ABSTRACT
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.
Subject(s)
Janus Kinase InhibitorsABSTRACT
Background@#Acne vulgaris is a chronic inflammatory condition of the pilosebaceous unit. Isotretinoin is used to treat moderate to severe acne that is resistant to antibiotics and topical agents. However, it may cause alterations in lipids and liver enzymes.@*Methods@#A total of 129 patients with acne vulgaris (moderate to severe facial acne) treated with isotretinoin were recruited between May 2020 and July 2021 from the dermatology clinics at Hospital Serdang and Hospital Kuala Lumpur. Of these, 120 patients with complete data of lipid panel (total cholesterol, low density lipoprotein cholesterol [LDL], triglycerides [TG], and high density lipoprotein cholesterol [HDL]) and hepatic panel (alanine transaminase [ALT] and aspartate transaminase [AST]) levels at baseline, and in three subsequent follow-up visits (i.e., one, three, and six months) were included in the analyses. Abnormalities were graded according to standard laboratory values and their severity according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE)grading system.@*Results@#Of the 120 study participants, 83% were female and 37% were male between the ages of 15 and 36 years. We observed a significant increase in median values at baseline and at the six-month follow-up for total cholesterol (p<0.0001), triglycerides (p<0.0001), LDL (p<0.0001), ALT (p<0.0001), and AST (p<0.0001). We observed a significant correlation between body mass index and the HDL (r2 =- 0.26, p=0.01) and ALT (r2 =0.383, p=7.9x10-06) levels. Based on the CTCAE grading system, almost all study participants with abnormal results had grade 1 abnormalities. Only one patient had a grade 2 abnormality in ALT, which required treatment discontinuation.@*Conclusion@#Low dose isotretinoin therapy for acne vulgaris may cause mild and non-progressive elevation of LDL, total cholesterol, and liver transaminases which do not require treatment withdrawal in most cases.