a National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology , University Medical Center Utrecht , Utrecht , The Netherlands.
Expert Opin Biol Ther. 2019 May;19(5):469-476. doi: 10.1080/14712598.2019.1583204. Epub 2019 Feb 26.
For many years, oral immunosuppressive drugs such as cyclosporine A, azathioprine, mycophenolic acid, and methotrexate were the only treatment options, in addition to topical treatment, in patients with severe atopic dermatitis (AD). Dupilumab, a monoclonal antibody targeting the IL-4 receptor alpha, is the first antibody-based treatment commercially available for the treatment of AD. In the near future, more antibody-based treatments and small molecules will become available in the treatment of severe AD.
This review gives an overview of current and future therapies for severe AD, outlines options to optimize treatment with oral immunosuppressive drugs and gives an insight into the future of personalized treatment in AD.
Due to the heterogeneous character of AD, it is unlikely that all patients will respond equally to these newly tested drugs. We believe that biomarkers will lead to better identification of patients that will benefit from these highly specific, but expensive new treatments. In addition to a role for biomarkers in new treatments, the use of pharmacogenomic biomarkers can improve the efficacy of currently used oral immunosuppressive drugs in AD, which will still be needed for the treatment of moderate to severe AD in the coming years.
多年来，除了局部治疗外，环孢素 A、硫唑嘌呤、霉酚酸酯和甲氨蝶呤等口服免疫抑制剂是重度特应性皮炎（AD）患者的唯一治疗选择。靶向 IL-4 受体α的单克隆抗体度普利尤单抗是首个可用于治疗 AD 的基于抗体的治疗药物。在不久的将来，更多的基于抗体的治疗药物和小分子药物将可用于治疗重度 AD。
本综述概述了目前和未来用于重度 AD 的治疗方法，概述了优化口服免疫抑制剂治疗的选择，并探讨了 AD 个体化治疗的未来。
由于 AD 的异质性，并非所有患者对这些新测试的药物都会有同等的反应。我们相信，生物标志物将有助于更好地识别那些将从这些高度特异性但昂贵的新疗法中获益的患者。除了生物标志物在新疗法中的作用外，药物基因组学生物标志物的使用可以提高 AD 中目前使用的口服免疫抑制剂的疗效，这些药物在未来几年仍将用于治疗中重度 AD。
