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Oral Agents for Atopic Dermatitis: Current and in Development

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Biologic and Systemic Agents in Dermatology

Abstract

Atopic dermatitis is a chronic, pruritic inflammatory skin condition due to a defective skin barrier and aberrant immune responses with a significant impact on one’s quality of life. Although many patients are controlled with conservative measures and topical therapy, 10% of patients will require systemic therapy to control their disease. Currently, many immunosuppressive agents are used off-label to control the disease, including cyclosporine, azathioprine, methotrexate, mycophenolate mofetil, and oral corticosteroids, which will be reviewed here. Although efficacy of these agents is noted, their use is limited mostly by off-target side effects and end-organ toxicity. A look forward at new oral agents in development has shown both promising and disappointing results in phase 2 studies on familiar and novel targets. In an era of targeted biological therapy showing potential in the treatment of atopic dermatitis, new oral agents will need to show a clear advantage for their use in this population.

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Abbreviations

AD:

Atopic dermatitis

AZA:

Azathioprine

CRTH2:

Chemoattractant receptor-homologous molecule expressed on T-helper type 2 cells

CsA:

Cyclosporine

DGLA:

Dihomo-gamma-linolenic acid

EASI:

Eczema Area and Severity Index

EC-MPS:

Enteric-coated mycophenolate sodium

FDA:

U.S. Food and Drug Administration

H4R:

Histamine H4 receptor

HTN:

Hypertension

IGA:

Investigator’s Global Assessment

IL:

Interleukin

JAK:

Janus kinase

MMF:

Mycophenolate mofetil

MPS:

Mycophenolate sodium

MTX:

Methotrexate

NK-1R:

Neurokinin 1 receptor

OGCs:

Oral glucocorticoids

PDE4:

Phosphodiesterase-4

PGD1:

Prostaglandin D1

PGD2:

Prostaglandin D2

SASSAD:

Six area six sign atopic dermatitis

SCORAD:

Scoring for atopic dermatitis

TPMT:

Thiopurine methyltransferase

VAS:

Visual analog scale

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Authors and Affiliations

  1. University of Manitoba, Winnipeg, MB, Canada

    Julia Mayba BSc

  2. SKiN Centre for Dermatology, 775 Monaghan Rd., Peterborough, ON, Canada, K9J 5K2

    Julia Mayba BSc & Melinda Gooderham MD, MSc, FRCPC

  3. Probity Medical Research, Waterloo, ON, Canada

    Melinda Gooderham MD, MSc, FRCPC

  4. Queen’s University, Kingston, ON, Canada

    Melinda Gooderham MD, MSc, FRCPC

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Correspondence to Melinda Gooderham MD, MSc, FRCPC .

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  1. Division of Dermatology, David Geffen School of Medicine a UCLA, Los Angeles, California, USA

    Paul S. Yamauchi

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Mayba, J., Gooderham, M. (2018). Oral Agents for Atopic Dermatitis: Current and in Development. In: Yamauchi, P. (eds) Biologic and Systemic Agents in Dermatology. Springer, Cham. https://doi.org/10.1007/978-3-319-66884-0_32

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  • DOI: https://doi.org/10.1007/978-3-319-66884-0_32

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-66883-3

  • Online ISBN: 978-3-319-66884-0

  • eBook Packages: MedicineMedicine (R0)

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