Current and Future Monoclonal Antibodies in the Treatment of Atopic Dermatitis
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Current and Future Monoclonal Antibodies in the Treatment of Atopic Dermatitis Peter Ip Fung Chun 1 & Heather Lehman 1,2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Atopic dermatitis is a common immunologic skin disease. Mild atopic dermatitis can be managed with emollients and topical therapies such as low potency topical steroids, which have a favorable safety profile. Severe atopic dermatitis, in contrast, is a challenging disease to treat. Topical therapies are typically inadequate for control of severe atopic dermatitis. When topical therapies fail, the mainstay of therapy for severe atopic dermatitis has traditionally been phototherapy or off-label use of systemic immunosuppressant treatment, yet systemic immunosuppressants all have significant potential toxicities, drug interactions, and contraindications, requiring close monitoring. Targeted biologics are therefore attractive treatment options for topical therapyrefractory cases of atopic dermatitis, with the potential to offer effective, safer treatment of uncontrolled atopic dermatitis. Dupilumab, as the only biologic therapy currently FDA-approved for atopic dermatitis, is effective for many patients, but there is need for continuing study of additional biologic therapies to address the needs of diverse patients with uncontrolled atopic dermatitis. Keywords Atopic dermatitis . Eczema . IgE . IL-5 . IL-4 . IL-13 . Thymic stromal lymphopoietin (TSLP)
Abbreviations AD Atopic dermatitis ADIQ Atopic dermatitis impact questionnaire EASI Eczema area and severity index IGA Investigator global assessment PGA Physician’s global assessment SCORAD SCORing Atopic Dermatitis SQ Subcutaneously VAS Visual analog scale
Introduction Atopic dermatitis (AD) is a very common immune-mediated skin disease, occurring in 10–20% of children, and in 3–6% of adults in the USA [1–4]. It is characterized by eczematous * Heather Lehman [email protected] 1
Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
2
Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, 1001 Main Street, Buffalo, NY 14203, USA
lesions, xerosis, and pruritus. Mild atopic dermatitis often may be controlled satisfactorily with emollients and low potency topical steroids which have a relatively benign side effect profile. However, many cases severe atopic dermatitis have required treatment with systemic anti-inflammatory drugs such as oral corticosteroids and cyclosporine, which have broad immunosuppressive activities and significant side effects. Phototherapy is another treatment option for moderate-to-severe atopic dermatitis, but its use is limited in some cases by cost, local availability, and patient adherence to therapy [5]. Targeted biologics are therefore attractive treatment options for topical therapy-refractory cases of atopic dermatitis. These include anti-cytokine therapies targeting the inflammation that substantially contri
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