Promising New Therapies for Atopic Dermatitis
Atopic dermatitis (AD) is a T-cell-driven, chronic inflammatory skin disease with a prevalence of up to 10% in adults and 25% in children.[1,2] Classic AD presents during infancy with recurrent facial dermatitis, morphing during childhood into chronic inflammatory flexural patches and lichenified plaques. Characteristics include pruritus, associated atopic diathesis (asthma, allergic rhinitis/conjunctivitis, food allergies), impaired epidermal barrier function, and such comorbid conditions as sleep disruption and failure to thrive.
Our understanding of the pathophysiology of another chronic inflammatory skin disease—psoriasis—has undergone a revolution over the past decade, yielding novel and highly effective immune-targeted therapies for this notoriously tough-to-treat chronic skin disease. In a similar vein, researchers are now mapping the immune dysregulation behind AD, which is characterized by chronic activation of the Th2 immune response.[3]
Systemic T-cell-suppressing therapies, such as azathioprine, methotrexate, mycophenolate mofetil, and cyclosporine, are effective at controlling moderate to severe AD (all as off-label indications). However, these treatments are limited by side effects, including immunosuppression, risk for cancer, and multiorgan toxicity, especially when taken chronically.
In contrast, dupilumaba human monoclonal antibody targeting the interleukin-4 receptor alpha (IL-4R-alpha), received US Food and Drug Administration (FDA) approval for the treatment of moderate to severe AD in adults, in part on the basis of its remarkable safety profile and efficacy similar to that of some broader and more toxic immunosuppressive agents.
