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Practice Guideline
. 2024 Feb;90(2):e43-e56.
doi: 10.1016/j.jaad.2023.08.102. Epub 2023 Nov 7.

Guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies

Affiliations
Practice Guideline

Guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies

Dawn M R Davis et al. J Am Acad Dermatol. 2024 Feb.

Abstract

Background: For people with atopic dermatitis (AD) refractory to topical therapies, treatment with phototherapy and systemic therapies can be considered. Multiple biologic therapies and Janus kinase (JAK)inhibitors have been approved since 2014 to treat AD. These guidelines update the 2014 recommendations for management of AD with phototherapy and systemic therapies.

Objective: To provide evidence-based recommendations on the use of phototherapy and systemic therapies for AD in adults.

Methods: A multidisciplinary workgroup conducted a systematic review and applied the GRADE approach for assessing the certainty of evidence and formulating and grading recommendations.

Results: The workgroup developed 11 recommendations on the management of AD in adults with phototherapy and systemic agents, including biologics, oral JAK inhibitors, and other immunomodulatory medications.

Limitations: Most randomized controlled trials of phototherapy and systemic therapies for AD are of short duration with subsequent extension studies, limiting comparative long-term efficacy and safety conclusions.

Conclusions: We make strong recommendations for the use of dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib. We make conditional recommendations in favor of using phototherapy, azathioprine, cyclosporine, methotrexate, and mycophenolate, and against the use of systemic corticosteroids.

Keywords: JAK inhibitor; atopic dermatitis; azathioprine; biologic; cyclosporine; dupilumab; eczema; methotrexate; phototherapy.

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Conflict of interest statement

Conflicts of interest Dr Drucker receives research grants paid to his institution from the National Eczema Association, Eczema Society of Canada, Canadian Dermatology Foundation, Canadian Institutes for Health Research, US National Institutes of Health, and Physician Services Incorporated Foundation. Dr Cohen serves on the board of directors for Timber and Evommune receiving stock options and/or fees; as a consultant for Asana Biosciences, Ferndale Laboratories, Inc, Novartis, Facilitation of International Dermatology Education, Dermavant Sciences, Leo Pharma, Inc, UCB, and Cosmetic Ingredient Review receiving honoraria and/or stock options. Dr Eichenfield serves on the board of directors for Forte Biosciences and Verrica Pharmaceuticals, Inc, receiving honoraria and/or stock options; as an investigator for AbbVie, Arcutis, Dermavant, Galderma Laboratories, Pfizer, and Bausch receiving research grants, fees, and/or honoraria; as a consultant for AbbVie, Almirall, Arcutis, Asana, Dermavant, Eli Lilly, Galderma, Ichnos/Glenmark, Incyte, Janssen, Leo Pharma, Novartis, Ortho Dermatologics, Otsuka, Pfizer, Regeneron, and Sanofi Genzyme, honoraria; as an independent contractor for Elsevier, Inc receiving royalties. Dr Paller serves as a consultant for Abbvie, Abeona, Almirall, Amagma, Anaptysbio, Arena, Bausch, Bristol Myer Squibb, Dermavant, Dermira, Eli Lilly, Exicure, Forte, Leo, Lifemax, Novartis, Phoenix, Pierre Fabre, Pfizer, Rapt, Regeneron, Sanofi, Sol-Gel, UCB, and Venthera receiving honoraria; as an investigator for Anaptysbio, Eli Lilly, Incyte, Janssen, Krystal Bio, Lenus, Regeneron, and UCB receiving no compensation. Dr Schwarzenberger is the founder of Pretel, Inc and serves as a data safety monitoring board member for Pfizer, Inc receiving fees. Dr Sidbury serves as an advisory board member for Pfizer, Inc receiving honoraria; as a principal investigator for Regeneron receiving grants and research funding; as an investigator for Brickell Biotech, Inc, and Galderma USA receiving grants and research funding; as a consultant for Galderma Global and Microes receiving fees or no compensation. Dr Silverberg serves as an advisory board member for BioMX, Boehringer Ingelheim, RAPT Therapeutics, Celgene, Ortho Dermatologics, TARGET Pharma, AFYX Therapeutics, Corrona, Inc, Dermira, Pfizer, Inc, Leo Pharma, Inc, and Menlo Therapeutics receiving honoraria and/or fees; as an investigator for DS Pharma, TARGET Pharma, Kiniksa Pharmaceuticals, Ltd, Menlo Therapeutics, GlaxoSmithKline, AbbVie, Leo Pharma, Inc, and Regeneron receiving research funding, honoraria, or no compensation; as a consultant for AOBiome, Bluefin Biomedicine, Bodewell, BiomX, Inc, Galderma Research & Development, LLC, Arena Pharmaceuticals, Dermavant Sciences, Incyte Corporation, DS Biopharma, Sun Pharmaceutical Industries, Ltd, AnaptysBio, Asana Biosciences, LLC, Pfizer, Inc, Glenmark Generics, Inc, Sanofi, Kiniksa Pharmaceuticals, Ltd, GlaxoSmithKlein, Eli Lilly and Company, AbbVie, Regeneron, and Medimmune receiving honoraria or fees; as a speaker for the Fall Clinical Dermatology Conference, Maui Derm, and Regeneron receiving honoraria or fees. Dr Singh serves as an advisory board member for Incyte receiving honoraria. DR Wu is an author for UpToDate, Inc receiving honoraria. Dr Davis, Dr Alikhan, Dr Bercovitch, Athor Darr, and Dr Frazer-Green have no conflicts of interest to declare.

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