Acta Dermato Venereologica,
Год журнала:
2023,
Номер
103, С. adv13363 - adv13363
Опубликована: Дек. 14, 2023
Atopic
dermatitis
is
a
common
inflammatory
disease
with
chronic
and
relapsing
course.
Although
considered
childhood
disease,
it
now
evident
that
atopic
also
in
adulthood
the
elderly
population.
typically
manifests
bilateral
symmetrical
eczematous
lesions
on
face,
trunk
skin
folds.
Itch
invariably
present
may
be
very
severe,
markedly
affecting
daily
life
sleep.
In
older
adults,
have
high
level
of
impact
quality
life,
frequently
burdening
an
already
complex
comorbid
situation.
The
full
assessment
burden
(localizations,
itch
severity,
sleep
alterations,
history,
comorbidities)
crucial
to
identify
most
appropriate
treatment.
many
cases,
moderate-to-severe
population
can
successfully
safely
treated
biological
agents
inhibiting
interleukin-4/-13
pathway,
whereas
use
Janus
kinase
inhibitors
pose
concerns
about
safety
profile.
Journal of the European Academy of Dermatology and Venereology,
Год журнала:
2024,
Номер
38(11), С. 2139 - 2148
Опубликована: Июль 11, 2024
Abstract
Background
Current
treat‐to‐target
recommendations
for
atopic
dermatitis
(AD)
may
not
include
high
enough
treatment
targets
and
do
fully
consider
patient
needs.
Objective
To
develop
optimized
AD
management,
including
disease
severity
assessments,
goals
targets,
guidance
escalation/modification.
Methods
An
international
group
of
expert
dermatologists
drafted
a
series
management
using
insights
from
global
study
87
44
countries.
Experts
voted
on
modified
eDelphi
voting
process.
Results
The
Aiming
High
in
Eczema/Atopic
Dermatitis
(AHEAD)
establish
novel
approach
to
incorporating
shared
decision‐making
concept
minimal
activity
(MDA).
Consensus
(≥70%
agreement)
was
reached
all
1
round
voting;
strong
consensus
(≥90%
30/34
recommendations.
In
the
AHEAD
approach,
patients
select
their
most
troublesome
feature(s);
clinician
chooses
corresponding
patient‐reported
measure
objective
measure.
Treatment
are
chosen
list
‘moderate’
‘optimal’
with
achievement
defined
as
MDA.
Conclusions
Patient
led
development
recommendations,
which
management.
Patients
were
involved
process
used
generate
each
recommendation.
However,
perspectives
captured
global,
qualitative
research
that
considered
by
experts
initial
drafting
Expert Review of Clinical Immunology,
Год журнала:
2025,
Номер
unknown
Опубликована: Янв. 14, 2025
In
recent
years,
the
understanding
of
atopic
dermatitis
(AD)
pathogenetic
mechanisms
has
expanded
and
now
it
is
recognized
that
Th2
immune
axis
dysregulation
pivotal
to
AD
pathogenesis.
The
advent
biological
drugs
small
molecules
have
marked
a
revolution
in
treatment
AD.
Dupilumab,
targeting
IL-4
IL-13,
been
first
demonstrate
efficacy
treating
moderate
severe
by
modulating
type-2
inflammation
pathways.
Increasing
knowledge
different
cytokines
fueled
development
new
biologics
molecules.
JAK
inhibitors
which
targets
JAK-STAT
pathway,
involved
cytokine
signaling,
represent
promising
novel
therapeutic
strategy,
enlarging
options
for
dermatitis.
This
comprehensive
review
aims
provide
an
updated
critical
overview
currently
use
under
investigation
children
adolescents,
along
with
addressing
unmet
needs
future
research
perspectives.
Biologics
offer
promise
enlarge
arsenal
As
patient's
response
depends
on
their
pheno-endotype
AD,
choosing
right
crucial
ensuring
therapy
success.
Dermatology and Therapy,
Год журнала:
2023,
Номер
13(2), С. 651 - 660
Опубликована: Янв. 9, 2023
The
treatment
of
severe
atopic
dermatitis
(AD)
includes
cyclosporine
and
recently
approved
biologics
small
molecules.
Among
these,
upadacitinib
is
a
selective
inhibitor
Janus
kinase
1,
for
the
AD
in
adolescents/adults.
Upadacitinib
has
shown
efficacy
safety
several
phase
3
clinical
trials,
but
data
on
real-life
patients
are
still
lacking.
We
conducted
retrospective
observational
study
to
evaluate
effectiveness
up
week
16
cohort
both
bio-naïve
bio-experienced
patients.
This
was
carried
out
by
analyzing
database
records
an
Italian
referral
hospital.
Thirty-eight
were
included
this
study,
35
completed
weeks
treatment.
At
16,
patients,
percentages
Eczema
Area
Severity
Index
(EASI)
50,
EASI
75,
90
100
responses
94.29,
91.43,
74.29,
60%,
respectively.
A
decrease
at
least
4
points
from
baseline
itch-NRS
reported
94.74
91.43%
8
16.
Regarding
upadacitinib,
26.32%
experienced
one
adverse
event
(AE),
total
13
AEs
recorded,
including
blood
test
abnormalities
papulopustular
acne.
None
our
interrupted
drug
because
AE.
observed
higher
rates
EASI75/EASI90/EASI100
compared
with
trials.
profile
favorable,
as
no
leading
discontinuation
Pharmaceutics,
Год журнала:
2023,
Номер
15(2), С. 577 - 577
Опубликована: Фев. 8, 2023
Atopic
dermatitis
(AD),
a
pruritic,
inflammatory
chronic
disease
with
multifactorial
pathogenesis,
has
been
therapeutic
challenge.
Novel
target
treatments
aim
to
reduce
not
only
the
immunologic
dysfunction
and
microbiome
dysbiosis
but
also
recovery
of
damaged
skin
barrier.
The
current
review
focuses
on
interleukin
31
(IL-31)
pathway
AD
offers
an
overview
clinical
studies
monoclonal
antibodies
blocking
this
cascade.
Pruritus,
key
symptom
AD,
substantial
participation
IL-31
complex
activation
relevant
signaling
pathways.
Epidermal
keratinocytes,
cells,
cutaneous
peripheral
nerves
express
interleukin-31
receptor
α-chain
(IL-31RA),
upregulated
by
Staphylococcus
aureus
toxins
or
Th2
cytokines
involved
in
AD.
Nemolizumab
is
humanized
antibody
that
antagonizes
IL-31RA,
inhibiting
cascade
therefore
contributing
reducing
pruritus
inflammation
recovering
barrier
patients.
Phases
2
3
trials
nemolizumab
show
suitable
safety
profile,
fast,
efficient,
sustained
reduction
severity
scores,
especially
when
associated
topical
treatment.
Deciphering
full
interplay
may
expand
potential
as
targeted
therapy
for
other
pruritic
conditions.
British Journal of Dermatology,
Год журнала:
2023,
Номер
189(4), С. 368 - 380
Опубликована: Июль 5, 2023
Abstract
Background
On
the
basis
of
safety
data
for
patients
with
inflammatory
rheumatism
or
bowel
disease,
treatment
Janus
kinase
(JAK)
inhibitors
(JAKi)
has
been
linked
to
occurrence
major
adverse
cardiovascular
events
(MACE).
However,
these
diseases
are
proatherogenic;
in
contrast,
atopic
dermatitis
(AD)
do
not
usually
have
a
high
(CV)
comorbidity
burden.
Objectives
To
perform
systematic
review
and
meta-analysis
MACE
AD
treated
JAKi.
Methods
We
systematically
searched
PubMed,
Embase,
Cochrane
Library
Google
Scholar
from
their
inception
2
September
2022.
Cohort
studies,
randomized
controlled
trials
pooled
analyses
providing
CV
on
taking
JAKi
were
selected.
included
aged
≥
12
years.
built
‘controlled-period’
cohort
(n
=
9309;
6000
exposed
3309
comparators)
an
‘all-JAKi’
9118
any
studies).
The
primary
outcome
was
composite
acute
coronary
syndrome
(ACS),
ischaemic
stroke
death.
broader
secondary
encompassed
ACS,
(whether
haemorrhagic),
transient
attack
frequency
assessed
both
cohorts.
A
fixed-effects
using
Peto
method
used
calculate
odds
ratio
(OR)
cohort.
Evaluation
risk
bias
done
risk-of-bias
tool
(version
2).
Certainty
evidence
Grading
Recommendations
Assessment,
Development
(GRADE)
approach.
Results
Eight
per
cent
records
identified
initially
met
selection
criteria,
corresponding
23
Patients
had
baricitinib,
upadacitinib,
abrocitinib,
ivarmacitinib,
placebo
dupilumab.
Four
(three
one
placebo)
five
(four
occurred
among
9309
(MACE
0.04%
0.05%,
respectively).
13
0.08%
0.14%,
OR
vs.
dupilumab
1.35
(95%
confidence
interval
0.15–12.21;
I
12%,
very
low
certainty
evidence).
Conclusions
Our
highlights
rare
cases
users
AD.
may
little-to-no
effect
comparators,
but
is
uncertain.
Real-life
long-term
population-level
studies
needed.
Clinical Cosmetic and Investigational Dermatology,
Год журнала:
2024,
Номер
Volume 17, С. 593 - 604
Опубликована: Март 1, 2024
Upadacitinib
is
a
selective
Janus
kinase
inhibitor
approved
for
the
treatment
of
severe
atopic
dermatitis
(AD).
This
systematic
review
aims
to
summarize
most
recent
data
in
terms
effectiveness
and
safety
upadacitinib
AD
real-world
setting.
The
included
comprehensive
search
databases,
including
PubMed,
Google
Scholar
Web
Science,
according
Preferred
Reporting
Items
Systematic
Reviews
Meta-analysis
(PRISMA)
guidelines.
literature
initially
identified
242
studies.
Of
these,
214
were
excluded
after
reviewing
their
titles
abstracts.
We
then
conducted
full-text
25
studies,
which
17
met
our
inclusion
criteria
therefore
review.
analysis
studies
showed
high
upadacitinib,
both
clinical
signs
subjective
symptoms,
different
patient
populations,
those
resistant
other
treatments.
No
new
significant
concerns
have
emerged
as
compared
randomized
trials.
Drug Design Development and Therapy,
Год журнала:
2024,
Номер
Volume 18, С. 277 - 289
Опубликована: Фев. 1, 2024
Abstract:
Atopic
dermatitis
(AD)
is
the
most
common
inflammatory
skin
disease
in
children.
Children
with
severe
AD
have
a
multidimensional
burden
characterized
by
lesions,
itching,
frequent
infections,
sleep
deprivation,
and
high
rate
of
comorbidities.
These
impact
mental
health
overall
quality
life
not
only
children
but
also
their
parents
caregivers.
There
are
few
effective
available
treatment
options
for
young
that
suitable
long-term
use.
Due
to
adverse
effects,
practice
guidelines
consider
systemic
agents
inappropriate
this
age
group,
although
they
still
used
off-label
extreme
cases.
The
biologic
dupilumab
has
recently
been
approved
aged
6–
11
years
(EU)
moderate-to-severe
(USA)
AD,
offering
hope
population
patients
unmet
clinical
need.
purpose
review
describe
needs
prior
approval
summarize
existing
data
supporting
dupilumab's
safety
efficacy
these
Keywords:
atopic
dermatitis,
children,
dupilumab,
pediatric,
