Systemic treatment of children and adolescents with atopic dermatitis aged ≥2 years: a Delphi consensus project mapping expert opinion in Northern Europe.

Autor: de Graaf M; Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands., Janmohamed SR; Department of Dermatology, Unit Pediatric Dermatology, SKIN Research Group, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium., Schuttelaar MLA; Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Agner T; Department of Dermatology and Venereology, Bispebjerg Hospital, Copenhagen, Denmark., Alfonso JH; Department of Dermatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway., De Schepper S; Department of Dermatology, Gent University Hospital, Gent, Belgium., Deleuran M; Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark., Despontin K; Department of Dermatology and Venereology, CHU UCL Namur, Namur, Belgium., Elenius V; Department of Pediatrics, Turku University Hospital, Turku, Finland., Ghislain PD; Department of Dermatology, UCL St-Luc, Louvain University, Brussels, Belgium., Huilaja L; PEDEGO Research Unit, University of Oulu, Oulu, Finland.; Department of Dermatology and Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland., Johansson EK; Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.; Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden., Kvenshagen BK; Department of Paediatrics, Østfold Hospital, Grålum, Norway., Mandelin JM; Department of Dermatology, Helsinki University Central Hospital, Helsinki, Finland., Olset H; Department of Dermatology, Haukeland University Hospital, Bergen, Norway., Svensson A; Department of Dermatology and Venereology, Malmö University Hospital, Malmö, Sweden., van Tuyll van Serooskerken AM; HagaZiekenhuis/Juliana Kinderziekenhuis, The Hague, The Netherlands., Thyssen JP; Department of Dermatology and Venereology, Bispebjerg Hospital, Copenhagen, Denmark., Vestergaard C; Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark.
Jazyk: angličtina
Zdroj: Journal of the European Academy of Dermatology and Venereology : JEADV [J Eur Acad Dermatol Venereol] 2022 Nov; Vol. 36 (11), pp. 2153-2165. Date of Electronic Publication: 2022 Jul 19.
DOI: 10.1111/jdv.18410
Abstrakt: Background: Paediatric atopic dermatitis (AD) can be burdensome, affecting mental health and impairing quality of life for children and caregivers. Comprehensive guidelines exist for managing paediatric AD, but practical guidance on using systemic therapy is limited, particularly for new therapies including biologics and Janus kinase (JAK) inhibitors, recently approved for various ages in this indication.
Objectives: This expert consensus aimed to provide practical recommendations within this advancing field to enhance clinical decision-making on the use of these and other systemics for children and adolescents aged ≥2 years with moderate-to-severe AD.
Methods: Nineteen physicians from Northern Europe were selected for their expertise in managing childhood AD. Using a two-round Delphi process, they reached full or partial consensus on 37 statements.
Results: Systemic therapy is recommended for children aged ≥2 years with a clear clinical diagnosis of severe AD and persistent disease uncontrolled after optimizing non-systemic therapy. Systemic therapy should achieve long-term disease control and reduce short-term interventions. Recommended are cyclosporine A for short-term use (all ages) and dupilumab or methotrexate for long-term use (ages ≥6 years). Consensus was not reached on the best long-term systemics for children aged 2-6 years, although new systemic therapies will likely become favourable: New biologics and JAK inhibitors will soon be approved for this age group, and more trial and real-world data will become available.
Conclusions: This article makes practical recommendations on the use of systemic AD treatments for children and adolescents, to supplement international and regional guidelines. It considers the systemic medication that was available for children and adolescents with moderate-to-severe AD at the time this consensus project was done: azathioprine, cyclosporine A, dupilumab, methotrexate, mycophenolate mofetil and oral glucocorticosteroids. We focus on the geographically similar Northern European countries, whose healthcare systems, local preferences for AD management and reimbursement structures nonetheless differ significantly.
(© 2022 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.)
Databáze: MEDLINE
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