Abstract
This review forms part of an annual update series on atopic eczema (AE), where systematic reviews (SRs) are gathered and appraised to provide a summary of key recent research findings. The focus of this article is systemic therapies used in AE, while a review on prevention and topical therapies is provided in Part 1. In total, 17 SRs on various systemic treatments used in AE were first published or indexed in 2018. There is a lack of evidence to support vitamin D supplementation, montelukast and naltrexone in AE treatment. The adverse effects of systemic corticosteroids are the main barrier to their use, and there is also a lack of data to determine the optimal delivery and duration of treatment with them. Of other immunosuppressants, ciclosporin has the most robust evidence of efficacy. Biologic therapies in AE treatment are being increasingly investigated, and to date, the greatest quantity of data and evidence of efficacy relates to dupilumab. The most commonly reported adverse effects are injection-site reactions and conjunctivitis. Other biologics showing some evidence of efficacy include nemolizumab, lebrikizumab and tralokinumab, although further data are needed. There are currently insufficient data on oral small molecules, including Janus kinase inhibitors, in the treatment of AE. A Cochrane review on probiotics showed no significant benefit, and SRs and meta-analyses on complementary and alternative medicines, including probiotics, in paediatric AE demonstrated significant heterogeneity, thereby limiting their interpretation. This summary of recent SRs provides up-to-date evidence for clinicians on systemic therapies in AE.
© 2020 British Association of Dermatologists.
Publication types
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Comparative Study
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Systematic Review
MeSH terms
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Acetates / administration & dosage
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Acetates / adverse effects
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Acetates / therapeutic use
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Adrenal Cortex Hormones / adverse effects
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Antibodies, Monoclonal / adverse effects
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Antibodies, Monoclonal / therapeutic use
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Antibodies, Monoclonal, Humanized / adverse effects
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Antibodies, Monoclonal, Humanized / therapeutic use
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Biological Therapy / adverse effects
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Biological Therapy / methods
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Biological Therapy / statistics & numerical data
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Child
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Complementary Therapies / adverse effects
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Complementary Therapies / methods
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Complementary Therapies / statistics & numerical data
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Cyclopropanes / administration & dosage
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Cyclopropanes / adverse effects
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Cyclopropanes / therapeutic use
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Cyclosporine / administration & dosage
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Cyclosporine / therapeutic use
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Cytochrome P-450 CYP1A2 Inducers / administration & dosage
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Cytochrome P-450 CYP1A2 Inducers / adverse effects
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Cytochrome P-450 CYP1A2 Inducers / therapeutic use
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Dermatitis, Atopic / diagnosis
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Dermatitis, Atopic / drug therapy*
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Dermatitis, Atopic / prevention & control
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Eczema / diagnosis
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Eczema / drug therapy*
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Eczema / pathology*
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Eczema / prevention & control
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Humans
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Immunosuppressive Agents / administration & dosage
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Immunosuppressive Agents / therapeutic use
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Janus Kinase Inhibitors / therapeutic use
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Naltrexone / administration & dosage
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Naltrexone / adverse effects
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Naltrexone / therapeutic use
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Narcotic Antagonists / administration & dosage
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Narcotic Antagonists / adverse effects
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Narcotic Antagonists / therapeutic use
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Omalizumab / adverse effects
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Omalizumab / therapeutic use
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Placebo Effect
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Probiotics / adverse effects
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Probiotics / therapeutic use
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Quinolines / administration & dosage
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Quinolines / adverse effects
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Quinolines / therapeutic use
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Sulfides / administration & dosage
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Sulfides / adverse effects
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Sulfides / therapeutic use
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Ustekinumab / adverse effects
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Ustekinumab / therapeutic use
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Vitamin D / supply & distribution
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Vitamin D / therapeutic use
Substances
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Acetates
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Adrenal Cortex Hormones
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Antibodies, Monoclonal
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Antibodies, Monoclonal, Humanized
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Cyclopropanes
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Cytochrome P-450 CYP1A2 Inducers
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Immunosuppressive Agents
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Janus Kinase Inhibitors
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Narcotic Antagonists
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Quinolines
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Sulfides
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Vitamin D
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Omalizumab
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dupilumab
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Naltrexone
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Cyclosporine
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Ustekinumab
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tralokinumab
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nemolizumab
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montelukast
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lebrikizumab