Atopic dermatitis: emerging and current treatments

Atopic dermatitis affects up to 30% of children and 10% of adults, and is common in both developed and developing countries. Two new medicines on the brink of entering the market — dupilumab, a biologic for severe disease, and crisaborole, a topical small molecule drug for milder disease — could herald a new era in the management of this condition, which has seen no major changes to the way it has been treated for over 15 years.

 

Epidemiology of atopic dermatitis

Source: Journal of Clinical Immunology; Allergologia et Immunopathologia

There is a wide variation in the global prevalence of atopic dermatitis, but it is common in both developed and developing countries.

 

How dupilumab works

Source: Expert Opinion on Biological Therapy; Nature Reviews Drug Discovery; Immunotherapy

The arrival of the first monoclonal antibody for atopic dermatitis, dupilumab, marketed as Dupixent, is anticipated as a revolution for patients with the most severe form of the disease. Dupilumab targets the Th2 pathway that drives atopic dermatitis

 

How crisaborole works

Source: Expert Opinion on Biological Therapy; Nature Reviews Drug Discovery; Immunotherapy

For mild disease, topical ointment crisaborole secured US Food and Drug Administration approval in December 2016. Crisaborole works by inhibiting the enzyme phosphodiesterase 4 (PDE4), which has long been known to have a role in atopic dermatitis

 

Current stepped treatment options for atopic dermatitis

Treatment for atopic dermatitis can be stepped up or down depending on disease severity. Acute flares will often require a temporary increase in the intensity of treatment

References

Editorial advisers: Tess McPherson, a consultant dermatologist at the Churchill Hospital in Oxford; Amy Paller, director of Northwestern University’s Skin Disease Research Center in Chicago, Illinois.

Graphics: alisdairmacdonald.co.uk

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Citation
The Pharmaceutical Journal, PJ, February 2017, Vol 298, No 7898;298(7898):DOI:10.1211/PJ.2017.20202373