Systemic treatment of severe adult Atopic dermatitis in clinical practice: analysis of prescribing pattern in a cohort of 241 patients

Hegazy, S.; Tauber, M.; Livideanu, Cristina Bulai; Uthuriague, C.; Giordano‐Labadie, F.; Marguery, M.C.; Regnault, M. Masson; Konstantinou, M.P.; Paul, C.

doi:10.1111/jdv.14238

Cited by 7 publications

(11 citation statements)

References 9 publications

(8 reference statements)

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“…Overall, 488 190 patients with AD and 73 334 352 controls were included, with 97 411 patients and 434 225 controls from Europe, 43,44,47–55,57–59,63,68,69,72–75,77,80,83–87,89,91 256 998 patients and 72 674 850 controls from North America, 22,35,39,45,46,64,70,78,90 133 678 patients and 225 420 controls from Asia 41,56,60–62,65–67,71,76,82,83 and 103 patients with AD internationally 88 . Included were 269 861 adults with AD and 718 873 control adults, and 52 530 children with AD and 340 356 control children with AD (five studies did not report age range).…”

Section: Resultsmentioning

confidence: 99%

“…The studies were published from 1975 to 2019. Nineteen (37%) were cohort studies, 41,[44][45][46]48,49,52,[56][57][58][59]67,71,74,[82][83][84]86,89 16 (31%) were cross-sectional, 22,35,39,51,60,62,[64][65][66]69,70,73,76,77,90,91 eight (16%) were randomized control trials, 50,[53][54][55]61,72,85,88 seven (14%) were case-control studies 43,47,68,75,78,80,87 and one (2%) was a crossover study. 63 The studies were con...…”

Section: Study Characteristicsmentioning

confidence: 99%

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Association between atopic dermatitis and hypertension: a systematic review and meta‐analysis*

et al. 2021

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Background Previous studies have found conflicting results about the association of atopic dermatitis (AD) with hypertension. Objectives To determine whether AD and AD severity are associated with hypertension. Methods A systematic review was performed of published studies in Ovid MED-LINE, Embase, Scopus, Web of Science, and GREAT (Global Resource for EczemA Trials) databases. At least two reviewers conducted title/abstract, full-text review and data extraction. Quality of evidence was assessed using the Newcastle-Ottawa Scale.Results Fifty-one studies met the inclusion criteria and 19 had sufficient data for meta-analysis. AD was associated with higher odds of hypertension compared with healthy controls [increased in nine of 16 studies; pooled prevalence 16Á4% vs. 13Á8%; random-effects regression, pooled unadjusted odds ratio (OR) 1Á16, 95% confidence interval (CI) 1Á04-1Á30], but lower odds of hypertension compared with psoriasis [decreased in five of eight studies; 15Á4% vs. 24Á8% (OR 0Á53, 95% CI 0Á37-0Á76)]. In particular, moderate-to-severe AD was associated with hypertension compared with healthy controls [increased in four of six studies; 24Á9% vs. 14Á7% (OR 2Á33, 95% CI 1Á10-4Á94)]. Hypertension was commonly reported as an adverse event secondary to AD treatments, particularly systemic ciclosporin A. Limitations include lack of longitudinal studies or individual-level data, and potential confounding. Conclusions AD, particularly moderate-to-severe disease, was associated with increased hypertension compared with healthy controls, but with lower odds than for psoriasis.What is already known about this topic?• Previous studies have showed conflicting results regarding the association between atopic dermatitis (AD) and hypertension.

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Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Association between atopic dermatitis and hypertension: a systematic review and meta‐analysis*

et al. 2021

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“…This was the largest group in this SR. These studies consisted of three RCTs, two observational follow-up studies, five retrospective cohorts and 16 case series (22,29,31,43,44,46,52,55,57,62,64,70,(85)(86)(87)(88)(89)(90)(91)(92)(93)(94)(95)(96)(97)(98). In the RCT of El-Khalawany (64), in which MTX was compared to ciclosporin in 40 children, no significant difference in SCORing Atopic Dermatitis index (SCORAD) reduction was found (Table S3.…”

Section: Juvenile and Adult Atopic Dermatitis (Ad)mentioning

confidence: 99%

On which evidence can we rely when prescribing off-label methotrexate in dermatological practice? – a systematic review with GRADE approach

Huizen

Vermeulen

Bik³

et al. 2021

Journal of Dermatological Treatment

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If an authorized drug is prescribed for a use that is not described in the Summary of Product Characteristics, this is defined as 'off-label use.' Methotrexate is often used off-label for dermatological indications. Off-label use is permitted if physicians can justify the treatment based on scientific evidence available to them. Our objective here was therefore to summarize the evidence for the effectiveness, efficacy, and safety of the dermatological off-label use of methotrexate in a systematic review. We searched MEDLINE, EMBASE, and CENTRAL for studies for evidence on the effectiveness, efficacy, and safety of the off-label use of methotrexate in dermatological indications up to November 2019. We used the GRADE system to rate the quality of the evidence. The search retrieved 34,583 hits of which 3566 were selected after the title and abstract screening. After the full-text screening, 143 studies were included, which involved 3688 patients in total. We found low-quality evidence for the effectiveness, efficacy, and safety of the off-label use of methotrexate in 31 dermatological diseases.To optimize the quality of evidence to support off-label use, we need high-quality studies in which well-characterized patients are treated with standardized treatments regimens using well-validated outcomes relevant to patients and physicians.

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“…Nonetheless, treatment guidelines currently in use consider systemic treatment to be last‐resort therapy in AD patients and even recent guidelines recommend systemic treatment only in patients with severe AD (SCORAD >50 or persistent eczema) . Many adult patients with severe AD are maintained on topical therapy because of potential side‐effects of systemic therapy and because of lack of long‐term control with currently available systemic agents …”

Section: Advances In the Understanding Of Atopic Dermatitis Leading Tmentioning

confidence: 99%

Dermatology today and tomorrow: from symptom control to targeted therapy

Blume-Peytavi

Bagot

Tennstedt

et al. 2018

Acad Dermatol Venereol

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For many decades and until recently, medical approach to dermatologic diseases has been based on the physician's ability to recognize and treat symptoms. Nowadays, advances in the understanding of the biology of diseases and in technologies for intervening against them have allowed physicians to diagnose and treat underlying disease processes rather than simply addressing the symptoms. This means that rather than addressing ‘the disease in humans’, physicians can now address the particular pathologic (biologic, molecular) disturbance as it presents in the individual patient, i.e., physicians now can practice something much closer to ‘personalized medicine’, leading to greater benefits for the patients and the health of society in general. The deeper understanding of ultraviolet radiation, the importance of photoprotection and increased knowledge about signalling pathways of melanoma and carcinoma have led to more complete care for the dermatologic patient. The current popularity for excessive exposure to the sun, without adequate application of the appropriate photoprotection remedies, is the origin of melanoma, but also for the weakening of the structure and functions of the skin. Indeed, fragility of the skin can affect humans around the world. In the senior population, this skin fragility is accompanied by pruritus, whereas atopic dermatitis is an inflammatory disease with highest prevalence in children and adolescents. Acne, the number one reason for dermatologic consultations worldwide, increases its prevalence in adolescents and in females. Senescent alopecia affects humans after menopause and andropause. The articles in this publication present an overview of the current advanced understanding of the diagnosis and therapeutic approaches in 6 fields of dermatology – dermatopaediatry and gerontodermatology, oncodermatology, hair loss, atopic dermatitis, photoprotection and acne – and thereby serve as a useful compendium of updated information and references for all healthcare professionals who see patients with presentations of the symptoms of these diseases.

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Systemic treatment of severe adult Atopic dermatitis in clinical practice: analysis of prescribing pattern in a cohort of 241 patients

Cited by 7 publications

References 9 publications

Association between atopic dermatitis and hypertension: a systematic review and meta‐analysis*

Association between atopic dermatitis and hypertension: a systematic review and meta‐analysis*

On which evidence can we rely when prescribing off-label methotrexate in dermatological practice? – a systematic review with GRADE approach

Dermatology today and tomorrow: from symptom control to targeted therapy

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