Lugović-Mihić Liborija, Barac Ema, Tomašević Renata, Parać Ena, Zanze Lucija, Ljevar Ana, Dolački Lorena, Štrajtenberger Maja
Department of Dermatovenereology, University Hospital Center Sestre Milosrdnice, 10000 Zagreb, Croatia.
School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia.
Pharmaceuticals (Basel). 2024 Oct 30;17(11):1455. doi: 10.3390/ph17111455.
: Atopic dermatitis (AD) impacts various aspects of patients' lives including personal life, psychological aspects/disturbances (e.g., depression, anxiety, or even suicidal thoughts), school, and work-related activities, including career advancement. The aim of this narrative review is to present the latest information available on how to best approach AD patient management, as well as decisions regarding standard/advanced systemic therapy, by gathering evidence from the relevant medical literature (PubMed and other prominent medical databases). : Thus, AD patient management and decisions regarding advanced/systemic therapy are complex, requiring the consideration of multiple disease-related factors: age; disease severity; patient medical history and comorbidities; previous topical therapy use and any adverse reactions; treatment efficacy concerns; patient preferences, expectations and fears; pregnancy planning; ability and willingness to adhere to the treatment regimen; impact on related risks; and any associated psychological or psychiatric issues. Current guidelines and systematic reviews support the safety and efficacy of systemic therapy including conventional drugs (cyclosporine, methotrexate, and azathioprine), biologics (dupilumab and tralokinumab), and JAK inhibitors (baricitinib, upadacitinib, and abrocitinib) recommended for treating moderate and severe AD. Recently, additional biologics have been evaluated in clinical trials, including lebrikizumab, nemolizumab, eblasakimab, and OX40/OX40L, among others. : The most recently suggested approach to treating AD patients suggests focusing on therapy that targets and achieves minimal disease activity (MDA), where therapy decisions are informed by both the patient and the clinician. Available data also indicate the importance of a personalized, stepwise, and multidisciplinary approach. This type of approach promotes patient compliance, satisfaction with therapy, and increased engagement, which all lead to better patient outcomes.
特应性皮炎（AD）会影响患者生活的各个方面，包括个人生活、心理层面/障碍（如抑郁、焦虑，甚至自杀念头）、学业以及与工作相关的活动，包括职业发展。本叙述性综述的目的是通过从相关医学文献（PubMed和其他著名医学数据库）中收集证据，呈现关于如何最佳管理AD患者以及有关标准/高级全身治疗决策的最新信息。因此，AD患者的管理以及有关高级/全身治疗的决策很复杂，需要考虑多种与疾病相关的因素：年龄；疾病严重程度；患者病史和合并症；既往局部治疗的使用情况及任何不良反应；对治疗疗效的关注；患者的偏好、期望和恐惧；妊娠计划；坚持治疗方案的能力和意愿；对相关风险的影响；以及任何相关的心理或精神问题。当前的指南和系统评价支持全身治疗的安全性和有效性，包括推荐用于治疗中度和重度AD的传统药物（环孢素、甲氨蝶呤和硫唑嘌呤）、生物制剂（度普利尤单抗和曲洛珠单抗）以及JAK抑制剂（巴瑞替尼、乌帕替尼和阿布昔替尼）。最近，其他生物制剂已在临床试验中进行了评估，包括乐必妥珠单抗、奈莫利单抗、依布拉西单抗和OX40/OX40L等。最近建议的治疗AD患者的方法是专注于靶向并实现最小疾病活动度（MDA）的治疗，治疗决策由患者和临床医生共同做出。现有数据还表明个性化、逐步和多学科方法的重要性。这种方法可提高患者的依从性、对治疗的满意度并增强参与度，所有这些都能带来更好的患者治疗效果。
