Recommendations developed for atopic dermatitis therapies

In updated guidelines issued by the American Academy of Dermatology and published online Nov. 7 in the Journal of the American Academy of Dermatology, recommendations are presented for use of phototherapy and systemic therapies for atopic dermatitis (AD) and include strong endorsements of monoclonal antibodies and Janus kinase inhibitors.

Dawn M. R. Davis, M.D., from the Mayo Clinic in Rochester, Minnesota, and colleagues conducted a systematic review and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of evidence and formulating and grading recommendations to provide evidence-based recommendations for use of phototherapy and systemic therapies for adults with AD.

The workgroup developed 11 recommendations on management of AD in adults. These include strong recommendations for dupilumab, tralokinumab, upadacitinib, abrocitinib, and baricitinib for adults with moderate-to-severe AD. Phototherapy is conditionally recommended for adults with AD. Methotrexate is also conditionally recommended, with proper monitoring, as is mycophenolate mofetil, azathioprine, and limited-term use of cyclosporine, all with proper monitoring. There is a conditional recommendation against use of systemic corticosteroids.

"When AD is more severe or refractory to topical treatment, advanced treatment with phototherapy or systemic medications can be considered," the authors write. "In this clinical practice guideline, we make strong recommendations for the use of dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib."

Several authors disclosed ties to the pharmaceutical industry.