Systemic Therapy for Atopic Dermatitis in Older Adults and Adults With Comorbidities: A Scoping Review and International Eczema Council Survey

TY - JOUR

T1 - Systemic Therapy for Atopic Dermatitis in Older Adults and Adults With Comorbidities

T2 - A Scoping Review and International Eczema Council Survey

AU - Drucker, Aaron M.

AU - Lam, Megan

AU - Flohr, Carsten

AU - Thyssen, Jacob P.

AU - Kabashima, Kenji

AU - Bissonnette, Robert

AU - Dlova, Ncoza C.

AU - Aoki, Valeria

AU - Chen, Max

AU - Yu, Joshua

AU - Zhu, Jie Wei

AU - Micieli, Robert

AU - Nosbaum, Audrey

N1 - Publisher Copyright: Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Contact Dermatitis Society.

PY - 2022/5/1

Y1 - 2022/5/1

N2 - BACKGROUND: Clinical trials of systemic therapies for atopic dermatitis (AD) often exclude patients based on age and comorbidities. OBJECTIVES: We conducted a scoping review of observational studies and survey of International Eczema Council (IEC) members on the treatment of AD in patients with liver disease, renal disease, viral hepatitis, HIV, or history of malignancy. METHODS: We searched MEDLINE via Ovid, Embase via Ovid, and Web of Science from inception to September 14, 2020. We mapped the available evidence on the use of cyclosporine, methotrexate, azathioprine, mycophenolate, systemic corticosteroids, and dupilumab for AD in older adults (≥65 years) and adults with the previously mentioned comorbidities. We surveyed IEC members on their preferred systemic medications for each patient population. RESULTS: We identified 25 studies on the use of systemic medications in special populations of adults with AD. Although IEC members preferred dupilumab as the first-line systemic agent across all special populations, many could not identify viable third-line systemic therapy options for some populations. CONCLUSIONS: Data on systemic therapy for AD for older adults and adults with comorbidities are limited. Although IEC members' access to systemic therapies differs geographically, expert opinion suggests that dupilumab is preferred for those patients.

AB - BACKGROUND: Clinical trials of systemic therapies for atopic dermatitis (AD) often exclude patients based on age and comorbidities. OBJECTIVES: We conducted a scoping review of observational studies and survey of International Eczema Council (IEC) members on the treatment of AD in patients with liver disease, renal disease, viral hepatitis, HIV, or history of malignancy. METHODS: We searched MEDLINE via Ovid, Embase via Ovid, and Web of Science from inception to September 14, 2020. We mapped the available evidence on the use of cyclosporine, methotrexate, azathioprine, mycophenolate, systemic corticosteroids, and dupilumab for AD in older adults (≥65 years) and adults with the previously mentioned comorbidities. We surveyed IEC members on their preferred systemic medications for each patient population. RESULTS: We identified 25 studies on the use of systemic medications in special populations of adults with AD. Although IEC members preferred dupilumab as the first-line systemic agent across all special populations, many could not identify viable third-line systemic therapy options for some populations. CONCLUSIONS: Data on systemic therapy for AD for older adults and adults with comorbidities are limited. Although IEC members' access to systemic therapies differs geographically, expert opinion suggests that dupilumab is preferred for those patients.

UR - http://www.scopus.com/inward/record.url?scp=85130863211&partnerID=8YFLogxK

U2 - 10.1097/DER.0000000000000845

DO - 10.1097/DER.0000000000000845

M3 - Review article

C2 - 35170524

AN - SCOPUS:85130863211

SN - 2162-5220

VL - 33

SP - 200

EP - 206

JO - Dermatitis : contact, atopic, occupational, drug

JF - Dermatitis : contact, atopic, occupational, drug

IS - 3

ER -