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Ferrara F, Zovi A, Capuozzo M, Langella R. Atopic dermatitis: treatment and innovations in immunotherapy. Inflammopharmacology 2024; 32:1777-1789. [PMID: 38581639 DOI: 10.1007/s10787-024-01453-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/25/2024] [Indexed: 04/08/2024]
Abstract
Atopic dermatitis (AD) is a common inflammatory skin disease characterized by itching and skin barrier dysfunction. Moderate to severe AD is often refractory to first-line topical treatments, and systemic immunosuppressants have been shown to be effective but have significant adverse effects. The paucity of basic treatments has contributed to the development of targeted topical and systemic immunotherapies based on the use of small molecules and biologic drugs which can directly interact with AD pathogenetic pathways. They represent a new era of therapeutic innovation. Additional new treatments are desirable since AD is a heterogeneous disease marked by different immunological phenotypes. This manuscript will review the mechanism of action, safety profile, and efficacy of promising new systemic immunological treatments for AD. Since moderate to severe AD can result in poor quality of life, the development of targeted and well-tolerated immunomodulators is a crucial purpose. The introduction of new pharmacological agents may offer new therapeutic options. However, there is the need to evaluate how "narrow-acting" agents, such as individual interleukin inhibitors, will perform under the safety and efficacy profiles compared with "broad-acting" agents, such as JAK inhibitors.
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Affiliation(s)
- Francesco Ferrara
- Pharmaceutical Department, Asl Napoli 3 Sud, Dell'Amicizia Street, 22, 80035, Nola, Naples, Italy
| | - Andrea Zovi
- Ministry of Health, Viale Giorgio Ribotta, 5, 00144, Rome, Italy.
| | - Maurizio Capuozzo
- Pharmaceutical Department, Asl Napoli 3 Sud, Marittima Street, 3, 80056, Ercolano, Naples, Italy
| | - Roberto Langella
- Italian Society of Hospital Pharmacy (SIFO), SIFO Secretariat of the Lombardy Region, Via Carlo Farini, 81, 20159, Milan, Italy
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Yang DY, Jing WW, Liu X, Li L, Lu T, Li XL. Pruritus Anesis in Dystrophic Epidermolysis Bullosa Pruriginosa with Dupilumab. Adv Skin Wound Care 2024; 37:1-4. [PMID: 38241457 DOI: 10.1097/asw.0000000000000096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
ABSTRACT Dystrophic epidermolysis bullosa pruriginosa (DEB-Pr) is a rare subtype of dystrophic epidermolysis bullosa, and traditional treatments have limited efficacy. Dupilumab has demonstrated remarkable efficacy in relieving pruritus. In this case study, after traditional treatment failed, providers recommended the patient begin dupilumab to treat his pruritus. The patient was administrated a loading dose of 600 mg of dupilumab and a dose of 300 mg every 2 weeks. The Dermatology Life Quality Index and Pruritic Numeric Rating Scale were used to assess the patient's situation. After several months, the patient's DEB-Pr was considered in remission. Dupilumab may be a better choice than immunosuppressants for the treatment of pruritus in patients with DEB-Pr.
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Affiliation(s)
- Dan-Yang Yang
- At the Xi'an Jiaotong University and Second Affiliated Hospital, Shaanxi, China, Dan-Yang Yang, MM, Wen-Wen Jing, BM, and Xin Liu, BM, are Medical Students; Li Li, MM, and Tao Lu, MM, are Doctors; and Xiao-Li Li, PhD, is Associate Professor
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Jesenak M, Diamant Z, Simon D, Tufvesson E, Seys SF, Mukherjee M, Lacy P, Vijverberg S, Slisz T, Sediva A, Simon HU, Striz I, Plevkova J, Schwarze J, Kosturiak R, Alexis NE, Untersmayr E, Vasakova MK, Knol E, Koenderman L. Eosinophils-from cradle to grave: An EAACI task force paper on new molecular insights and clinical functions of eosinophils and the clinical effects of targeted eosinophil depletion. Allergy 2023; 78:3077-3102. [PMID: 37702095 DOI: 10.1111/all.15884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/21/2023] [Accepted: 08/27/2023] [Indexed: 09/14/2023]
Abstract
Over the past years, eosinophils have become a focus of scientific interest, especially in the context of their recently uncovered functions (e.g. antiviral, anti-inflammatory, regulatory). These versatile cells display both beneficial and detrimental activities under various physiological and pathological conditions. Eosinophils are involved in the pathogenesis of many diseases which can be classified into primary (clonal) and secondary (reactive) disorders and idiopathic (hyper)eosinophilic syndromes. Depending on the biological specimen, the eosinophil count in different body compartments may serve as a biomarker reflecting the underlying pathophysiology and/or activity of distinct diseases and as a therapy-driving (predictive) and monitoring tool. Personalized selection of an appropriate therapeutic strategy directly or indirectly targeting the increased number and/or activity of eosinophils should be based on the understanding of eosinophil homeostasis including their interactions with other immune and non-immune cells within different body compartments. Hence, restoring as well as maintaining homeostasis within an individual's eosinophil pool is a goal of both specific and non-specific eosinophil-targeting therapies. Despite the overall favourable safety profile of the currently available anti-eosinophil biologics, the effect of eosinophil depletion should be monitored from the perspective of possible unwanted consequences.
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Affiliation(s)
- Milos Jesenak
- Department of Clinical Immunology and Allergology, University Teaching Hospital in Martin, Martin, Slovak Republic
- Department of Paediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovak Republic
- Department of Pulmonology and Phthisiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovak Republic
| | - Zuzana Diamant
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
- Department Microbiology Immunology & Transplantation, KU Leuven, Catholic University of Leuven, Leuven, Belgium
- Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Dagmar Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ellen Tufvesson
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
| | - Sven F Seys
- Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Manali Mukherjee
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- The Firestone Institute for Respiratory Health, Research Institute of St. Joe's Hamilton, Hamilton, Ontario, Canada
| | - Paige Lacy
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Susanne Vijverberg
- Amsterdam UMC Location University of Amsterdam, Pulmonary Diseases, Amsterdam, The Netherlands
| | - Tomas Slisz
- Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Anna Sediva
- Department of Immunology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Hans-Uwe Simon
- Institute of Pharmacology, University of Bern, Bern, Switzerland
- Institute of Biochemistry, Brandenburg Medical School, Neuruppin, Germany
| | - Ilja Striz
- Department of Clinical and Transplant Immunology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jana Plevkova
- Department of Pathophysiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Jurgen Schwarze
- Child Life and Health and Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Radovan Kosturiak
- Department of Paediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovak Republic
- Outpatient Clinic for Clinical Immunology and Allergology, Nitra, Slovak Republic
| | - Neil E Alexis
- Center for Environmental Medicine, Asthma and Lung Biology, Department of Paediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Eva Untersmayr
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Martina Koziar Vasakova
- Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Edward Knol
- Department Center of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Leo Koenderman
- Department Center of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department Pulmonary Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
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Drucker AM, Bai L, Eder L, Chan AW, Pope E, Tu K, Jaakkimainen L. Sociodemographic characteristics and emergency department visits and inpatient hospitalizations for atopic dermatitis in Ontario: a cross-sectional study. CMAJ Open 2022; 10:E491-E499. [PMID: 35672041 PMCID: PMC9177197 DOI: 10.9778/cmajo.20210194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Some jurisdictions experience sociodemographic disparities in atopic dermatitis care, including emergency department visits, but data from Canada are limited. Our objectives were to estimate the prevalence of atopic dermatitis in Ontario and to identify sociodemographic factors associated with emergency department visits and hospitalizations for this condition. METHODS We conducted a cross-sectional analysis of patients in the Electronic Medical Record Primary Care database linked with administrative health data for Ontario, Canada. We estimated period prevalence and health service utilization for atopic dermatitis from 2005 to 2015. We used multivariable log-binomial regression to calculate adjusted risk ratios (RRs) and 95% confidence intervals (CIs) for associations between local dermatologist density and the proportion of emergency department visits and hospitalizations for atopic dermatitis. RESULTS Among 249 984 patients, we identified 7812 with atopic dermatitis (period prevalence 2005-2015: 3.1%). Almost all physician visits for atopic dermatitis were to primary care physicians (> 99%). For every additional dermatologist per 100 000 population, the proportions of emergency department visits and hospitalizations for atopic dermatitis increased by 29% (RR 1.29, 95% CI 1.05-1.57). This relationship occurred in and around Toronto but was not consistent across the province. INTERPRETATION In Ontario, higher dermatologist density was not associated with lower emergency department utilization and hospitalization for atopic dermatitis; the association varied in different locales with similar dermatologist densities. Strategies to improve access to care for atopic dermatitis should be tailored to local contexts.
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Affiliation(s)
- Aaron M Drucker
- Department of Medicine (Drucker, Eder, Chan), University of Toronto; Women's College Research Institute (Drucker, Eder, Chan), Women's College Hospital; ICES Central (Drucker, Bai, Chan, Jaakkimainen); Department of Pediatrics (Pope), University of Toronto; Section of Pediatric Dermatology (Pope), Department of Pediatrics, Hospital for Sick Children; North York General Hospital (Tu), Toronto Western Hospital Family Health Team (Tu), University Health Network; Department of Family and Community Medicine (Tu, Jaakkimainen), University of Toronto; Sunnybrook Health Sciences Centre (Jaakkimainen), Toronto, Ont.
| | - Li Bai
- Department of Medicine (Drucker, Eder, Chan), University of Toronto; Women's College Research Institute (Drucker, Eder, Chan), Women's College Hospital; ICES Central (Drucker, Bai, Chan, Jaakkimainen); Department of Pediatrics (Pope), University of Toronto; Section of Pediatric Dermatology (Pope), Department of Pediatrics, Hospital for Sick Children; North York General Hospital (Tu), Toronto Western Hospital Family Health Team (Tu), University Health Network; Department of Family and Community Medicine (Tu, Jaakkimainen), University of Toronto; Sunnybrook Health Sciences Centre (Jaakkimainen), Toronto, Ont
| | - Lihi Eder
- Department of Medicine (Drucker, Eder, Chan), University of Toronto; Women's College Research Institute (Drucker, Eder, Chan), Women's College Hospital; ICES Central (Drucker, Bai, Chan, Jaakkimainen); Department of Pediatrics (Pope), University of Toronto; Section of Pediatric Dermatology (Pope), Department of Pediatrics, Hospital for Sick Children; North York General Hospital (Tu), Toronto Western Hospital Family Health Team (Tu), University Health Network; Department of Family and Community Medicine (Tu, Jaakkimainen), University of Toronto; Sunnybrook Health Sciences Centre (Jaakkimainen), Toronto, Ont
| | - An-Wen Chan
- Department of Medicine (Drucker, Eder, Chan), University of Toronto; Women's College Research Institute (Drucker, Eder, Chan), Women's College Hospital; ICES Central (Drucker, Bai, Chan, Jaakkimainen); Department of Pediatrics (Pope), University of Toronto; Section of Pediatric Dermatology (Pope), Department of Pediatrics, Hospital for Sick Children; North York General Hospital (Tu), Toronto Western Hospital Family Health Team (Tu), University Health Network; Department of Family and Community Medicine (Tu, Jaakkimainen), University of Toronto; Sunnybrook Health Sciences Centre (Jaakkimainen), Toronto, Ont
| | - Elena Pope
- Department of Medicine (Drucker, Eder, Chan), University of Toronto; Women's College Research Institute (Drucker, Eder, Chan), Women's College Hospital; ICES Central (Drucker, Bai, Chan, Jaakkimainen); Department of Pediatrics (Pope), University of Toronto; Section of Pediatric Dermatology (Pope), Department of Pediatrics, Hospital for Sick Children; North York General Hospital (Tu), Toronto Western Hospital Family Health Team (Tu), University Health Network; Department of Family and Community Medicine (Tu, Jaakkimainen), University of Toronto; Sunnybrook Health Sciences Centre (Jaakkimainen), Toronto, Ont
| | - Karen Tu
- Department of Medicine (Drucker, Eder, Chan), University of Toronto; Women's College Research Institute (Drucker, Eder, Chan), Women's College Hospital; ICES Central (Drucker, Bai, Chan, Jaakkimainen); Department of Pediatrics (Pope), University of Toronto; Section of Pediatric Dermatology (Pope), Department of Pediatrics, Hospital for Sick Children; North York General Hospital (Tu), Toronto Western Hospital Family Health Team (Tu), University Health Network; Department of Family and Community Medicine (Tu, Jaakkimainen), University of Toronto; Sunnybrook Health Sciences Centre (Jaakkimainen), Toronto, Ont
| | - Liisa Jaakkimainen
- Department of Medicine (Drucker, Eder, Chan), University of Toronto; Women's College Research Institute (Drucker, Eder, Chan), Women's College Hospital; ICES Central (Drucker, Bai, Chan, Jaakkimainen); Department of Pediatrics (Pope), University of Toronto; Section of Pediatric Dermatology (Pope), Department of Pediatrics, Hospital for Sick Children; North York General Hospital (Tu), Toronto Western Hospital Family Health Team (Tu), University Health Network; Department of Family and Community Medicine (Tu, Jaakkimainen), University of Toronto; Sunnybrook Health Sciences Centre (Jaakkimainen), Toronto, Ont
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