531 DOI: 10.5694/mja2.51560] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/31/2022] [Accepted: 03/28/2022] [Indexed: 01/22/2023]
Abstract
Atopic dermatitis (atopic eczema) is the most common inflammatory skin disease and has a significant burden on the quality of life of patients, families and caregivers. Its pathogenesis is a complex interplay between genetics and environment, involving impaired skin barrier function, immune dysregulation primarily involving the Th2 inflammatory pathway, itch, and skin microbiome. Restoration of skin barrier integrity with regular emollients and prompt topical anti-inflammatory therapies are mainstays of treatment. Systemic therapy is considered for moderate to severe disease. New understanding of inflammatory pathways and developments in targeted systemic immunotherapies have significantly advanced atopic dermatitis management. Dupilumab is a safe and effective treatment that is now available in Australia. Other promising agents for atopic dermatitis include Janus kinase, interleukin (IL)-13 and IL-31 inhibitors.
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Affiliation(s)
- Michelle Sy Goh
- Peter MacCallum Cancer Centre, Melbourne, VIC.,St Vincent's Hospital Melbourne, Melbourne, VIC
| | - Jenny Sw Yun
- Peter MacCallum Cancer Centre, Melbourne, VIC.,Royal Melbourne Hospital, Melbourne, VIC
| | - John C Su
- Eastern Health, Monash University, Melbourne, VIC.,Murdoch Children's Research Institute, Melbourne, VIC
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35
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Montero-Vilchez T, Rodriguez-Pozo JA, Diaz-Calvillo P, Salazar-Nievas M, Tercedor-Sanchez J, Molina-Leyva A, Arias-Santiago S. Dupilumab Improves Skin Barrier Function in Adults with Atopic Dermatitis: A Prospective Observational Study. J Clin Med 2022; 11:3341. [PMID: 35743415 PMCID: PMC9225017 DOI: 10.3390/jcm11123341] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023] Open
Abstract
Epidermal barrier dysfunction plays an important role in atopic dermatitis (AD). The difficulty of objectively assessing AD severity and the introduction of new biologicals into clinical practice highlight the need to find parameters to monitor clinical outcomes. The aim of this study is to evaluate the impact of dupilumab on skin barrier function and compare it with other treatments in patients with AD. A prospective observational study was conducted in adults with AD treated with topical corticosteroids (TCS), cyclosporine, or dupilumab. The main outcome measures after 16 weeks of treatment were Eczema Area and Severity (EASI)-50 (50% improvement in EASI), and transepidermal water loss (TEWL)-50 (50% improvement in TEWL). Forty-six patients with AD were included in the study. The proportion of patients who achieved EASI-50 at week 16 was significantly higher in patients receiving dupilumab (81.8% vs. 28.6% vs. 40%, p = 0.004). In eczematous lesions, TEWL decreased in patients receiving dupilumab (31.02 vs. 12.10 g·h−1·m−2, p < 0.001) and TCS (25.30 vs. 14.88 g·h−1·m−2, p = 0.047). The proportion of patients who achieved TEWL-50 at week 16 was higher for dupilumab than for cyclosporine or TCS. Temperature only decreased in the dupilumab group. Stratum corneum hydration increased in eczematous lesions and non-involved skin only in patients with dupilumab. In conclusion, dupilumab improves skin barrier function in patients with AD better than TCS or cyclosporine, both in eczematous lesions and in non-lesioned skin.
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Affiliation(s)
- Trinidad Montero-Vilchez
- Department of Dermatology, Virgen de las Nieves University Hospital, 18012 Granada, Spain; (T.M.-V.); (J.-A.R.-P.); (P.D.-C.); (M.S.-N.); (J.T.-S.); (S.A.-S.)
- Biosanitary Institute of Granada (ibs.GRANADA), 18012 Granada, Spain
| | - Juan-Angel Rodriguez-Pozo
- Department of Dermatology, Virgen de las Nieves University Hospital, 18012 Granada, Spain; (T.M.-V.); (J.-A.R.-P.); (P.D.-C.); (M.S.-N.); (J.T.-S.); (S.A.-S.)
- Biosanitary Institute of Granada (ibs.GRANADA), 18012 Granada, Spain
| | - Pablo Diaz-Calvillo
- Department of Dermatology, Virgen de las Nieves University Hospital, 18012 Granada, Spain; (T.M.-V.); (J.-A.R.-P.); (P.D.-C.); (M.S.-N.); (J.T.-S.); (S.A.-S.)
- Biosanitary Institute of Granada (ibs.GRANADA), 18012 Granada, Spain
| | - Maria Salazar-Nievas
- Department of Dermatology, Virgen de las Nieves University Hospital, 18012 Granada, Spain; (T.M.-V.); (J.-A.R.-P.); (P.D.-C.); (M.S.-N.); (J.T.-S.); (S.A.-S.)
| | - Jesús Tercedor-Sanchez
- Department of Dermatology, Virgen de las Nieves University Hospital, 18012 Granada, Spain; (T.M.-V.); (J.-A.R.-P.); (P.D.-C.); (M.S.-N.); (J.T.-S.); (S.A.-S.)
- Biosanitary Institute of Granada (ibs.GRANADA), 18012 Granada, Spain
| | - Alejandro Molina-Leyva
- Department of Dermatology, Virgen de las Nieves University Hospital, 18012 Granada, Spain; (T.M.-V.); (J.-A.R.-P.); (P.D.-C.); (M.S.-N.); (J.T.-S.); (S.A.-S.)
- Biosanitary Institute of Granada (ibs.GRANADA), 18012 Granada, Spain
| | - Salvador Arias-Santiago
- Department of Dermatology, Virgen de las Nieves University Hospital, 18012 Granada, Spain; (T.M.-V.); (J.-A.R.-P.); (P.D.-C.); (M.S.-N.); (J.T.-S.); (S.A.-S.)
- Biosanitary Institute of Granada (ibs.GRANADA), 18012 Granada, Spain
- Cell Production and Tissue Engineering Unit, Virgen de las Nieves University Hospital, Andalusian Network of Design and Translation of Advanced Therapies, 18012 Granada, Spain
- Department of Dermatology, Faculty of Medicine, University of Granada, 18071 Granada, Spain
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Prasannanjaneyulu V, Nene S, Jain H, Nooreen R, Otavi S, Chitlangya P, Srivastava S. Old drugs, new tricks: Emerging role of drug repurposing in the management of atopic dermatitis. Cytokine Growth Factor Rev 2022; 65:12-26. [PMID: 35550114 DOI: 10.1016/j.cytogfr.2022.04.007] [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: 04/19/2022] [Accepted: 04/29/2022] [Indexed: 11/03/2022]
Abstract
Atopic dermatitis is a chronic recurring pruritic inflammatory skin disease manifested by increased pro-inflammatory mediators which lead to dry, thickened, cracked, scaly skin. The current treatment options for atopic dermatitis management comprise drawbacks and leave unmet effective clinical needs. So, the approach for repurposing existing drugs for atopic dermatitis management may potentially overcome these unmet needs. Diseases that share the common pathophysiological pathways with atopic dermatitis can serve as a foundation for the repurposing of drugs. Drugs used in the management of cancer, rheumatoid arthritis, and other immune-mediated diseases such as psoriasis are under investigation to know the potential in atopic dermatitis management by utilizing repurposing strategies for a novel therapeutic indication. This review mainly envisages the probable repurposing of drugs for the management of atopic dermatitis disease; the barriers and regulatory aspects involved in the repurposing of existing drugs.
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Affiliation(s)
- Velpula Prasannanjaneyulu
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, India
| | - Shweta Nene
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, India
| | - Harsha Jain
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, India
| | - Rimsha Nooreen
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, India
| | - Shivam Otavi
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, India
| | - Palak Chitlangya
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, India
| | - Saurabh Srivastava
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, India.
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37
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Kychygina A, Cassagne M, Tauber M, Galiacy S, Paul C, Fournié P, Simon M. Dupilumab-Associated Adverse Events During Treatment of Allergic Diseases. Clin Rev Allergy Immunol 2022; 62:519-533. [PMID: 35275334 DOI: 10.1007/s12016-022-08934-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 12/12/2022]
Abstract
Among the new biological therapies for atopic diseases, dupilumab is a fully human monoclonal antibody directed against IL-4Rα, the common chain of interleukin-4 and interleukin-13 receptors. Dupilumab showed clinical improvements in patients with atopic dermatitis, asthma, and chronic rhinosinusitis and is currently under development for other indications. While dupilumab is considered to be well tolerated, a number of recent publications have reported various adverse events. This review aims to summarize the current knowledge about these adverse events, which may help clinicians to improve the follow-up of patients on dupilumab. Injection-site reactions are the most common reported adverse event. However, dupilumab has also been shown to cause ophthalmic complications (e.g., dry eyes, conjunctivitis, blepharitis, keratitis, and ocular pruritus), head and neck dermatitis, onset of psoriatic lesions, progression of cutaneous T-cell lymphoma exacerbation, alopecia areata, hypereosinophilia, and arthritis. Most are managed during dupilumab treatment continuation, but some (e.g., severe conjunctivitis) may result in a discontinuation of treatment. Their molecular origin is unclear and requires further investigations. Among other hypothesis, it has been suggested that T helper (Th)2-mediated pathway inhibition may worsen Th1/Th17-dependent immune responses. An ophthalmological examination for the presence of potential predictive indicators of ophthalmic adverse events is recommended before initiation of dupilumab therapy.
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Affiliation(s)
- Anna Kychygina
- Infinity, Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), Toulouse University, CNRS, Paul Sabatier Toulouse III University, Inserm, Toulouse, France
| | - Myriam Cassagne
- Infinity, Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), Toulouse University, CNRS, Paul Sabatier Toulouse III University, Inserm, Toulouse, France.,Department of Ophthalmology, Toulouse Hospital, Toulouse, France
| | - Marie Tauber
- Infinity, Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), Toulouse University, CNRS, Paul Sabatier Toulouse III University, Inserm, Toulouse, France.,Department of Dermatology, CHU and Toulouse III University, Toulouse, France
| | - Stéphane Galiacy
- Infinity, Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), Toulouse University, CNRS, Paul Sabatier Toulouse III University, Inserm, Toulouse, France.,Department of Ophthalmology, Toulouse Hospital, Toulouse, France
| | - Carle Paul
- Infinity, Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), Toulouse University, CNRS, Paul Sabatier Toulouse III University, Inserm, Toulouse, France.,Department of Dermatology, CHU and Toulouse III University, Toulouse, France
| | - Pierre Fournié
- Infinity, Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), Toulouse University, CNRS, Paul Sabatier Toulouse III University, Inserm, Toulouse, France.,Department of Ophthalmology, Toulouse Hospital, Toulouse, France
| | - Michel Simon
- Infinity, Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), Toulouse University, CNRS, Paul Sabatier Toulouse III University, Inserm, Toulouse, France.
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Ming SWY, Zhou Y, Smith M, Were J. A Retrospective Database Cohort Study Evaluating the Association Between Immune Suppressive Therapy and the Development of Cancer in Patients with Atopic Dermatitis Within UK Primary Care. EUROPEAN MEDICAL JOURNAL 2022. [DOI: 10.33590/emj/22-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: First-line regular systemic treatment for atopic dermatitis (AD) in the UK consists of methotrexate, azathioprine, ciclosporin, or mycophenolate (immune-suppressive therapies [IST]). ISTs have been associated with malignancy, hence the need for evaluation for the relationship to the risk of developing cancer.
Method: This retrospective cohort study utilising the Clinical Practice Research Datalink (CPRD) followed two cohorts with moderate or severe AD: one prescribed ISTs and one without. A total of 222,978 patients were included. The index date was the date of first IST prescription within primary care for the IST cohort, and the date of first potent topical steroid prescription from January 2001 to May 2021. Cohorts were propensity matched 1:1, resulting in 17,556 patients per cohort. Cox proportional hazard models were used to model the hazard of a cancer diagnosis. A secondary analysis was carried out on a restricted population, excluding patients with other comorbidities where ISTs were commonly prescribed. A further analysis explored the relation between the dose and the association with the risk of cancer.
Results: Both the primary (hazard ratio: 1.01; 95% confidence interval: 0.94–1.08) and secondary (hazard ratio: 1.03; 95% confidence interval: 0.93–1.14) analyses did not show a significant difference in the hazard of a cancer code in the IST and non-IST cohorts. The exploratory dose–response analysis showed a higher risk of cancer associated with more prescriptions of IST per year.
Conclusion: This study shows that amongst patients with moderate or severe AD, overall IST prescription in primary care is not associated with the onset of a cancer code. However, there is a trend with a higher risk of cancer coding with more prescriptions of IST.
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Dellon ES, Simon D, Wechsler ME. Controversies in Allergy: The Potential Role of Biologics as First-Line Therapy in Eosinophilic Disorders. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1169-1176. [PMID: 35167955 PMCID: PMC9086115 DOI: 10.1016/j.jaip.2022.01.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/17/2022] [Accepted: 01/28/2022] [Indexed: 01/11/2023]
Abstract
With advances in understanding the role of eosinophils in disease pathogenesis, particularly in the airways, gastrointestinal tract, and skin, targeting eosinophils or the cytokines that lead to their production, activation, and survival has become an increasingly pursued therapeutic approach. Newly developed biologic agents target eosinophils directly, other cells interacting with or activating eosinophils, or cytokines in the type 2 inflammatory pathway with specific antibodies. Current treatment paradigms reserve therapy with biologics for patients refractory to or intolerant of corticosteroids or immunosuppressants. Given accumulating data for safety and efficacy of these biologics, however, there is the question of whether targeted treatments should be used earlier in the treatment algorithm. In this article, we discuss the pros and cons of using biologics as first-line therapy for eosinophilic diseases of the airways, gastrointestinal tract, and skin. We highlight emerging biologic agents and future directions for research, as well as a rationale for the early use of some biologics to prevent tissue damage, disease progression, and organ dysfunction in selected conditions.
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Affiliation(s)
- Evan S Dellon
- Center for Esophageal Diseases and Swallowing, and Center for Gastrointestinal Biology and Diseases, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - Dagmar Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael E Wechsler
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colo
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Silverberg JI, Hong HCH, Thyssen JP, Calimlim BM, Joshi A, Teixeira HD, Collins EB, Crowell MM, Johnson SJ, Armstrong AW. Comparative Efficacy of Targeted Systemic Therapies for Moderate to Severe Atopic Dermatitis without Topical Corticosteroids: Systematic Review and Network Meta-analysis. Dermatol Ther (Heidelb) 2022; 12:1181-1196. [PMID: 35435637 PMCID: PMC9110624 DOI: 10.1007/s13555-022-00721-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/30/2022] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION The comparative efficacy of targeted systemic therapies for moderate to severe atopic dermatitis (AD) has not been systematically assessed using recent phase 3 data. This network meta-analysis assesses the comparative efficacy of targeted systemic therapies without the addition of topical corticosteroids (TCS) and/or topical calcineurin inhibitors (TCI) in adults with moderate to severe AD. METHODS The systematic literature review searched through 17 May 2021 for phase 3/4 trials with upadacitinib, interleukin-4 (IL-4), interleukin-13 (IL-13), or JAK inhibitors compared with placebo or active intervention for adults and adolescents with moderate to severe AD with inadequate response to TCS/TCI or for whom TCS/TCI was medically inadvisable, without restrictions on year or region. Researchers assessed data using PRISMA guidelines. The proportion of patients achieving trial co-primary endpoints [Investigator Global Assessment (IGA) score of 0 or 1 (clear or almost clear) and reduction of ≥ 2 points from baseline; proportion of patients achieving Eczema Area and Severity Index (EASI) improvement ≥ 75% from baseline (EASI-75)]; EASI improvement ≥ 90% from baseline (EASI-90); and ≥ 4-point improvement on Pruritus Numerical Rating Scale from baseline (ΔNRS ≥ 4) were evaluated using Bayesian network meta-analysis. RESULTS Of 3415 initially identified records, network meta-analysis (NMA) ultimately included 6 records representing 9 unique studies. Two upadacitinib trials were also included. Eleven clinical trials including 6254 patients were analyzed. Upadacitinib 30 mg daily was the most efficacious therapy across all endpoints at the primary endpoint (week 12 or 16) and at earlier timepoints, followed by upadacitinib 15 mg daily and abrocitinib 200 mg daily. DISCUSSION Many factors need to be considered for treatment selection for AD. These findings can help healthcare providers when personalizing a patient's treatment. CONCLUSION Upadacitinib 30 mg daily, upadacitinib 15 mg daily, and abrocitinib 200 mg daily may be the most efficacious targeted systemic therapies over 12-16 weeks of therapy in AD.
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Grants
- JI Silverberg is an advisor, speaker, or consultant for AbbVie. Note disclosures in the manuscript.
- C Hong is a researcher, consultant, and/or advisor for AbbVie. Note disclosures in the manuscript.
- JP Thyssen is an advisor, investigator, and speaker for AbbVie. Note disclosures in the manuscript.
- BM Calimlim, A Joshi, and HD Teixeira are full-time, salaried employees of AbbVie Inc. and own AbbVie stock or stock options.
- E Collins, M Crowell, and S Johnson are employees of Medicus Economics LLC, which was paid fees by AbbVie to conduct the research in the manuscript.
- AW Armstrong reported receiving grants and personal fees from AbbVie. Note disclosures in the manuscript.
- No honoraria or payments were made for authorship.
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Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave NW, Ste 2B-425, Washington, DC, 20037, USA.
| | - H Chih-Ho Hong
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
- Probity Medical Research, Surrey, BC, Canada
| | - Jacob P Thyssen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | | | | | - April W Armstrong
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Kook HD, Hong N, Lee DH, Jung HJ, Park MY, Ahn J. The Effect of Baricitinib Add-on Therapy in Atopic Dermatitis Patients Treated with Dupilumab. Dermatol Ther 2022; 35:e15525. [PMID: 35441774 DOI: 10.1111/dth.15525] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/08/2022] [Accepted: 04/13/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Hyung Don Kook
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Narang Hong
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Dong Heon Lee
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Hye Jung Jung
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Mi Youn Park
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Jiyoung Ahn
- Department of Dermatology, National Medical Center, Seoul, Korea
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Xue Y, Bao W, Zhou J, Zhao QL, Hong SZ, Ren J, Yang BC, Wang P, Yin B, Chu CC, Liu G, Jia CY. Global Burden, Incidence and Disability-Adjusted Life-Years for Dermatitis: A Systematic Analysis Combined With Socioeconomic Development Status, 1990–2019. Front Cell Infect Microbiol 2022; 12:861053. [PMID: 35493737 PMCID: PMC9039287 DOI: 10.3389/fcimb.2022.861053] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDermatitis is an important global health problem that not only affects social interaction and physical and mental health but also causes economic burden. Health problems or distress caused by dermatitis may be easily overlooked, and relevant epidemiological data are limited. Therefore, a better understanding of the burden of dermatitis is necessary for developing global intervention strategies.MethodsAll data on dermatitis, including atopic dermatitis (AD), contact dermatitis (CD) and seborrhoeic dermatitis (SD), were obtained from the Global Burden of Disease 2019 (GBD2019) database. The extracted age-standardized incidence rates (ASIR) and disability-adjusted life-years (DALYs) rates (ASDR) data were analysed by stratification, including by sex, country or region, and sociodemographic index (SDI) indicators. Finally, we analysed the correlation between the global burden of dermatitis and socioeconomic development status.ResultsAccording to the GBD 2019 estimate, the ASIR and ASDR for the three major types of dermatitis in 2019 were 5244.3988 (95% CI 4551.7244–5979.3176) per 100,000 person-years and 131.6711 (95% CI 77.5876–206.8796) per 100,000 person-years. The ASIR and ASDR of atopic dermatitis, contact dermatitis and seborrhoeic dermatitis are: Incidence (95%CI,per 100,000 person-years), 327.91 (312.76-343.67), 3066.04 (2405.38-3755.38), 1850.44 (1706.25- 1993.74); DALYs (95%CI, per 100,000 person-years), 99.69 (53.09-167.43), 28.06 (17.62-41.78), 3.93 (2.24-6.25). In addition, among the three dermatitis types, the greatest burden was associated with AD. According to the ASDR from 1990 to 2019, the burden of dermatitis has exhibited a slow downward trend in recent years. In 2019, the ASIR showed that the USA had the greatest burden, while the ASDR showed that Asian countries (such as Japan, Mongolia, Kazakhstan, and Uzbekistan) and some European countries (France, Estonia) had the greatest burden. According to SDI stratification and the three major dermatitis types, high ASIR and ASDR corresponded to high SDI areas (especially for AD).ConclusionThe burden of dermatitis is related to socioeconomic development status, especially for AD, which is positively correlated with the SDI. The results based on GBD2019 data are valuable for formulating policy, preventing and treating dermatitis and reducing the global burden of dermatitis.
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Affiliation(s)
- Yi Xue
- Department of Burns and Plastic and Wound Repair Surgery, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- School of Medicine, Xiamen University, Xiamen, China
| | - Wu Bao
- Department of Burns and Plastic and Wound Repair Surgery, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- School of Medicine, Xiamen University, Xiamen, China
| | - Jie Zhou
- School of Medicine, Xiamen University, Xiamen, China
| | - Qing-Liang Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics and Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, China
| | - Su-Zhuang Hong
- Division of Plastic Surgery, Zhongshan Hospital Xiamen University, Xiamen, China
| | - Jun Ren
- Department of Dermatology, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Bai-Cheng Yang
- Division of Plastic Surgery, Zhongshan Hospital Xiamen University, Xiamen, China
| | - Peng Wang
- Department of Burns and Plastic and Wound Repair Surgery, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- School of Medicine, Xiamen University, Xiamen, China
| | - Bin Yin
- Department of Burns and Plastic and Wound Repair Surgery, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- School of Medicine, Xiamen University, Xiamen, China
| | - Cheng-Chao Chu
- School of Medicine, Xiamen University, Xiamen, China
- Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen University, Xiamen, China
- *Correspondence: Chi-Yu Jia, ; Gang Liu, ; Cheng-Chao Chu,
| | - Gang Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics and Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, China
- *Correspondence: Chi-Yu Jia, ; Gang Liu, ; Cheng-Chao Chu,
| | - Chi-Yu Jia
- Department of Burns and Plastic and Wound Repair Surgery, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- School of Medicine, Xiamen University, Xiamen, China
- *Correspondence: Chi-Yu Jia, ; Gang Liu, ; Cheng-Chao Chu,
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Lockhart MK, Siegfried EC. Evolving Landscape of Systemic Therapy for Pediatric Atopic Dermatitis. Dermatol Clin 2022; 40:137-143. [DOI: 10.1016/j.det.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kortekaas Krohn I, Aerts JL, Breckpot K, Goyvaerts C, Knol E, Van Wijk F, Gutermuth J. T-cell subsets in the skin and their role in inflammatory skin disorders. Allergy 2022; 77:827-842. [PMID: 34559894 DOI: 10.1111/all.15104] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/11/2021] [Indexed: 12/20/2022]
Abstract
T lymphocytes (T cells) are major players of the adaptive immune response. Naive T cells are primed in the presence of cytokines, leading to polarization into distinct T-cell subsets with specific functions. These subsets are classified based on their T-cell receptor profile, expression of transcription factors, surface cytokine and chemokine receptors, and their cytokine production, which together determine their specific function. This review provides an overview of the various T-cell subsets and their function in several inflammatory skin disorders ranging from allergic inflammation to skin tumors. Moreover, we highlight similarities of T-cell responses across different skin disorders, demonstrating the presence of similar and opposing functions for the different T-cell subsets. Finally, we discuss the effects of currently available and promising therapeutic approaches to harness T cells in inflammatory skin diseases for which efficacy next to unwanted side effects provide new insights into the pathophysiology of skin disorders.
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Affiliation(s)
- Inge Kortekaas Krohn
- Vrije Universiteit Brussel (VUB)Skin Immunology & Immune Tolerance (SKIN) Research Group Brussels Belgium
- Vrije Universiteit Brussel (VUB)Universitair Ziekenhuis Brussel (UZ Brussel)Department of DermatologyUniversitair Ziekenhuis Brussel Brussels Belgium
| | - Joeri L. Aerts
- Vrije Universiteit Brussel (VUB)Neuro‐Aging and Viro‐Immunotherapy (NAVI) Research Group Brussels Belgium
| | - Karine Breckpot
- Vrije Universiteit Brussel (VUB)Laboratory for Molecular and Cellular Therapy (LMCT)Department of Biomedical Sciences Brussels Belgium
| | - Cleo Goyvaerts
- Vrije Universiteit Brussel (VUB)Laboratory for Molecular and Cellular Therapy (LMCT)Department of Biomedical Sciences Brussels Belgium
| | - Edward Knol
- Center for Translational Immunology University Medical Center Utrecht Utrecht The Netherlands
- Department Dermatology/Allergology University Medical Center Utrecht Utrecht The Netherlands
| | - Femke Van Wijk
- Center for Translational Immunology University Medical Center Utrecht Utrecht The Netherlands
| | - Jan Gutermuth
- Vrije Universiteit Brussel (VUB)Skin Immunology & Immune Tolerance (SKIN) Research Group Brussels Belgium
- Vrije Universiteit Brussel (VUB)Universitair Ziekenhuis Brussel (UZ Brussel)Department of DermatologyUniversitair Ziekenhuis Brussel Brussels Belgium
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Osthole Inhibits Expression of Genes Associated with Toll-like Receptor 2 Signaling Pathway in an Organotypic 3D Skin Model of Human Epidermis with Atopic Dermatitis. Cells 2021; 11:cells11010088. [PMID: 35011650 PMCID: PMC8750192 DOI: 10.3390/cells11010088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/18/2021] [Accepted: 12/23/2021] [Indexed: 12/15/2022] Open
Abstract
The Toll-like receptor (TLR) family signature has been linked to the etiopathology of atopic dermatitis (AD), a chronic inflammatory skin disease associated with skin barrier dysfunction and immune system imbalance. We aimed to investigate whether osthole (a plant-derived compound) can inhibit the genetic profile of key genes associated with TLR2 signaling (TIRAP, MyD88, IRAK1, TRAF6, IκBα, NFκB) after stimulation with LPS or histamine in a 3D in vitro model of AD. Overexpression of the aforementioned genes may directly increase the secretion of proinflammatory cytokines (CKs) and chemokines (ChKs), which may exacerbate the symptoms of AD. Relative gene expressions were quantified by qPCR and secretion of CKs and ChKs was evaluated by ELISA assay. LPS and histamine increased the relative expression of genes related to the TLR2 pathway, and osthole successfully reduced it. In summary, our results show that osthole inhibits the expression of genes associated with the TLR signaling pathway in a skin model of AD. Moreover, the secretion of CKs and ChKs after treatment of AD with osthole in a 3D skin model in vitro suggests the potential of osthole as a novel compound for the treatment of AD.
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Ogulur I, Pat Y, Ardicli O, Barletta E, Cevhertas L, Fernandez‐Santamaria R, Huang M, Bel Imam M, Koch J, Ma S, Maurer DJ, Mitamura Y, Peng Y, Radzikowska U, Rinaldi AO, Rodriguez‐Coira J, Satitsuksanoa P, Schneider SR, Wallimann A, Zhakparov D, Ziadlou R, Brüggen M, Veen W, Sokolowska M, Baerenfaller K, Zhang L, Akdis M, Akdis CA. Advances and highlights in biomarkers of allergic diseases. Allergy 2021; 76:3659-3686. [PMID: 34519063 PMCID: PMC9292545 DOI: 10.1111/all.15089] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 05/19/2021] [Accepted: 09/08/2021] [Indexed: 12/16/2022]
Abstract
During the past years, there has been a global outbreak of allergic diseases, presenting a considerable medical and socioeconomical burden. A large fraction of allergic diseases is characterized by a type 2 immune response involving Th2 cells, type 2 innate lymphoid cells, eosinophils, mast cells, and M2 macrophages. Biomarkers are valuable parameters for precision medicine as they provide information on the disease endotypes, clusters, precision diagnoses, identification of therapeutic targets, and monitoring of treatment efficacies. The availability of powerful omics technologies, together with integrated data analysis and network‐based approaches can help the identification of clinically useful biomarkers. These biomarkers need to be accurately quantified using robust and reproducible methods, such as reliable and point‐of‐care systems. Ideally, samples should be collected using quick, cost‐efficient and noninvasive methods. In recent years, a plethora of research has been directed toward finding novel biomarkers of allergic diseases. Promising biomarkers of type 2 allergic diseases include sputum eosinophils, serum periostin and exhaled nitric oxide. Several other biomarkers, such as pro‐inflammatory mediators, miRNAs, eicosanoid molecules, epithelial barrier integrity, and microbiota changes are useful for diagnosis and monitoring of allergic diseases and can be quantified in serum, body fluids and exhaled air. Herein, we review recent studies on biomarkers for the diagnosis and treatment of asthma, chronic urticaria, atopic dermatitis, allergic rhinitis, chronic rhinosinusitis, food allergies, anaphylaxis, drug hypersensitivity and allergen immunotherapy. In addition, we discuss COVID‐19 and allergic diseases within the perspective of biomarkers and recommendations on the management of allergic and asthmatic patients during the COVID‐19 pandemic.
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Xu X, Reitsma S, Wang DY, Fokkens WJ. Highlights in the advances of chronic rhinosinusitis. Allergy 2021; 76:3349-3358. [PMID: 33948955 DOI: 10.1111/all.14892] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/15/2021] [Accepted: 04/26/2021] [Indexed: 12/27/2022]
Abstract
Chronic rhinosinusitis (CRS) is a complex upper airway inflammatory disease with a broad spectrum of clinical variants. As our understanding of the disease pathophysiology evolves, so too does our philosophy towards the approach and management of CRS. Endotyping is gaining favour over phenotype-based classifications, owing to its potential in prognosticating disease severity and delivering precision treatment. Endotyping is especially useful in challenging CRS with nasal polyposis cases, for whom novel treatment options such as biologicals are now available. The latest European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS2020) reflects these changes with updated rhinosinusitis classifications and new integrated care pathways. With the coronavirus disease 2019 (COVID-19) pandemic, physicians and rhinologists have to balance the responsibility of managing their patients' upper airway while adequately protecting themselves from droplet and aerosol transmission. This review summarises the key updates from EPOS2020, endotype-based classification and biomarkers. The role of biologicals in CRS and the lessons we can draw from their use in severe asthma will be examined. Finally, the principles of CRS management during COVID-19 will also be discussed.
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Affiliation(s)
- Xinni Xu
- Department of Otolaryngology ‐ Head & Neck Surgery National University Hospital Singapore Singapore
| | - Sietze Reitsma
- Department of Otorhinolaryngology Amsterdam University Medical Centers, location AMC Amsterdam The Netherlands
| | - De Yun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
| | - Wytske J. Fokkens
- Department of Otorhinolaryngology Amsterdam University Medical Centers, location AMC Amsterdam The Netherlands
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Hülpüsch C, Weins AB, Traidl‐Hoffmann C, Reiger M. A new era of atopic eczema research: Advances and highlights. Allergy 2021; 76:3408-3421. [PMID: 34407212 DOI: 10.1111/all.15058] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 05/03/2021] [Accepted: 08/12/2021] [Indexed: 01/09/2023]
Abstract
Atopic eczema (AE) is an inflammatory skin disease with involvement of genetic, immunological and environmental factors. One hallmark of AE is a skin barrier disruption on multiple, highly interconnected levels: filaggrin mutations, increased skin pH and a microbiome dysbiosis towards Staphylococcus aureus overgrowth are observed in addition to an abnormal type 2 immune response. Extrinsic factors seem to play a major role in the development of AE. As AE is a first step in the atopic march, its prevention and appropriate treatment are essential. Although standard therapy remains topical treatment, powerful systemic treatment options emerged in the last years. However, thorough endotyping of the individual patients is still required for ideal precision medicine approaches in future. Therefore, novel microbial and immunological biomarkers were described recently for the prediction of disease development and treatment response. This review summarizes the current state of the art in AE research.
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Affiliation(s)
- Claudia Hülpüsch
- Department of Environmental Medicine Faculty of Medicine University of Augsburg Augsburg Germany
- Institute of Environmental Medicine Helmholtz Zentrum München Augsburg Germany
- CK CARE – Christine Kühne Center for Allergy research and Education Davos Switzerland
| | - Andreas B. Weins
- Department of Dermatology Faculty of Medicine University of Augsburg Augsburg Germany
| | - Claudia Traidl‐Hoffmann
- Department of Environmental Medicine Faculty of Medicine University of Augsburg Augsburg Germany
- Institute of Environmental Medicine Helmholtz Zentrum München Augsburg Germany
- CK CARE – Christine Kühne Center for Allergy research and Education Davos Switzerland
- ZIEL Technical University of Munich Freising Germany
| | - Matthias Reiger
- Department of Environmental Medicine Faculty of Medicine University of Augsburg Augsburg Germany
- Institute of Environmental Medicine Helmholtz Zentrum München Augsburg Germany
- CK CARE – Christine Kühne Center for Allergy research and Education Davos Switzerland
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Hassoun D, Malard O, Barbarot S, Magnan A, Colas L. Type 2 immunity-driven diseases: Towards a multidisciplinary approach. Clin Exp Allergy 2021; 51:1538-1552. [PMID: 34617355 PMCID: PMC9292742 DOI: 10.1111/cea.14029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/23/2021] [Accepted: 09/08/2021] [Indexed: 12/31/2022]
Abstract
Asthma, atopic dermatitis and chronic rhinoconjunctivitis are highly heterogeneous. However, epidemiologic associations exist between phenotypic groups of patients. Atopic march is one such association but is not the only common point. Indeed, beyond such phenotypes, hallmarks of type 2 immunity have been found in these diseases involving immune dysregulation as well as environmental triggers and epithelial dysfunction. From the canonical Th2 cytokines (IL-4, IL-5, IL-13), new cellular and molecular actors arise, from the epithelium's alarmins to new innate immune cells. Their interactions are now better understood across the different environmental barriers, and slight differences appeared. In parallel, the development of type 2-targeting biotherapies not only raised hope to treat those diseases but also raised new questions regarding their true pathophysiological involvement. Here, we review the place of type 2 immunity in the different phenotypes of asthma, chronic rhinitis, chronic rhinosinusitis and atopic dermatitis, highlighting nuances between them. New hypotheses rising from the use of biotherapies will be discussed along with the uncertainties and unmet needs of this field.
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Affiliation(s)
- Dorian Hassoun
- CHU Nantes, CNRS, INSERM, l'institut du Thorax, Université de Nantes, Nantes, France
| | - Olivier Malard
- Department of Otorhinolaryngology and Head and Neck Surgery, Nantes University Hospital, Nantes, France
| | - Sébastien Barbarot
- Department of Dermatology, CHU Nantes, UMR 1280 PhAN, INRA, Nantes Université, Nantes, France
| | - Antoine Magnan
- INRAe UMR_S 0892, Hôpital Foch, Université de Versailles Saint-Quentin, Paris Saclay, France
| | - Luc Colas
- Plateforme Transversale d'Allergologie et d'Immunologie Clinique, Institut du Thorax, CHU de Nantes, Nantes, France.,INSERM, CHU Nantes, Centre de Recherche en Transplantation et Immunologie UMR1064, Nantes Université, ITUN, Nantes, France
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Salvati L, Cosmi L, Annunziato F. From Emollients to Biologicals: Targeting Atopic Dermatitis. Int J Mol Sci 2021; 22:10381. [PMID: 34638722 PMCID: PMC8508966 DOI: 10.3390/ijms221910381] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 12/20/2022] Open
Abstract
Atopic dermatitis (AD) is the most common chronic inflammatory skin disease and significantly impacts patients' lives, particularly in its severe forms. AD clinical presentation varies over the course of the disease, throughout different age groups, and across ethnicities. AD is characterized by a spectrum of clinical phenotypes as well as endotypes. Starting from the current description of AD pathogenesis, this review explores the rationale of approved AD therapies from emollients to biologicals and introduces novel promising drugs.
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Affiliation(s)
| | - Lorenzo Cosmi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (L.S.); (F.A.)
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