Azathioprine treatment and drug survival in patients with chronic hand eczema – results from daily practice

Oosterhaven, Jart A F; Politiek, Klaziena; Schuttelaar, Marielouise

doi:10.1111/cod.12691

Cited by 19 publications

(16 citation statements)

References 5 publications

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Section: Systemic Agentsmentioning

confidence: 99%

“…Patients continued to use their treatment regimen after 1 year (n = 6), 2 years (n = 4), or 6 years (n = 1). Patients who discontinued treatment were lost to follow up, achieved remission, or were worried about long-term adverse effects of immunosuppressive therapy (Oosterhaven et al, 2017 While azathioprine has some efficacy in patients with HE, larger prospective studies are needed to determine proper treatment guidelines.…”

Section: Azathioprinementioning

confidence: 99%

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Current and emerging therapies for hand eczema

Lee

Maarouf

Hendricks

et al. 2019

Dermatologic Therapy

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Although hand eczema (HE) and chronic hand eczema (CHE) are common conditions with significant disease burden, they traditionally have had limited treatment options beyond topical and short‐term systemic corticosteroids. We reviewed published and preliminary evidence on the current and emerging topical and systemic therapeutic agents for HE and CHE. The etiologies of various HE subtypes are discussed, and remaining knowledge and practice gaps are highlighted to encourage further investigations. A comprehensive search of http://clinicaltrials.gov and PubMed was completed for clinical trials that utilized known and emerging treatment options for HE and CHE. Several agents that target IL‐4 and IL‐13 signaling, keratinocyte proliferation, inflammatory cytokine production, bacterial protein synthesis, and inflammatory mediator (TNF‐α, JAK1, JAK2, and JAK3) proliferation are shown to be involved in the pathogenesis of CHE. Systemic agents include dupilumab, alitretinoin, acitretin, cyclosporine, azathioprine, and probiotics. Topical agents include delgocitinib, retapamulin, halometasone/triclosan, calcipotriol/betamethasone, tacrolimus, and pimecrolimus. These modalities have demonstrated varying degrees of clinical efficacy, evaluated by subjective assessments and scoring indexes. Targeted therapies are emerging for HE, but options are still limited, partially due to our narrow understanding of this heterogeneous condition. Additional and targeted therapeutic options are needed to match the rising prevalence and burden of HE. Keypoints Hand eczema (HE) is a heterogenous dermatosis with limited therapeutic options due to a lack of international guidelines regarding classification of HE subtypes and treatment. This review discusses current and emerging topical and systemic agents and their efficacies in the treatment of different types of hand eczema.

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Section: Systemic Agentsmentioning

confidence: 99%

Section: Azathioprinementioning

confidence: 99%

Current and emerging therapies for hand eczema

Lee

Maarouf

Hendricks

et al. 2019

Dermatologic Therapy

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“…In dermatology, it is used off-label for a variety of diseases, especially autoimmune bullous diseases, because of its steroid-saving effect, although the evidence varies widely. 65 Oosterhaven et al 66 published a retrospective review of 30 adult patients with severe chronic hand eczema who were treated with azathioprine. 64 Further side effects may include gastrointestinal disturbances and infections.…”

Section: Azathioprinementioning

confidence: 99%

“…63 Azathioprine is a prodrug metabolized to 6-mercaptopurine Mercaptopurine is further metabolized via three metabolic pathways, including 6-thioguanine nucleotides (6-TGN), which are responsible for most of the immunosuppressive activity of thiopurines, but also cause their bone marrow toxicity. 66 In conclusion, the efficacy of azathioprine in the management of hand dermatitis seems to be rather limited, and careful monitoring of the drug is required. 65 Oosterhaven et al 66 published a retrospective review of 30 adult patients with severe chronic hand eczema who were treated with azathioprine.…”

Section: Azathioprinementioning

confidence: 99%

“…64 Further side effects may include gastrointestinal disturbances and infections. 65 Oosterhaven et al 66 published a retrospective review of 30 adult patients with severe chronic hand eczema who were treated with azathioprine. Seven patients showed a satisfactory response at the 3-month assessment, but 17 of 30 patients discontinued treatment, 15 of those because of adverse effects.…”

Section: Azathioprinementioning

confidence: 99%

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Hand eczema: treatment

Elsner

Agner

2019

Acad Dermatol Venereol

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Hand eczema is a highly prevalent, multietiological disease with a wide spectrum of severity and chronicity. The treatment of hand eczema, especially in severe and chronic cases, is a challenge to the dermatologist requiring not only diagnostic and therapeutic, but also excellent patient communication skills. This review discusses the spectrum of therapeutic options for hand eczema, the evidence for their efficacy and safety, and proposes a stepwise approach of intensity of treatment depending on disease severity and chronicity. In the near future, hand eczema patients may benefit from new therapeutic principles such as biologics for the treatment of atopic eczema and topical Janus Kinase inhibitors.

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