Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK.
Research and Development, Barnsley Hospital NHS Foundation Trust, Barnsley, UK.
Clin Exp Dermatol. 2021 Oct;46(7):1211-1215. doi: 10.1111/ced.14775. Epub 2021 Aug 18.
This review forms part of a series of annual evidence updates on atopic eczema (AE), and provides a summary of key findings from systematic reviews (SRs) published or indexed in 2019 related to AE treatment. Several SRs assessed the efficacy of topical corticosteroids (TCS), topical calcineurin inhibitors, topical phosphodiesterase-4 inhibitors and topical Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway inhibitors. However, there is a lack of good-quality trials comparing topical treatment agents with TCS, which remain the standard of care for patients with AE. Most of the included trials lack meaningful comparisons as they used vehicle as a comparator. There is also lack of harmonization of outcome measures for AE across studies. Large, well-designed RCTs are needed to further determine whether any specific emollients offer superior benefit. There is evidence highlighting limited benefit of oral H1 antihistamines as 'add-on' therapy to topical treatment of eczema. Mycophenolate mofetil may have a role in patients with refractory AE. Among biologic therapies, most of the efficacy data relate to dupilumab. Furthermore, there is growing evidence for the efficacy and safety of systemic JAK/STAT pathway inhibitors, but the existing data are of low quality.
本综述是一系列特应性皮炎（AE）年度证据更新的一部分，总结了 2019 年发表或索引的与 AE 治疗相关的系统评价（SR）的关键发现。有几项 SR 评估了局部皮质类固醇（TCS）、局部钙调磷酸酶抑制剂、局部磷酸二酯酶-4 抑制剂和局部 Janus 激酶/信号转导和转录激活因子（JAK/STAT）通路抑制剂的疗效。然而，缺乏将局部治疗药物与 TCS 进行比较的高质量试验，TCS 仍然是 AE 患者的标准治疗方法。大多数纳入的试验缺乏有意义的比较，因为它们使用载体作为对照。AE 的研究之间也缺乏对结果测量的协调。需要进行大型、精心设计的 RCT 来进一步确定任何特定的保湿剂是否具有更好的益处。有证据表明，口服 H1 抗组胺药作为湿疹局部治疗的“附加”疗法的益处有限。霉酚酸酯可能对难治性 AE 患者有作用。在生物疗法中，大多数疗效数据与度普利尤单抗有关。此外，全身性 JAK/STAT 通路抑制剂的疗效和安全性也有越来越多的证据，但现有数据质量较低。
