Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina.
J Am Acad Dermatol. 2019 Feb;80(2):411-416.e4. doi: 10.1016/j.jaad.2018.09.053. Epub 2018 Oct 6.
Systemic medications are often required for severe atopic dermatitis (AD) refractory to topical therapies. Biologic medications are a recent advancement in the field and a comparison with standard systemic approaches would be beneficial.
To compare efficacies of systemic therapies for the treatment of AD.
A systematic literature review was performed using Medline, Ovid, and Embase. Randomized controlled trials looking at the efficacy of systemic treatments for AD in adults and children were included.
A total of 41 studies met criteria and were included in our final analysis. Consistent improvements in Eczema Area and Severity Index and Scoring Atopic Dermatitis were reported with dupilumab and cyclosporine. Phase 2 clinical trials for lebrikizumab and tralokinumab were effective and would benefit from phase 3 trials. No study reported efficacy of biologic medications in pediatric patients; however, cyclosporine improved clinical severity by the greatest amount in this group.
A lack of well controlled comparison studies make direct comparisons between the treatments difficult.
For treatment of severe AD, the strongest evidence currently exists for dupilumab and cyclosporine at improving clinical disease severity. Further research is required to determine long-term safety and efficacy of biologic medications.
对于外用疗法难治的重度特应性皮炎（AD），常需要全身用药物治疗。生物制剂是该领域的最新进展，如果能与标准全身治疗方法进行比较将很有益处。
比较全身治疗 AD 的疗效。
采用 Medline、Ovid 和 Embase 进行系统文献检索。纳入评估成人和儿童 AD 全身治疗疗效的随机对照试验。
共有 41 项研究符合标准并纳入最终分析。度普利尤单抗和环孢素可显著改善 Eczema Area and Severity Index 和 Scoring Atopic Dermatitis。Lebrikizumab 和 tralokinumab 的 2 期临床试验有效，需要开展 3 期临床试验。尚无研究报告生物制剂在儿科患者中的疗效，但环孢素在该组中对临床严重程度的改善最大。
缺乏良好对照的比较研究，使得治疗之间的直接比较变得困难。
对于重度 AD 的治疗，目前改善临床疾病严重程度的最强证据是度普利尤单抗和环孢素。需要进一步研究来确定生物制剂的长期安全性和疗效。
