Consensus on the Clinical Approach to Moderate-to-Severe Atopic Dermatitis in Spain: A Delphi Survey

Autor: Sastre, Joaquin, Serra-Baldrich, E, Armario Hita, José Carlos, Herráez, L., Jáuregui, Ignacio, Martín-Santiago, Ana, Ortiz de Frutos, Javier, Silvestre, Juan Francisco, Valero, Antonio, Universitat Autònoma de Barcelona
Přispěvatelé: Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD), UAM. Departamento de Medicina, Medicina, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (ISS-FJD)
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Zdroj: Dermatology Research and Practice
Biblos-e Archivo. Repositorio Institucional de la UAM
Universidad Camilo José Cela (UCJC)
Dermatology Research and Practice Volume 2020 Article ID 1524293
RODIN. Repositorio de Objetos de Docencia e Investigación de la Universidad de Cádiz
instname
Dipòsit Digital de Documents de la UAB
Universitat Autònoma de Barcelona
Dermatology Research and Practice, Vol 2020 (2020)
Biblos-e Archivo: Repositorio Institucional de la UAM
Universidad Autónoma de Madrid
ISSN: 1687-6113
1687-6105
Popis: Background. The purpose of this study was to gather information on the current assessment and management of patients with moderate-to-severe AD in routine daily practice. Methods. A cross-sectional two-round Delphi survey with the participation of dermatologists and allergologists throughout Spain was conducted. They completed a 46-item questionnaire, and consensus was defined when responses of >= 80% of participants coincided in the categories of a 5-point Likert scale for that item. Results. A total of 105 specialists (aged 40-59 years) completed the two rounds. Participants agreed regarding the consideration of AD as a multifaceted disease and the differences in clinical presentation of AD according to the patient's age. It is recommendable to perform a skin biopsy to exclude early stage T-cell cutaneous lymphoma, psoriasis, or dermatitis herpetiformis, among others (99.1%). Also, consensus was reached regarding the use of the SCORAD index to quantify the severity of the disease (86.7%), the use of wet wraps to increase the effect of topical corticosteroids (90.4%), the usefulness of proactive treatment during follow-up (85.6%) and tacrolimus ointment (91.2%) to reduce new flares, and the fact that crisaborole is not the treatment of choice for severe AD (92.4%). AD was not considered a contraindication for immunotherapy in patients with allergic respiratory diseases (92.4%). In patients with severe AD, the use of immune response modifier drugs (97.6%) or phototherapy (92.8%) does not sufficiently cover their treatment needs. Consensus was also obtained regarding the role of the new biologic drugs (93.6%) targeting cytokines involved in the Th2 inflammatory pathway (92.0%) and the potential role of dupilumab as first-line treatment (90.4%) in moderate-to-severe AD patients. Conclusion. This study contributes a reference framework to the care of AD patients. There is no diagnostic test or biomarkers to direct treatment or to assess the severity of the disease, and many therapeutic challenges remain.
The authors would like to thank the experts who have participated as panelists: agueda Pulpillo Ruiz, Alejandro Joral Badas, Alicia Enriquez Matas, Almudena Hernandez Nunez, Almudena Mateu, Amalia Perez Gil, Amparo Perez Ferriols, Ana Beristain Urquiza, Ana Batalla Cebey, Ana Bauza Alonso, Ana Isabel Tabar Purroy, Ana Maria Delgado Marquez, Ana Martin-Santiago, Ana Rosado Ingelmo, Angela Hernandez Martin, Antonio Valero, Antonio Velez Garcia-Nieto, Araceli Sanchez, Arancha Jimenez, Ariel Callero Viera, Berta Perez, Blanca Andres Lopez, Carmelo Escudero, Carmen DAmelio Garofalo, Cesar Rivas-Plata, Consuelo Fernandez Rodriguez, Dario Antolin, David Gonzalez De Olano, Diego De Argila, Eloina Gonzalez Mancebo, Encarnacion Anton Casas, Enrique Gomez De La Fuente, Enrique Jorquera, Esther Roe Crespo, Eulalia Baselga, Fernando Rodriguez Fernandez, Francisco Javier Ruano Perez, Francisco Javier Vicente Martin, Francisco Jose De Leon Marrero, Gloria Garnacho Saucedo, Gonzalo Bernaola Hortiguela, Hugo Vazquez Veiga, Idoia Gonzalez Mahave, Ignacio Jauregui Presa, Inmaculada Ruiz, Iran Sanchez Ramos, Isabel Betlloch, Isabel Ma Sanchez Matas, JM Revelles, Javier Dominguez Ortega, Javier Mataix, Javier Miquel Miquel, Javier Ortiz de Frutos, Javier Pedraz, Javier Ruiz Hornillos, Jesus Tercedor Sanchez, Joaquin Sastre, Jose Carlos Armario Hita, Jose Luis Garcia Abujeta, Jose Manuel Azana Defez, Jose Manuel Barcelo Munoz, Jose Manuel Zubeldia Ortuno, Jose Suarez Hernandez, Juan Francisco Silvestre, Juan Marquez Enriquez, Laura Berbegal, Lourdes Rodriguez Fernandez-Freire, Lys Herraez Herrera, M. Bergon, Maria del Mar Moro, MM Siguenza, Manuel Galan Gutierrez, Mar Garces Sotillos, Mar Reano, Marcos Hervella, Maria alvarez Puebla, Maria Antonia Gonzalez Ensenat, Maria Ascension Aranzabal Soto, Marta Feito Rodriguez, Marta Valdivielso Ramos, Mercedes Alcalde Alonso, Mercedes Rodriguez Serna, Milagros Lazaro Sastre, Miquel Casals Andreu, Monica Venturini Diaz, Natalia Hernandez Cano, Paloma Ibanez Sandin, Paloma Poza Guedes, Pedro Manuel Gamboa Setien, Pedro Mercader Garcia, Raul De Lucas Laguna, Ricardo Gonzalez, Ricardo Ruiz Villaverde, Ruth Barranco, Ruth Mielgo Ballesteros, Santiago Quirce Gancedo, Sara Isabel Palencia Perez, Sergio Vano, Sofia Ezsol, Susana Bel Pla, Susana Cordoba Guijarro, Susana Echechipia Madoz, Trinidad Repiso Montero, Violeta Zaragoza, and Yolanda Puente Crespo. The authors also thank GOC Networking for providing methodology advice during the study and Marta Pulido, MD, PhD, for the help in writing the manuscript and for the editorial assistance. This work was supported by a grant from Sanofi Genzyme SA.
Databáze: OpenAIRE
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