ABSTRACT
Atopic dermatitis (AD) is a chronic or chronically recurrent Inflammatory dermatosis associated with multiple triggers that has a complex pathophysiological mechanism. It is characterized by a heterogeneous clinical expression, signs, and symptoms. Its etiology and pathogenesis are complex and are influenced by multiple immune-mediated factors. Treatment of AD can also be complex, given the high number of available drugs and multiple therapeutic targets. In this review, we summarize current literature on the efficacy and safety of topical and systemic drugs to treat moderate-to-severe AD. We begin with topical treatments such as corticosteroids and calcineurin inhibitors and subsequently address the latest systemic treatments, such as Janus kinase inhibitors (upadacitinib, baricitinib, abrocitinib, gusacitinib) and interleukin (IL) inhibitors, which have proven efficacious in AD, namely, dupilumab (IL-4 and IL-13), tralokinumab (IL-13), lebrikizumab (IL-13), and nemolizumab (IL-31). Given the large number of drugs available, we summarize the pivotal clinical trials for each drug, evaluate recent real-world experience in terms of safety and efficacy for purposes of compilation, and provide evidence to guide the optimal choice of therapy.
Subject(s)
Dermatitis, Atopic , Janus Kinase Inhibitors , Humans , Dermatitis, Atopic/drug therapy , Interleukin-13 , Immunologic Factors/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Janus Kinase Inhibitors/therapeutic use , Treatment OutcomeABSTRACT
Atopic dermatitis (AD) is a chronic or chronically recurrent Inflammatory dermatosis associated with multiple triggers that has a complex pathophysiological mechanism. It is characterized by a heterogeneous clinical expression, signs, and symptoms. Its etiology and pathogenesis are complex and are influenced by multiple immune-mediated factors. Treatment of AD can also be complex, given the high number of available drugs and multiple therapeutic targets. In this review, we summarize current literature on the efficacy and safety of topical and systemic drugs to treat moderate-to-severe AD. We begin with topical treatments such as corticosteroids and calcineurin inhibitors and subsequently address the latest systemic treatments, such as Janus kinase inhibitors (upadacitinib, baricitinib, abrocitinib, gusacitinib) and interleukin (IL) inhibitors, which have proven efficacious in AD, namely, dupilumab (IL-4 and IL-13), tralokinumab (IL-13), lebrikizumab (IL-13), and nemolizumab (IL-31). Given the large number of drugs available, we summarize the pivotal clinical trials for each drug, evaluate recent real-world experience in terms of safety and efficacy for purposes of compilation, and provide evidence to guide the optimal choice of therapy (AU)
La dermatitis atópica (DA) es una dermatosis inflamatoria crónica o crónicamente recurrente, asociada a múltiples desencadenantes y con un mecanismo fisiopatológico complejo. Se caracteriza por una expresión clínica, signos y síntomas heterogéneos. Su etiopatogenia es compleja y está influenciada por múltiples factores inmunomediados. El tratamiento de la DA también resulta complejo; esto se debe a que existen varios fármacos que pueden utilizarse para tratar la DA con múltiples dianas terapéuticas. En esta revisión, resumimos la literatura actual sobre la eficacia y seguridad de los fármacos tópicos y sistémicos para tratar la DA de moderada a grave. Partiremos desde tratamientos tópicos como los corticoides y los inhibidores de la calcineurina tópicos, hasta los últimos tratamientos sistémicos como los inhibidores cinasas Jano JAK (upadacitinib, baricitinib, abrocitinib, gusacitinib) y los inhibidores de la interleucina (IL) que han demostrado eficacia sobre la DA: dupilumab (IL-4 e IL-13), tralokinumab (IL-13), lebrikizumab (IL-13) y nemolizumab (IL-31). Como hemos visto existen multitud de fármacos para tratar la DA, por este motivo hemos realizado una revisión en la cual se han tenido en cuenta todos los ensayos clínicos de fase III de cada fármaco. También ha sido evaluada su experiencia reciente en la práctica clínica en concepto de seguridad y eficacia con el propósito de compilar esta evidencia para ayudar a seleccionar la terapia adecuada (AU)
