Immunosuppressive therapy for atopic dermatitis



Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Treatment of patients with atopic dermatitis is always full with challenges for dermatologist, which is due to the complexity of the immunopathogenesis of the disease, the chronic nature of itchy dermatosis, low predictability of the individual course of the skin process and not always reliable patient adherence to treatment. A brief review of the effectiveness of the main systemic immunosuppressive drugs used today for the treatment of patients with moderate to severe atopic dermatitis is presented: cyclosporine A, methotrexate, azathioprine and commonly used phototherapy. Their clinical efficacy, dose-dependent effectiveness, the effect of patient's phototype on outcomme, and the expected side effects were considered. The possibilities of increasing clinical efficacy and reducing the risk of side effects through the combined use of various immunosuppressive drugs, in particular with phototherapy, are discussed, which, besides all, will expand the therapeutic arsenals for the doctor.

Full Text

Restricted Access

About the authors

Yingyu Ding

Clinic of Skin and Venereal Diseases named after V. A. Rakhmanov

Author for correspondence.
Email: dininyui@yandex.ru
ORCID iD: 0009-0002-2342-276X

皮肤性病科研究生

China

Nikolay G. Kochergin

Sechenov First Moscow State Medical University (Sechenov University)

Email: nkocha@yandex.ru
ORCID iD: 0000-0001-7136-4053
SPIN-code: 1403-3031

医学博士、博士科学。 （医学），教授

Russian Federation, Moscow

References

  1. REFERENCES:
  2. Frazier W, Bhardwaj N. Atopic Dermatitis: Diagnosis and Treatment. Am Fam Physician. 2020;101(10):590-598. (https://pubmed.ncbi.nlm.nih.gov/32412211/)
  3. Schuler CF 4th, Billi AC, Maverakis E, Tsoi LC, Gudjonsson JE. Novel insights into atopic dermatitis. J Allergy Clin Immunol. 2023;151(5):1145-1154. doi: 10.1016/j.jaci.2022.10.023 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10164702/#R19)
  4. Kochergin N.G., Olisova O.Yu. Combined external therapy for atopic dermatitis // Farmateka. - 2017. - №3S. - P. 44-49.
  5. Raimondo A, Lembo S. Atopic Dermatitis: Epidemiology and Clinical Phenotypes. Dermatol Pract Concept. 2021;11(4):e2021146 . Published 2021 Oct 1. doi: 10.5826/dpc.1104a146 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8648436/)
  6. Jingru Tian, ​​Dingyao Zhang, Yi Yang, Yaqing Huang, Lu Wang , Xu Yao, Qianjin Lu, Global epidemiology of atopic dermatitis: a comprehensive systematic analysis and modeling study, British Journal of Dermatology, Volume 190, Issue 1, January 2024, Pages 55–61, https://doi.org/10.1093/ bjd/ljad339
  7. Molochkova Yu.V., Karzanov O.V., Molochkov V.A., Monaenkova M.K. Dupilumab in dermatology: atopic dermatitis and promising directions. Effective pharmacotherapy. 2022; 18 (9): 18–23.
  8. Migacheva N.B. Evolutionary aspects of the epidemiology, treatment and prevention of atopic dermatitis: Abstract of PhD thesis. med. sciences. M.; 2001.
  9. Boguniewicz M, Fonacier L, Guttman-Yassky E, Ong PY, Silverberg J, Farrar JR. Atopic dermatitis yardstick: practical recommendations for an evolving therapeutic landscape. Ann Allergy Asthma Immunol 2018;120 :10–22.
  10. Elsgaard S, Danielsen AK, Thyssen JP, Deleuran M, Vestergaard C. Drug survival of systemic immunosuppressive treatments for atopic dermatitis in a long-term pediatric cohort. Int J Womens Dermatol. 2021;7(5Part B):708-715. Published 2021 Jul 22. doi: 10.1016/j.ijwd.2021.07.005
  11. Ferrucci SM, Tavecchio S, Marzano AV, Buffon S. Emerging Systemic Treatments for Atopic Dermatitis. Dermatol Ther (Heidelb). 2023;13(5):1071-1081. doi: 10.1007/s13555-023-00920-4
  12. Baker, S., Kochergin, N. G., & Tkachenko, S. B. (2014). Modern approaches to the therapy of limited forms of atopic dermatitis. Russian Journal of Skin and Venereal Diseases diseases, 17 (1), 14-17.
  13. Macharadze D.Sh., Galanina A.V. What's new in the therapy of severe atopic dermatitis? // Pharmateka. - 2013. - No. 18. - P. 52-56. 13.Megna M, Napolitano M, Patruno C, et al. Systemic Treatment of Adult Atopic Dermatitis: A Review. Dermatol Ther (Heidelb). 2017;7(1):1–23. doi: 10.1007/s13555-016-0170-1
  14. Chavez-Alvarez S, Herz-Ruelas M, Villarreal-Martinez A, Ocampo-Candiani J, Garza-Garza R, Gomez-Flores M. Azathioprine: its uses in dermatology. An Bras Dermatol. 2020;95(6):731-736. doi: 10.1016/j.abd.2020.05.003
  15. Rueda-Robles A., Ibarrola-Villava M., Lobato-Berezo A. et al. Comparison of dupilumab efficacy and safety between pediatric and adult patients with moderate-to-severe atopic dermatitis: A systematic review and meta-analysis // Journal of the American Academy of Dermatology. 2023. Vol. 00, No. 00.
  16. Meggitt SJ, Reynolds NJ. Azathioprine for atopic dermatitis. Clin Exp Dermatol. 2001 Jul;26(5):369-75. doi: 10.1046/j.1365-2230.2001.00837 .x. PMID: 11488818.
  17. Sodnomova, L. B. (2013). Clinical case of complication of rheumatoid arthritis therapy with methotrexate. Bulletin of the Buryat State University. Medicine and Pharmacy, (12), 98-101.
  18. Drucker A. M., Ellis AG, Bohdanowicz M, 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: 10.1001/jamadermatol.2020.0796
  19. Berth-Jones J, Takwale A, Tan E, Barclay G, Agarwal S, Ahmed I, Hotchkiss K, Graham-Brown RA. Azathioprine in severe adult atopic dermatitis: a double-blind, placebo-controlled, crossover trial. Br J Dermatol. 2002 Aug;147(2):324-30. doi: 10.1046/j.1365-2133.2002.04989.x. PMID: 12174106.
  20. Kanevskaya M.Z., Gurskaya S.V. "Methotrexate in the treatment of rheumatic diseases" Modern rheumatology, no. 4, 2013, pp. 47-53.
  21. Malaviya AN. Landmark papers on the discovery of methotrexate for the treatment of rheumatoid arthritis and other systemic inflammatory rheumatic diseases: a fascinating story. Int J Rheum Dis. 2016;199:844–851. doi: 10.1111/1756-185X.12862.)
  22. Van Huizen AM, Sikkel R, Caron AGM, et al. Methotrexate dosing regimen for plaque-type psoriasis: an update of a systematic review. J Dermatolog Treat. 2022;338:3104–3118. doi: 10.1080/09546634.2022.2117539
  23. Doktorova S.A., Grabovetskaya Yu.Yu., Stefanov M., Rafalsky V.V. Improving the efficacy and safety of methotrexate use: focus on drug interactions ( review). Safety and risk of pharmacotherapy. 2024;12(3):285-298.
  24. Caron, A. G. M., Bloem, M., El Khattabi, H., de Waal, A. C., van Huizen, A. M., Denswil, N. P., … Spuls, P. I. (2023). The wide variety of methotrexate dosing regimens for the treatment of atopic dermatitis: a systematic review. Journal of Dermatological Treatment, 35(1). https://doi.org/10.1080/09546634.2023.2292962
  25. Schram, Mandy Elvira et al. A randomized trial of methotrexate versus azathioprine for severe atopic eczema , Journal of Allergy and Clinical Immunology, Volume 128, Issue 2, 353 – 359
  26. Kim K, Kim M, Rhee E, Lee MH, Yang HJ, Park S, Kim HS. Efficacy and Safety of Low-Dose Cyclosporine Relative to Immunomodulatory Drugs Used in Atopic Dermatitis: A Systematic Review and Meta-Analysis. J Clin Med. 2023 Feb 9;12(4):1390. doi: 10.3390/jcm12041390. PMID: 36835928; PMCID: PMC9959975.
  27. Salek MS, Finlay AY, Luscombe DK, Allen BR, Berth-Jones J, Camp RD, et al. Cyclosporin greatly improves the quality of life of adults with severe atopic dermatitis: a randomized, double-blind, placebo-controlled trial. Br J Dermatol 1993;129(4):422-30.
  28. Darsow U, Wollenberg A, Simon D, Taïeb A, Werfel T, Oranje A, et al. ETFAD/EADV eczema task force 2009 position paper on diagnosis and treatment of atopic dermatitis. J Eur Acad Dermatol Venereol 2010;24(3):317-28.
  29. Zurbriggen B, Wüthrich B, Cachelin AB, Wili PB, Kägi MK. Comparison of two formulations of cyclosporin A in the treatment of severe atopic dermatitis: a double-blind, single- centre, cross-over pilot study. Dermatology 1999;198(1):56- 60.
  30. Kandolf Sekulović, Lidija, et al. "Treatment of Severe Atopic Dermatitis with Cyclosporine: A Review of Eight Patients" Serbian Journal of Dermatology and Venereology, vol. 5, no. 1, Sciendo, 2013, pp. 13-20. https://doi.org/10.2478/sjdv-2013-0002.
  31. Van Joost T, Heule F, Korstanje M, van den Broek MJ, Stenveld HJ, van Vloten WA. Cyclosporin in atopic dermatitis: a multicentre placebo-controlled study. Br J Dermatol. 1994 May;130(5):634-40. doi: 10.1111/j.1365-2133.1994.tb13111.x. PMID: 8204472.
  32. Goujon C, Viguier M, Staumont-Sallé D, Bernier C, Guillet G, Lahfa M, Ferrier Le Bouedec MC, Cambazard F, Bottigioli D, Grande S, Dahel K, Bérard F, Rabilloud M, Mercier C, Nicolas JF. Methotrexate Versus Cyclosporine in Adults with Moderate-to-Severe Atopic Dermatitis: A Phase III Randomized Noninferiority Trial. J Allergy Clin Immunol Pract. 2018 Mar-Apr;6(2):562-569.e3. doi: 10.1016/j.jaip.2017.07.007. Epub 2017 Sep 28. PMID: 28967549.
  33. Barros NM, Sbroglio LL, Buffara MO, Baka JLCES, Pessoa AS, Azulay-Abulafia L. Phototherapy. An Bras Dermatol. 2021 Jul-Aug;96(4):397-407. doi: 10.1016/j.abd.2021.03.001. Epub 2021 Apr 2. PMID: 33849754; PMCID: PMC8245715.
  34. Brodsky M., Abrouk M., Lee P., Kelly K.M. Revisiting the History and Importance of Phototherapy in Dermatology. JAMA Dermatol. 2017;153:435. doi: 10.1001/jamadermatol.2017.0722.
  35. Valkova, S., & Velkova, A. (2004). UVA/UVB phototherapy for atopic dermatitis revisited. Journal of Dermatological Treatment, 15(4), 239–244. https://doi.org/10.1080/09546630410035338
  36. Pacifico A, Iacovelli P, Damiani G, Ferraro C, Cazzaniga S, Conic RRZ, Leone G, Morrone A. 'High dose' vs. 'medium dose' UVA1 phototherapy in italian patients with severe atopic dermatitis. J Eur Acad Dermatol Venereol. 2019 Apr;33(4):718-724. doi: 10.1111/jdv.15362. Epub 2018 Dec 28. PMID: 30468530; PMCID: PMC6440836.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) Eco-Vector


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 86501 от 11.12.2023 г. 
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ЭЛ № ФС 77 - 80653 от 15.03.2021 г.