Key words
Atopic dermatitis; cost-effectiveness; dupilumab; EASI; SCORAD
Introduction
Atopic dermatitis (AD) is a chronic inflammatory and relapsing disease
characterised by dry and scale skin, eczematous lesions and intense
itching that might turn chronic. AD displays a highly complex
pathophysiology and heterogeneous phenotypes, which are illustrated by
different features such as age of disease onset, variable response to
triggers, spectrum of severity, barrier defect, potential of IgE
autoreactivity and comorbidities (asthma, rhinitis, food allergy and
infections) (1,2,3,4,5,6). Similar to asthma, AD research is developing
and shaping precision medicine approaches aiming towards a biomarker
based molecular taxonomy (7,8,9,10).
IL-4 and IL-13 are key cytokines in driving the initiation and
chronicity of type 2 (T2) inflammation, a dominant inflammatory pathway
in AD (11,12). Dupilumab is a fully human anti-IL-4 receptor α (IL-4Rα)
monoclonal antibody that blocks both IL-4- and IL-13-mediated signalling
pathways (13,14). The European Medical Agency (EMA) recommends dupilumab
for moderate-to-severe AD in adult and adolescents (12 years and older)
patients who are candidates for systemic therapy (15). The United States
Food and Drug Administration (FDA) recommends dupilumab for patients
aged 6 years and older with moderate-to-severe AD whose disease is not
adequately controlled with topical prescription therapies or when those
therapies are not advisable (16).
The European Academy of Allergy and Clinical Immunology (EAACI) is
developing clinical practice guidelines for the use of biologicals in
patients with uncontrolled moderate-to-severe AD. To inform key clinical
recommendations, a systematic review (SR) evaluated the effectiveness
and safety of dupilumab for patients with uncontrolled
moderate-to-severe AD.
Methods
Guidelines Development
Group
The EAACI Atopic dermatitis Voting Panel and Steering Committee included
clinicians and researchers with different backgrounds (the complete list
of experts is available from the EAACI website) who voluntarily
participate in the development of the EAACI biologicals guideline. They
are referred to as the Guidelines Development Group (GDG).