The evolving atopic dermatitis management landscape

ABSTRACT

Introduction

Atopic dermatitis is a common dermatologic condition that affects millions of people worldwide, and a standardized approach to treatment was published by the American Academy of Dermatology (AAD) in 2013–14. Since 2014, new FDA-approved treatment options such as dupilumab and crisaborole have changed the landscape of AD management, and future therapies such as JAK inhibitors and anti-interleukin 13 and 31 antibodies appear effective, emphasizing the need for a comprehensive review to give clinicians an updated toolbox to aid in pharmacologic management.

Areas Covered

In this review, the authors explore the updated efficacy and safety data on established therapeutic options for AD including topical corticosteroids, topical calcineurin inhibitors, cyclosporine, azathioprine, methotrexate, and mycophenolate mofetil. In addition, the authors also explore trial data and studies on dupilumab, crisaborole, omalizumab, tofacitinib, ruxolinitib, abrocitinib, baricitinib, upadacitinib, delgocitinib, nemoliuzumab, and tralokinumab.

Expert opinion

The AAD guidelines must be updated in the future to include several new treatment modalities that have revolutionized the pharmacologic management of patients with AD, including dupilumab and crisaborole. The future of AD treatment is also extremely bright, as JAK inhibitors and Il-13/31 antibodies have shown convincing results in the improvement of AD patients’ lives in various trials and studies that have been examined in this paper.

KEYWORDS:

• Atopic dermatitis
• eczema
• pharmacotherapy
• treatment
• dupilumab
• crisaborole
• omalizumab
• JAK inhibitor
• AAD guidelines
• update

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Correction

Article highlights box

• Since 2014, new FDA-approved treatment options such as dupilumab and crisaborole have changed the landscape of AD management, and future therapies such as JAK inhibitors and anti-interleukin 13 and 31 antibodies appear effective.

• TCS and TCI can be used in conjunction with each other for AD, and safety/efficacy has been demonstrated in multiple large trials across many years.

• Older systemic therapies that have been used off-label for AD include cyclosporine, azathioprine, methotrexate, mycophenolate mofetil, and IFN gamma. These therapies have varying efficacy and safety data, but unlike newer agents such as dupilumab, these systemic options listen in the 2013-2014 guidelines do not have large, double blind randomized control trials to support their use.

• Dupilumab is an antibody to the interleukin-4 alpha receptor, that can be used as a systemic agent for moderate-severe AD, with fewer side effects relative to other systemic therapy agents.

• Crisaborole is a topical PDE 4 inhibitor that can be used similarly to TCI’s as a steroid sparing agent for mild-moderate AD, or in conjunction with TCS.

• Omalizumab is a human monoclonal antibody to IgE that can be used for refractory cases of AD, as a third/fourth-line agent.

• Tofacitinib, Ruxolitinib, Abrocitinib, Baricitinib, Upadacitinib, and Delgocitinib have all shown promise as agents in the JAK inhibitor class, for treatment of AD.

• Nemolizumab and Tralokinumab are IL-31 and IL-13 antibody’s, respectively, that are in phase II and III trials with encouraging preliminary data for their potential use as targeted therapeutic options for AD.

Declaration of Interest

S Feldman has received research, speaking and/or consulting support from Eli Lilly and Company, GlaxoSmithKline/Stiefel, AbbVie, Janssen, Alovtech, vTv Therapeutics, Bristol-Myers Squibb, Samsung, Pfizer, Boehringer Ingelheim, Amgen Inc, Dermavant, Arcutis, Novartis, Novan, UCB, Helsinn, Sun Pharma, Almirall, Galderma, Leo Pharma, Mylan, Celgene, Valeant, Menlo, Merck & Co, Qurient Forte, Arena, Biocon, Accordant, Argenx, Sanofi, Regeneron, the National Biological Corporation, Caremark, Advance Medical, Suncare Research, Informa, UpToDate and the National Psoriasis Foundation. He is also the founder and majority owner of www.DrScore.com and founder and part owner of Causa Research. Meanwhile, L Strowd has received research support, speaking fees and/or consulting support from AbbVie, Pfizer, Sanofi, Regeneron, Galderma and Novartis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This manuscript was not funded.