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Rademaker M, Agnew K, Andrews M, Baker C, Foley P, Gebauer K, Gupta M, Rubel DM, Somerville C, Sullivan J, Wong LC. Managing atopic dermatitis with systemic therapies in adults and adolescents: An Australian/New Zealand narrative. Australas J Dermatol 2019; 61:9-22. [PMID: 31529493 DOI: 10.1111/ajd.13141] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/28/2019] [Indexed: 12/29/2022]
Abstract
With the rapid development of new, targeted therapies for the treatment of moderate/severe atopic dermatitis, it is opportune to review the available conventional systemic agents. We assess the published evidence for systemic therapies for atopic dermatitis and amalgamate this with real-world experience. Discussions are centred on when systemic therapy should be considered, which drug(s), what dose, how to sequence or combine these therapies, how long they should be continued for and what is considered success.
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Affiliation(s)
- Marius Rademaker
- Waikato Clinical Campus, University of Auckland's Faculty of Medical and Health Sciences, Hamilton, New Zealand
| | - Karen Agnew
- Dermatology Department, Greenlane Clinical Centre, Auckland, New Zealand.,Starship Children's Hospital, Auckland, New Zealand
| | | | - Christopher Baker
- St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Skin & Cancer Foundation Inc., Carlton, Victoria, Australia
| | - Peter Foley
- St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Skin & Cancer Foundation Inc., Carlton, Victoria, Australia
| | - Kurt Gebauer
- University of Western Australia, Perth, Western Australia, Australia.,Probity Medical Research, Freemantle, Western Australia, Australia
| | - Monisha Gupta
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia.,The Skin Hospital, Darlinghurst, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Diana M Rubel
- Woden Dermatology, Phillip, Australian Capital Territory, Australia.,Australian National University, Canberra, Australian Capital Territory, Australia
| | - Colin Somerville
- The Allergy West Clinic - Immunology, Perth, Western Australia, Australia
| | - John Sullivan
- Kingsway Dermatology, Miranda, New South Wales, Australia
| | - Li-Chuen Wong
- The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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van der Schaft J, Thijs JL, Garritsen FM, Balak D, de Bruin-Weller MS. Towards personalized treatment in atopic dermatitis. Expert Opin Biol Ther 2019; 19:469-476. [PMID: 30768375 DOI: 10.1080/14712598.2019.1583204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION For many years, oral immunosuppressive drugs such as cyclosporine A, azathioprine, mycophenolic acid, and methotrexate were the only treatment options, in addition to topical treatment, in patients with severe atopic dermatitis (AD). Dupilumab, a monoclonal antibody targeting the IL-4 receptor alpha, is the first antibody-based treatment commercially available for the treatment of AD. In the near future, more antibody-based treatments and small molecules will become available in the treatment of severe AD. AREAS COVERED This review gives an overview of current and future therapies for severe AD, outlines options to optimize treatment with oral immunosuppressive drugs and gives an insight into the future of personalized treatment in AD. EXPERT OPINION Due to the heterogeneous character of AD, it is unlikely that all patients will respond equally to these newly tested drugs. We believe that biomarkers will lead to better identification of patients that will benefit from these highly specific, but expensive new treatments. In addition to a role for biomarkers in new treatments, the use of pharmacogenomic biomarkers can improve the efficacy of currently used oral immunosuppressive drugs in AD, which will still be needed for the treatment of moderate to severe AD in the coming years.
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Affiliation(s)
- Jorien van der Schaft
- a National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Judith L Thijs
- a National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Floor M Garritsen
- a National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - D Balak
- a National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Marjolein S de Bruin-Weller
- a National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology , University Medical Center Utrecht , Utrecht , The Netherlands
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Thijs JL, de Bruin-Weller MS, Hijnen D. Current and Future Biomarkers in Atopic Dermatitis. Immunol Allergy Clin North Am 2017; 37:51-61. [DOI: 10.1016/j.iac.2016.08.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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