Bringing the Treatment of Atopic Eczema Into a New Era with Janus Kinase Inhibitors: A Position Statement By the Persatuan Dermatologi Malaysia

Abstract@#Atopic eczema (AE) is a complex, chronic and recurrent inflammatory pruritic skin condition that impacts the quality of life and exerts an economic toll on patients and their families. One of the factors contributing to AE is the immune dysregulation of the Janus kinase-signal transducers and activators of transcription (JAK-STAT) inflammatory pathway. This has prompted the conduct of various large clinical trial programs to evaluate the efficacy and safety of Janus kinase inhibitors (JAK-i) for AE. The overall and significant benefit of these drugs from clinical studies resulted in regulatory approvals for JAK-i to treat moderate-to-severe atopic eczema. The objective of this position paper was to evaluate the safety, efficacy and role of upadacitinib, baricitinib and abrocitinib in managing AE and update the current recommended treatment algorithm within the 2018 Malaysian Clinical Practice Guidelines for the Management of Atopic Eczema. The Persatuan Dermatologi Malaysia recommends that these JAK-i can be considered as an option for systemic therapy in severe AE.

Comparison of the efficacy and safety of Sungai Buloh Augmented Multiple Drug Therapy (SBA-MDT) and the World Health Organisation Multiple Drug Therapy (WHO-MDT) in the Treatment of Leprosy in Malaysia

Background Multiple drug therapy for leprosy has been in use in Malaysia since 1985. The SBAMDT is a modified WHO-MDT with an initial intensive phase and a longer duration of treatment. Objective The aim of the study is to compare the efficacy and safety of SBA-MDT against WHOMDT in the Treatment of Leprosy in Malaysia. Methodology A retrospective study was conducted between 1985 and 2009 in thirteen Malaysian dermatology centres. Data collected were analysed for comparison of relapse rates, compliance rates and adverse drug effects between the 2 regimes. Results A total of 1113 patients were included, of which 966 patients completed the SBA-MDT and 147 patients completed the WHO-MDT. Both the MDT regimes had a treatment failure rate of less than 2%. The relapse rate was 1.7% with SBA-MDT and 1.4% with WHO-MDT (p = 0.79). For multibacillary leprosy, the relapse rates were 0.9% with the former and 0 with the latter (p = 0.32). For paucibacillary leprosy, it was 3.1% and 5.0% respectively (p = 0.52). Patients on SBA-MDT had higher type 1 (16.1% vs. 8.8%, p = 0.03) and type 2 lepra reactions (19.2% vs. 6.1%, p < 0.001). Similarly, those on SBA-MDT also had higher rate of severe adverse drug reactions (11.1% vs. 5.6%, p = 0.01). Conclusion Both the SBA-MDT and the WHO-MDT regimes were effective in inducing clinical remission. Incidence of lepra reactions and severe adverse drug reactions were higher in patients with SBA-MDT.