Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
CCA Medical Research, Ajax, Ontario, Canada.
J Eur Acad Dermatol Venereol. 2023 Jun;37(6):1135-1148. doi: 10.1111/jdv.18922. Epub 2023 Feb 8.
With the increasing number of options for the treatment of moderate-to-severe atopic dermatitis, clinicians need guidance on a practical approach to selecting a systemic agent for specific patient populations. We convened an expert panel consisting of 12 members to conduct a literature review and summarize relevant data related to six scenarios of clinical interest: comorbid asthma, ocular surface disease, history of cancer, past and ongoing infections of interest (including herpes simplex virus, herpes zoster, hepatitis B, and tuberculosis), pregnancy and lactation, and the elderly. We performed a literature search and examined each clinical scenario with respect to three major categories of available systemic agents: traditional systemics (azathioprine, cyclosporine A, methotrexate, and mycophenolate mofetil), Janus kinase inhibitors (abrocitinib, baricitinib, and upadacitinib), and biologics (dupilumab, lebrikizumab, and tralokinumab). The expert panel and steering committee met virtually to review the data and discuss the drafted consensus statements. A modified Delphi process was used to arrive at a set of final consensus statements related to the systemic treatment of AD in these specific patient populations. To provide practical guidance on the choice of systemic therapy for atopic dermatitis in these six topics of clinical interest, 25 expert consensus statements and a summary of the supporting data are presented herein.
随着中重度特应性皮炎治疗选择的增多，临床医生需要指导，以便采用切实可行的方法为特定患者人群选择全身性药物。我们召集了一个由 12 名成员组成的专家小组，对与六个临床相关场景的文献进行了回顾，并总结了相关数据：合并哮喘、眼表疾病、癌症史、既往和正在发生的感染（包括单纯疱疹病毒、带状疱疹、乙型肝炎和结核病）、妊娠和哺乳期以及老年人。我们进行了文献检索，并根据三种可用全身性药物的主要类别对每种临床情况进行了检查：传统全身性药物（硫唑嘌呤、环孢素 A、甲氨蝶呤和霉酚酸酯）、Janus 激酶抑制剂（阿布昔替尼、巴瑞替尼和乌帕替尼）和生物制剂（度普利尤单抗、利匹鲁单抗和特利鲁单抗）。专家小组和指导委员会以虚拟方式开会审查数据并讨论起草的共识声明。采用改良 Delphi 流程，就这些特定患者人群中特应性皮炎的全身性治疗达成了一系列最终共识声明。为了在这六个临床关注的主题中提供关于特应性皮炎全身性治疗选择的实用指导，本文提出了 25 条专家共识声明和支持数据的摘要。
