Guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies

For people with atopic dermatitis (AD) refractory to topical therapies, treatment with phototherapy and systemic therapies can be considered. Multiple biologic therapies and Janus kinase (JAK)inhibitors have been approved since 2014 to treat AD. These guidelines update the 2014 recommendations for m...

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Bibliographic Details
Published in:Journal of the American Academy of Dermatology 2024-02, Vol.90 (2), p.e43-e56
Main Authors: Davis, Dawn M.R., Drucker, Aaron M., Alikhan, Ali, Bercovitch, Lionel, Cohen, David E., Darr, Jennifer M., Eichenfield, Lawrence F., Frazer-Green, Lindsy, Paller, Amy S., Schwarzenberger, Kathryn, Silverberg, Jonathan I., Singh, Anne Marie, Wu, Peggy A., Sidbury, Robert
Format: Article
Language:English
Subjects:
Adult
atopic dermatitis
azathioprine
biologic
cyclosporine
Cyclosporine - therapeutic use
Dermatitis, Atopic - drug therapy
dupilumab
eczema
Humans
Immunosuppressive Agents - therapeutic use
JAK inhibitor
Janus Kinase Inhibitors - therapeutic use
methotrexate
Methotrexate - therapeutic use
Phototherapy
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Summary:For people with atopic dermatitis (AD) refractory to topical therapies, treatment with phototherapy and systemic therapies can be considered. Multiple biologic therapies and Janus kinase (JAK)inhibitors have been approved since 2014 to treat AD. These guidelines update the 2014 recommendations for management of AD with phototherapy and systemic therapies. To provide evidence-based recommendations on the use of phototherapy and systemic therapies for AD in adults. A multidisciplinary workgroup conducted a systematic review and applied the GRADE approach for assessing the certainty of evidence and formulating and grading recommendations. The workgroup developed 11 recommendations on the management of AD in adults with phototherapy and systemic agents, including biologics, oral JAK inhibitors, and other immunomodulatory medications. Most randomized controlled trials of phototherapy and systemic therapies for AD are of short duration with subsequent extension studies, limiting comparative long-term efficacy and safety conclusions. We make strong recommendations for the use of dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib. We make conditional recommendations in favor of using phototherapy, azathioprine, cyclosporine, methotrexate, and mycophenolate, and against the use of systemic corticosteroids.
ISSN:0190-9622
1097-6787
DOI:10.1016/j.jaad.2023.08.102