Clinical trials of systemic therapies for atopic dermatitis (AD) often exclude patients based on age and comorbidities.
Objectives
We conducted a scoping review of observational studies and survey of International Eczema Council (IEC) members on the treatment of AD in patients with liver disease, renal disease, viral hepatitis, HIV, or history of malignancy.
Methods
We searched MEDLINE via Ovid, Embase via Ovid, and Web of Science from inception to September 14, 2020. We mapped the available evidence on the use of cyclosporine, methotrexate, azathioprine, mycophenolate, systemic corticosteroids, and dupilumab for AD in older adults (≥65 years) and adults with the previously mentioned comorbidities. We surveyed IEC members on their preferred systemic medications for each patient population.
Results
We identified 25 studies on the use of systemic medications in special populations of adults with AD. Although IEC members preferred dupilumab as the first-line systemic agent across all special populations, many could not identify viable third-line systemic therapy options for some populations.
Conclusions
Data on systemic therapy for AD for older adults and adults with comorbidities are limited. Although IEC members' access to systemic therapies differs geographically, expert opinion suggests that dupilumab is preferred for those patients.
Get full access to this article
View all access options for this article.
References
1.
SimpsonEL, Bruin-WellerM, FlohrC, 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(4):623–633. doi:.
2.
DruckerAM, EyerichK, de Bruin-WellerMS, et al.Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement. Br J Dermatol, 2018; 178(3):768–775. doi:.
3.
SimpsonEL, BieberT, EckertL, et al.Patient burden of moderate to severe atopic dermatitis (AD): insights from a phase 2b clinical trial of dupilumab in adults. J Am Acad Dermatol, 2016; 74(3):491–498. doi:.
4.
DruckerAM, EllisAG, BohdanowiczM, et al.Systemic immunomodulatory treatments for patients with atopic dermatitis: a systematic review and network meta-analysis. JAMA Dermatol, 2020; 156(6):659–667. doi:.
5.
SawangjitR, DilokthornsakulP, Lloyd-LaveryA, et al.Systemic treatments for eczema: a network meta-analysis. Cochrane Database Syst Rev, 2020; 9(9):CD013206. doi:.
6.
LamM, ZhuJW, MaqboolT, et al.Inclusion of older adults in randomized clinical trials for systemic medications for atopic dermatitis: a systematic review. JAMA Dermatol, 2020; 156(11):1240–1245. doi:.
7.
TangE, MaqboolT, LamM, et al.Safety of systemic medications among older adults with psoriasis and atopic dermatitis: a systematic review of observational studies. J Cutan Med Surg, 2021, 25, 397–408. doi:.
8.
ArkseyH, O'MalleyL. Scoping studies: towards a methodological framework. Int J Soc Res Methodol Theory Pract, 2005; 8(1):19–32. doi:.
9.
TriccoAC, LillieE, ZarinW, et al.PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med, 2018; 169(7):467–473. doi:.
10.
StephensRB, LeeML, CooperA. Cyclosporin treatment of atopic dermatitis: five case studies and literature review. Australas J Dermatol, 1994; 35(2):55–59. doi:.
11.
FowlerE, RosenJ, Lev-TovH, YosipovitchG. Two cancer patients receiving dupilumab for treatment of atopic dermatitis. Acta Derm Venereol, 2019; 99(10):899–900. doi:.
12.
GnarraM, De SimoneC, GarcovichM, GarcovichS. Low-dose cyclosporine A in the treatment of severe atopic dermatitis complicated by chronic hepatitis C virus infection. Pediatr Dermatol, 2017; 34(3):374–376. doi:.
13.
LiG, BerkenstockM, SoibermanU. Corneal ulceration associated with dupilumab use in a patient with atopic dermatitis. Am J Ophthalmol Case Rep. 2020; 19:100848. doi:.
14.
MarksDH, PiantadosiAL, PatilSU, RaffA, YuJ. Successful use of dupilumab for recalcitrant atopic dermatitis in an HIV patient. Dermatitis. 2019; 30(4):276–277. doi:.
15.
RomagnuoloM, AngileriL, TavecchioS, Marzano AV, FerrucciS. Safety and efficacy of dupilumab in a patient with severe atopic dermatitis and HIV infection, with 15 months of follow-up. Clin Exp Dermatol, 2020; 45(6):762–763. doi:.
16.
MollanazarNK, SavageKT, PoustiBT, et al.Cutaneous T-cell lymphoma and concomitant atopic dermatitis responding to dupilumab. Cutis. 2020; 106(3):131–132. doi:.
17.
MollanazarNK, QiuCC, AldrichJL, et al.Use of dupilumab in patients who are HIV-positive: report of four cases. Br J Dermatol, 2019; 181(6):1311–1312. doi:.
18.
CampioneE, PaternòEJ, DiluvioL, BianchiL, GiorgettiG, ChimentiS. Combination of low-dosage cyclosporine and topical pimecrolimus in severe atopic dermatitis with chronic hepatitis B. Acta Derm Venereol, 2008; 88(1):74–75. doi:.
19.
Halabi-TawilM, RuemmeleFM, FraitagS, et al.Cutaneous manifestations of immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome. Br J Dermatol, 2009; 160(3):645–651. doi:.
20.
KhaC, RajiK, ChisolmS. Treatment of atopic dermatitis with dupilumab in a renal transplant patient. Dermatitis, 2020; 31(2):E17–E18. doi:.
21.
LeeDH, CohenLM, YoonMK, TaoJP. Punctal stenosis associated with dupilumab therapy for atopic dermatitis. J Dermatolog Treat, 2021; 32(7):737–40. doi:.
22.
LyK, SmithMP, ThibodeauxQ, BeckK, BhutaniT, LiaoW. Dupilumab in patients with chronic hepatitis B on concomitant entecavir. JAAD Case Rep, 2019; 5(7):624–626. doi:.
23.
ThyssenJP, SkovL, HamannCR, GislasonGH, EgebergA. Assessment of major comorbidities in adults with atopic dermatitis using the Charlson Comorbidity Index. J Am Acad Dermatol. 2017; 76(6):1088–1092.e1. doi:.
24.
BalestriR, MagnanoM, GirardelliCR, BortolottiR, RechG. Long-term safety of combined biological therapy in a patient affected by arthropathic psoriasis and atopic dermatitis. Dermatol Ther, 2020; 33(4):e13498. doi:.
25.
BosmaAL, de WijsLEM, HofMH, et al.Long-term effectiveness and safety of treatment with dupilumab in patients with atopic dermatitis: results of the TREAT NL (TREatment of ATopic eczema, the Netherlands) registry. J Am Acad Dermatol, 2020; 83(5):1375–1384. doi:.
26.
ChoiE, CookA, PhuanC, et al.Outcomes of prolonged and low-dose ciclosporin in an Asian population. J Dermatolog Treat, 2021; 32(4):432–437. doi:.
27.
Estrada-ReyesE, Hernnández-RománMP, Gamboa-MarrufoJD, et al.Hypereosinophilia, hyper-IgE syndrome, and atopic dermatitis in a toddler with food hypersensitivity. J Investig Allergol Clin Immunol, 2008; 18(2):131–135.
28.
HeratizadehA, HaufeE, StölzlD, et al.Baseline characteristics, disease severity and treatment history of patients with atopic dermatitis included in the German AD Registry TREATgermany. J Eur Acad Dermatol Venereol, 2020; 34(6):1263–1272. doi:.
29.
LudriksoneL, ElsnerP, MalessaC, SettmacherU, SchliemannS. Effectiveness and safety of dupilumab for atopic dermatitis in a liver transplant recipient: a case report. J Dtsch Dermatol Ges, 2020; 18(7):740–742. doi:.
30.
MotleyRJ, WhittakerJA, HoltPJ. Resolution of atopic dermatitis in a patient treated with cyclosporin. Clin Exp Dermatol, 1989; 14(3):243–244. doi:.
31.
VarmaA, TassavorM, LevittJ. The utility of dupilumab for use in the pediatric population. JAAD Case Reports. 2019; 5(11):943–944. doi:.
32.
YangCM, YangYH, LinYT, et al.Natural killer cell deficiency associated with Hodgkin's lymphoma: a case report. J Formos Med Assoc, 2002; 101(1):73–75.
33.
BrodskaP, PanznerP, SedlacekD, TerlM, CetkovskaP. Use of dupilumab in a patient with atopic dermatitis, severe asthma, and HIV infection. Dermatol Ther. 2020; 33(6):e14159. doi:.
34.
LorM, VillaN, HollandV. Safe and effective treatment of atopic dermatitis using dupilumab over 23 months in a patient with HIV. Dermatol Ther. 2020; 33(6):e14271. doi:.
35.
KaushikSB, LebwohlMG. Psoriasis: which therapy for which patient: focus on special populations and chronic infections. J Am Acad Dermatol, 2019; 80(1):43–53. doi:.
