Suga Hiraku, Sato Shinichi
Department of Dermatology, Faculty of Medicine, The University of Tokyo , Tokyo , Japan.
Immunol Med. 2019 Jun;42(2):84-93. doi: 10.1080/25785826.2019.1642727. Epub 2019 Jul 18.
Atopic dermatitis (AD) is the most common inflammatory skin disease driven by both terminal keratinocyte differentiation defects and type 2 immune responses, and this condition causes psychological and social morbidity. Although patients with severe AD require systemic immunotherapy, conventional agents including ciclosporin could not be used for several years due to side effects such as nephrotoxicity, hypertension and long-term risks of malignancy. It is well known that dupilumab, which blocks receptor binding of both IL-4 and IL-13, is remarkably efficacious in the treatment of AD. We have entered a new era when many novel topical and systemic agents that may have great potential in AD treatment are emerging through clinical trials. The purpose of this article is to summarize the efficacy and safety of the current topical and systemic therapies in AD by reviewing recently published papers regarding phase II/III clinical trials. It is revealed that topical phosphodiesterase 4 inhibitors and Janus kinase (JAK) inhibitors are promising treatments for AD. Moreover, systemic therapies such as biologics targeting IL-13 and oral JAK inhibitors show strong efficacy in AD.
特应性皮炎（AD）是最常见的炎症性皮肤病，由终末角质形成细胞分化缺陷和2型免疫反应共同驱动，这种疾病会导致心理和社会方面的发病情况。尽管重度AD患者需要全身免疫治疗，但包括环孢素在内的传统药物由于肾毒性、高血压等副作用以及长期的恶性肿瘤风险，多年来一直无法使用。众所周知，阻断IL-4和IL-13受体结合的度普利尤单抗在AD治疗中具有显著疗效。我们已经进入了一个新时代，许多可能在AD治疗中具有巨大潜力的新型局部和全身药物正在通过临床试验涌现出来。本文的目的是通过回顾最近发表的关于II/III期临床试验的论文，总结当前局部和全身疗法在AD中的疗效和安全性。结果表明，局部磷酸二酯酶4抑制剂和Janus激酶（JAK）抑制剂是AD的有前景的治疗方法。此外，针对IL-13的生物制剂和口服JAK抑制剂等全身疗法在AD中显示出强大的疗效。
