Department of Dermatology and Allergology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands.
Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, the Netherlands.
J Dermatolog Treat. 2023 Dec;34(1):2254567. doi: 10.1080/09546634.2023.2254567.
Biologicals are becoming increasingly important in the therapeutic landscape of pediatric patients with moderate-to-severe atopic dermatitis (AD). Currently, dupilumab and tralokinumab are registered for the treatment of moderate-to-severe AD, and novel biologicals are expected to follow. Dupilumab was the first biological registered for AD in pediatric patients and was recently approved for patients aged six months to five years. Current and emerging biologicals may address the unmet need for effective and safe treatment options for pediatric AD patients, however, little is known about the practical implementation of biologicals in infants and preschoolers (aged <6 years), including the timing of treatment initiation, discontinuation, and long-term administration of the subcutaneous injections. Currently, only a small number of biologicals are approved for the treatment of infants and preschoolers for other inflammatory diseases. Consequently, data on the practical implementation of biological treatment remain scarce. In addition, long-term effects, impact on co-morbidities, and impact on live-accentuated vaccination are still unknown. With the introduction of biologicals for AD from the age of six months, potential challenges within the implementation of biologicals may arise. Therefore, we aim to discuss current practical challenges and knowledge gaps of the treatment with biologicals in infants and preschoolers with AD.
生物制剂在中重度特应性皮炎（AD）患儿的治疗领域中变得越来越重要。目前，度普利尤单抗和特利鲁单抗已注册用于治疗中重度 AD，预计还会有新的生物制剂上市。度普利尤单抗是首个在儿科患者中注册用于 AD 的生物制剂，最近已批准用于 6 个月至 5 岁的患者。目前和新出现的生物制剂可能满足儿科 AD 患者对有效和安全治疗方案的未满足需求，然而，对于婴儿和学龄前儿童（<6 岁）中生物制剂的实际应用，包括治疗起始、停药和皮下注射的长期给药，人们知之甚少。目前，只有少数生物制剂被批准用于治疗其他炎症性疾病的婴儿和学龄前儿童。因此，关于生物治疗实际应用的数据仍然很少。此外，长期效果、对合并症的影响以及对活疫苗接种的影响仍不清楚。随着生物制剂在 6 个月大时用于 AD，生物制剂实施过程中可能会出现潜在挑战。因此，我们旨在讨论 AD 婴儿和学龄前儿童生物治疗的当前实际挑战和知识空白。
