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Relative efficacy of systemic treatments for atopic dermatitis
Journal of the American Academy of Dermatology ( IF 13.8 ) Pub Date : 2018-10-06 , DOI: 10.1016/j.jaad.2018.09.053
Edward W. Seger , Todd Wechter , Lindsay Strowd , Steven R. Feldman

Background

Systemic medications are often required for severe atopic dermatitis (AD) refractory to topical therapies. Biologic medications are a recent advancement in the field and a comparison with standard systemic approaches would be beneficial.

Objective

To compare efficacies of systemic therapies for the treatment of AD.

Methods

A systematic literature review was performed using Medline, Ovid, and Embase. Randomized controlled trials looking at the efficacy of systemic treatments for AD in adults and children were included.

Results

A total of 41 studies met criteria and were included in our final analysis. Consistent improvements in Eczema Area and Severity Index and Scoring Atopic Dermatitis were reported with dupilumab and cyclosporine. Phase 2 clinical trials for lebrikizumab and tralokinumab were effective and would benefit from phase 3 trials. No study reported efficacy of biologic medications in pediatric patients; however, cyclosporine improved clinical severity by the greatest amount in this group.

Limitations

A lack of well controlled comparison studies make direct comparisons between the treatments difficult.

Conclusion

For treatment of severe AD, the strongest evidence currently exists for dupilumab and cyclosporine at improving clinical disease severity. Further research is required to determine long-term safety and efficacy of biologic medications.



中文翻译:

全身治疗特应性皮炎的相对疗效

背景

对于局部治疗难以治疗的严重特应性皮炎(AD),通常需要使用全身性药物。生物药物是该领域的最新进展,与标准全身治疗方法进行比较将是有益的。

客观的

比较全身疗法治疗AD的疗效。

方法

使用Medline,Ovid和Embase进行了系统的文献综述。随机对照试验研究了成人和儿童对AD全身治疗的疗效。

结果

共有41项研究符合标准,并纳入了我们的最终分析。据报道,使用dupilumab和环孢霉素在湿疹面积和严重程度指数以及异位性皮炎评分方面均得到了持续改善。lebrikizumab和tralokinumab的2期临床试验是有效的,并且将从3期试验中受益。尚无研究报道生物药物治疗儿科患者的疗效。然而,环孢素在这一组中最大程度地改善了临床严重性。

局限性

缺乏良好对照的比较研究使治疗之间的直接比较变得困难。

结论

对于重度AD的治疗,目前有最强有力的证据表明dupilumab和环孢菌素可以改善临床疾病的严重程度。需要进一步的研究以确定生物药物的长期安全性和有效性。

更新日期:2018-10-06
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