the duration and age of onset of the essential and important features.
Subsequent treatment following a diagnosis of AD is reliant on treatment guidelines that reflect current knowledge. It is imperative, therefore, that AD treatment guidelines are updated regularly to reflect more accurately the risk–benefit profiles of systemic immunomodulators and to include newer treatment alternatives, particularly for moderate-to-severe AD cases. The advent of monoclonal antibodies aimed at targeting all aspects of the atopic disease spectrum may require us to revisit treatment algorithms, the implications of which would be far reaching, both for pharmaceutical drug development and in the establishment of guidelines for insurance-based drug formularies.
Subsequent treatment following a diagnosis of AD is reliant on treatment guidelines that reflect current knowledge. It is imperative, therefore, that AD treatment guidelines are updated regularly to reflect more accurately the risk–benefit profiles of systemic immunomodulators and to include newer treatment alternatives, particularly for moderate-to-severe AD cases. The advent of monoclonal antibodies aimed at targeting all aspects of the atopic disease spectrum may require us to revisit treatment algorithms, the implications of which would be far reaching, both for pharmaceutical drug development and in the establishment of guidelines for insurance-based drug formularies.
DISCLOSURES
Matthew Reynolds is a medical advisor and speaker for Sanofi-
Regeneron; medical advisor for AbbVie Inc. and Eli Lilly and
Company. Matthew Bruno is a medical advisor for AbbVie Inc.,
Dermira, Mayne Pharma, and PharmaDerm; and speaker and
medical advisor for Almirall, S.A., Pfizer Inc., and Sun Pharmaceutical
Industries Ltd. Joe Gorelick is a consultant, advisor, and
speaker for AbbVie Inc., Beiersdorf, Celgene Corporation, Dermira,
Eli Lilly and Company, Encore Dermatology Inc., Foamix
Pharmaceuticals Ltd., LEO Pharma, Mayne Pharma, Novartis
Pharmaceuticals, Ortho Dermatologics Inc., Primus Pharmaceuticals,
PruGen Pharmaceuticals, Regeneron Pharmaceuticals,
Inc., Sanofi-Genzyme, Sun Pharmaceutical Industries Ltd., and
UCB S.A.
REFERENCES
1. Weidinger S, Novak N. Atopic dermatitis. Lancet. 2016;387:1109-1122.
2. Yew YW, Thyssen JP, Silverberg JI. A systematic review and meta-analysis of the regional and age-related differences in atopic dermatitis clinical characteristics. J Am Acad Dermatol. 2019;80:390-401.
3. Chiesa Fuxench ZC, Block JK, Boguniewicz M, et al. Atopic dermatitis in America study: a cross-sectional study examining the prevalence and disease burden of atopic dermatitis in the US adult population. J Invest Dermatol. 2019;139:583-590.
4. Silverberg J, Wollenberg A, Egeberg A, et al. Worldwide prevalence and severity of atopic dermatitis: results from a global epidemiology survey. Abstract presented at: European Academy of Dermatology and Venereology Annual Meeting; Paris, France; September 12-16, 2018. Abstract 1710.
5. Eichenfield LF, Tom WL, Chamlin SL, et al. Guidelines of care for the management of atopic dermatitis: Section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014;70:338-351.
6. Pugliarello S, Cozzi A, Gisondi P, Girolomoni G. Phenotypes of atopic dermatitis. J Dtsch Dermatol Ges. 2011;9:12-20.
7. Silverberg JI, Vakharia PP, Chopra R, et al. Phenotypical differences of childhood- and adult-onset atopic dermatitis. J Allergy Clin Immunol Pract. 2018;6:1306-1312.
8. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol. 1980;92:44-47.
9. Brenninkmeijer EE, Schram ME, Leeflang MM, et al. Diagnostic criteria for atopic dermatitis: a systematic review. Br J Dermatol. 2008;158:754-765.
10. Mevorah B, Frenk E, Wietlisbach V, Carrel CF. Minor clinical features of atopic dermatitis. Evaluation of their diagnostic significance. Dermatologica. 1988;177:360-364.
11. Rudzki E, Samochocki Z, Rebandel P, et al. Frequency and significance of the major and minor features of Hanifin and Rajka among patients with atopic dermatitis. Dermatology. 1994;189:41-46.
12. Williams HC, Burney PG, Hay RJ, et al. The U.K. Working Party's diagnostic criteria for atopic dermatitis. I. Derivation of a minimum set of discriminators for atopic dermatitis. Br J Dermatol. 1994;131:383-396.
13. Williams HC, Burney PG, Strachan D, Hay RJ. The U.K. Working Party's diagnostic criteria for atopic dermatitis. II. Observer variation of clinical diagnosis and signs of atopic dermatitis. Br J Dermatol. 1994;131:397-405.
14. Williams HC, Burney PG, Pembroke AC, Hay RJ. The U.K. Working Party's diagnostic criteria for atopic dermatitis. III. Independent hospital validation. Br J Dermatol. 1994;131:406-416.
15. Bos JD, Van Leent EJ, Sillevis Smitt JH. The millennium criteria for the diagnosis of atopic dermatitis. Exp Dermatol. 1998;7:132-138. 16. Schram ME, Leeflang MM, DEN Ottolander JP, et al. Validation and refinement of the millennium criteria for atopic dermatitis. J Dermatol. 2011;38:850-858.
17. Eichenfield LF, Tom WL, Berger TG, et al. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014;71:116-132.
18. Sidbury R, Davis DM, Cohen DE, et al. Guidelines of care for the management of atopic dermatitis: Section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol. 2014;71:327-349.
19. Eichenfield LF, Ahluwalia J, Waldman A, et al. Current guidelines for the evaluation and management of atopic dermatitis: a comparison of the Joint Task Force Practice Parameter and American Academy of Dermatology guidelines. J Allergy Clin Immunol. 2017;139:S49-S57.
20. Boguniewicz M, Alexis AF, Beck LA, et al. Expert perspectives on management of moderate-to-severe atopic dermatitis: a multidisciplinary consensus addressing current and emerging therapies. J Allergy Clin Immunol Pract. 2017;5:1519-1531.
21. Megna M, Napolitano M, Patruno C, et al. Systemic treatment of adult atopic dermatitis: a review. Dermatol Ther (Heidelb). 2017;7:1-23.
22. Wollenberg A, Barbarot S, Bieber T, et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: Part II. J Eur Acad Dermatol Venereol. 2018;32:850-878.
23. Simpson EL, Bruin-Weller M, Flohr C, et al. When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council. J Am Acad Dermatol. 2017;77:623-633.
24. Goujon C, Viguier M, Staumont-Sallé D, et al. Methotrexate versus cyclosporine in adults with moderate-to-severe atopic dermatitis: a phase III randomized noninferiority trial. J Allergy Clin Immunol Pract. 2018;6:562-569.
25. Fleischer AB Jr. Guideline-based medicine grading on the basis of the guidelines of care for ambulatory atopic dermatitis treatment in the United States. J Am Acad Dermatol. 2019;80:417-424.
26. Vakharia PP, Chopra R, Silverberg JI. Systematic review of diagnostic criteria used in atopic dermatitis randomized controlled trials. Am J Clin Dermatol. 2018;19:15-22.
2. Yew YW, Thyssen JP, Silverberg JI. A systematic review and meta-analysis of the regional and age-related differences in atopic dermatitis clinical characteristics. J Am Acad Dermatol. 2019;80:390-401.
3. Chiesa Fuxench ZC, Block JK, Boguniewicz M, et al. Atopic dermatitis in America study: a cross-sectional study examining the prevalence and disease burden of atopic dermatitis in the US adult population. J Invest Dermatol. 2019;139:583-590.
4. Silverberg J, Wollenberg A, Egeberg A, et al. Worldwide prevalence and severity of atopic dermatitis: results from a global epidemiology survey. Abstract presented at: European Academy of Dermatology and Venereology Annual Meeting; Paris, France; September 12-16, 2018. Abstract 1710.
5. Eichenfield LF, Tom WL, Chamlin SL, et al. Guidelines of care for the management of atopic dermatitis: Section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014;70:338-351.
6. Pugliarello S, Cozzi A, Gisondi P, Girolomoni G. Phenotypes of atopic dermatitis. J Dtsch Dermatol Ges. 2011;9:12-20.
7. Silverberg JI, Vakharia PP, Chopra R, et al. Phenotypical differences of childhood- and adult-onset atopic dermatitis. J Allergy Clin Immunol Pract. 2018;6:1306-1312.
8. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol. 1980;92:44-47.
9. Brenninkmeijer EE, Schram ME, Leeflang MM, et al. Diagnostic criteria for atopic dermatitis: a systematic review. Br J Dermatol. 2008;158:754-765.
10. Mevorah B, Frenk E, Wietlisbach V, Carrel CF. Minor clinical features of atopic dermatitis. Evaluation of their diagnostic significance. Dermatologica. 1988;177:360-364.
11. Rudzki E, Samochocki Z, Rebandel P, et al. Frequency and significance of the major and minor features of Hanifin and Rajka among patients with atopic dermatitis. Dermatology. 1994;189:41-46.
12. Williams HC, Burney PG, Hay RJ, et al. The U.K. Working Party's diagnostic criteria for atopic dermatitis. I. Derivation of a minimum set of discriminators for atopic dermatitis. Br J Dermatol. 1994;131:383-396.
13. Williams HC, Burney PG, Strachan D, Hay RJ. The U.K. Working Party's diagnostic criteria for atopic dermatitis. II. Observer variation of clinical diagnosis and signs of atopic dermatitis. Br J Dermatol. 1994;131:397-405.
14. Williams HC, Burney PG, Pembroke AC, Hay RJ. The U.K. Working Party's diagnostic criteria for atopic dermatitis. III. Independent hospital validation. Br J Dermatol. 1994;131:406-416.
15. Bos JD, Van Leent EJ, Sillevis Smitt JH. The millennium criteria for the diagnosis of atopic dermatitis. Exp Dermatol. 1998;7:132-138. 16. Schram ME, Leeflang MM, DEN Ottolander JP, et al. Validation and refinement of the millennium criteria for atopic dermatitis. J Dermatol. 2011;38:850-858.
17. Eichenfield LF, Tom WL, Berger TG, et al. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014;71:116-132.
18. Sidbury R, Davis DM, Cohen DE, et al. Guidelines of care for the management of atopic dermatitis: Section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol. 2014;71:327-349.
19. Eichenfield LF, Ahluwalia J, Waldman A, et al. Current guidelines for the evaluation and management of atopic dermatitis: a comparison of the Joint Task Force Practice Parameter and American Academy of Dermatology guidelines. J Allergy Clin Immunol. 2017;139:S49-S57.
20. Boguniewicz M, Alexis AF, Beck LA, et al. Expert perspectives on management of moderate-to-severe atopic dermatitis: a multidisciplinary consensus addressing current and emerging therapies. J Allergy Clin Immunol Pract. 2017;5:1519-1531.
21. Megna M, Napolitano M, Patruno C, et al. Systemic treatment of adult atopic dermatitis: a review. Dermatol Ther (Heidelb). 2017;7:1-23.
22. Wollenberg A, Barbarot S, Bieber T, et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: Part II. J Eur Acad Dermatol Venereol. 2018;32:850-878.
23. Simpson EL, Bruin-Weller M, Flohr C, et al. When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council. J Am Acad Dermatol. 2017;77:623-633.
24. Goujon C, Viguier M, Staumont-Sallé D, et al. Methotrexate versus cyclosporine in adults with moderate-to-severe atopic dermatitis: a phase III randomized noninferiority trial. J Allergy Clin Immunol Pract. 2018;6:562-569.
25. Fleischer AB Jr. Guideline-based medicine grading on the basis of the guidelines of care for ambulatory atopic dermatitis treatment in the United States. J Am Acad Dermatol. 2019;80:417-424.
26. Vakharia PP, Chopra R, Silverberg JI. Systematic review of diagnostic criteria used in atopic dermatitis randomized controlled trials. Am J Clin Dermatol. 2018;19:15-22.
AUTHOR CORRESPONDENCE
Matthew Reynolds PA-C mreynolds@arkansasdermatology.com
