Novel agents for atopic dermatitis in patients over 50 years of age: A case series

Abstract

Lan et al recently highlighted the under-representation of older adults in clinical trials of systemic therapies for atopic dermatitis (AD). Late-onset AD is increasingly recognized in older adults. Spontaneous remission is uncommon with this phenotype. Existing drug treatments such as corticosteroids, methotrexate, ciclosporin, and azathioprine are complicated by adverse effects including increased malignancy risk, immunosuppression in the context of immunosenescence, and drug interactions in the setting of polypharmacy. A case series is presented of seven patients over 50 years of age with AD who were prescribed dupilumab or tofacitinib or upadacitinib for at least 6 months. All patients were clear or almost clear (investigator global assessment score 0/1) after 1 month of therapy. No significant adverse events were seen. This case series provides preliminary evidence about the safety and efficacy of these novel drugs for AD in older adults. Further studies with higher numbers of participants are needed to obtain realworld evidence for these drugs in older adults, given the limited data in clinical trials.

Experiences from daily practice of upadacitinib treatment on atopic dermatitis with a focus on hand eczema: Results from the BioDay registry

“…Daily practice data of upadacitinib effectiveness in AD is promising, but scarce. Only three clinical daily practice studies and a few case series/reports have been published 10–23 . Moreover, daily practice data of the effectiveness of upadacitinib on HE in AD patients has not been published.…”

Mesenchymal stem/stromal cell therapy in atopic dermatitis and chronic urticaria: immunological and clinical viewpoints

“…To control histamine effects, antihistamines have been used for a long time, and corticosteroids are widely used for severe allergic conditions. In refractory cases of allergic diseases, cyclosporine A is frequently used, as are other regimens, including alkylating agents [ 5 ]. Recently, dupilumab, a monoclonal antibody to the IL-4 receptor α chain, which is the same as the IL-13 receptor α chain, has been actively used for moderate and severe recalcitrant AD [ 14 , 15 ].…”

“…However, patients suffer from symptoms and signs due to the repetitive recurrence of diseases and the continuous medication. Cyclosporin A and alkylating agents are used for refractory allergic diseases [ 5 ]. Some patients want to end their need for medication by achieving remission or cure through causative treatment.…”